Blacks more likely to die of curable lung cancer than whites

Even when they have equal access to specialized care, blacks with potentially curable lung cancer are about half as likely as whites to undergo surgery that could save their lives, according to a study by Dana-Farber Cancer Institute researchers.

Designed to identify the causes of racial discrepancies in lung cancer treatment in the United States, the research ruled out unequal access to medical care as the sole explanation. It did show that blacks were somewhat less likely to be offered lung cancer surgery, and were slightly more likely to refuse it than were whites. Overall, the study found that blacks who had equal access to care were 45 percent less likely than whites to have lung cancer surgery.

These findings point to a subtle and complex "communications problem" underlying the inequality, said Christopher Lathan, MD, of Dana-Farber and lead author of the report that is published online by the Journal of Clinical Oncology and is scheduled to run in the journal's Jan. 20 print issue.

"Something's not happening. There was no specific reason that could be found, but there needs to be more attention paid to the doctor-patient interaction."

The generally poorer health of blacks and other racial minorities is often blamed on social and financial obstacles to obtaining medical care. The new study, however, documents that the lower rate of surgery for black lung cancer patients "is not just about access to care or not being physically able to undergo treatment," said Craig Earle, MD, of Dana-Farber and the paper's senior author. "There still seems to be a racial disparity."

According to the American Cancer Society, lung cancer is the leading cause of cancer deaths among blacks Americans, and blacks have the highest lung cancer mortality rate in the United States. It is estimated that 15,500 blacks will die from lung cancer in the United States in 2005 (accounting for nearly a quarter of all cancer deaths), and that more than 19,000 will be diagnosed with the disease, which is approximately 14 percent of all new cancer cases among blacks.

Yet, blacks have been previously found less likely to get surgical treatment. Someone who is diagnosed before the cancer has spread very far - Stage I or II - has up to a 50 percent chance of being alive at five years if surgery is performed. Untreated, the disease is almost always fatal.

The researchers, who also included Bridget Neville, MPH, of Dana-Farber, analyzed cancer registry records and insurance claims of 21,219 Medicare-eligible patients diagnosed with non-metastatic lung cancer between 1991 and 2001. With Medicare, inequalities due to insurance coverage were eliminated. Of these patients, 14,224 had undergone invasive procedures to "stage" the disease by its extent, which is a guide to treatment decisions.

The procedures included bronchoscopy, the insertion of a viewing tube into the lungs, and mediastinoscopy and thoracoscopy, where surgeons make incisions in the chest wall under general anesthesia, through which viewing scopes are placed. Blacks were 25 percent less likely than whites to have staging examinations.