African Americans Disproportionately Affected By Lung Cancer

By: Ingrid Lamont

Despite similar smoking rates, African Americans are more likely to develop and die from lung cancer than white Americans, according to a new report from the American Lung Association (ALA). The report explores the biological, political, environmental, and social factors behind this disparity and outlines potential ways to close the gap, such as improved access to health care, expanded smoke-free legislation, and increased funding for research.

“The American Lung Association’s report provides overwhelming evidence to support the case for a racial difference in the burden of lung cancer,” said William J. Hicks, MD, Professor of Clinical Medicine Division of Hematology and Oncology, Ohio State University Comprehensive Cancer Center and author of the preface to the report.

Lung cancer in African Americans

Lung cancer is by far the leading cause of cancer death among both men and women in the United States, and African Americans suffer more from the disease than any other group.

According to the new report, black men are 37% more likely to get lung cancer and 22% more likely to die from it, compared to white men. (Black women are just about as likely to get the disease as white women.) African American men also have shorter survival rates, the report says: only 12% live longer than 5 years, compared to 16% of whites. Studies have shown black men are also more likely to be diagnosed later when the cancer is less treatable, to wait longer to get treatment, and to refuse treatment.

African Americans don’t receive the same quality of care as whites, either, the report found. They’re more likely to see doctors who aren’t board-certified, and they’re also less likely to have surgery or receive chemotherapy for their cancer compared to their white counterparts.

Smoking is the by far leading risk factor for the disease – roughly 87% of all lung cancer deaths are thought to be related to smoking. African American men are only about as likely to smoke as white men, 25.5% and 23.6% respectively, so other variables must be contributing to the disparity, the researchers say.

Behind the numbers

The report’s authors trace the unequal burden to a combination of biological, environmental, political, and cultural factors.

While African Americans don’t smoke more than whites, research shows that they are more likely to smoke menthol cigarettes, in part, the report says, because of targeted ads by tobacco companies. Menthol smokers have higher levels of cotinine, a nicotine byproduct, in their blood. This is a sign of higher exposure to nicotine, which may lead to higher levels of addiction. The report cites studies showing that menthol smokers are less likely to try quitting smoking and are more likely to relapse after they quit.

Many African Americans also struggle with social factors that make lung cancer prevention efforts and treatment less effective, the report says. Among these are unequal access to health care, unequal quality of health care, racism, lower socioeconomic status, and lower education levels.

Environmental health hazards are also a major concern. Because of lower income levels, African Americans often end up living in more polluted communities. African American neighborhoods face an average 1.5 times higher levels of air toxics — a group of almost 200 different air pollutants, including diesel exhaust and benzene — than other communities, according to the report. The report says African Americans are also more likely to be exposed to air pollution inside their homes, such as secondhand smoke.

Genetics also play a role, but because of low enrollment of African Americans in clinical trials, progress in understanding how genetic factors affect lung cancer growth and development has been slow.

Efforts underway

To help close the disparity gap, the ALA report calls for:
Improved access to affordable health care
Increased research funding for lung cancer and health disparities
Enhanced and expanded smoke-free air laws
Efforts to curb radon exposure in federal housing
Greater support for smoking cessation services
Strategies to improve cultural competency of medical professionals and recruit more African Americans into medicine

The ALA is also eagerly awaiting results from a Food and Drug Administration (FDA) review of menthol cigarettes and their impact on public health.

“While some progress has been made, especially in reducing smoking rates and exposure to secondhand smoke,” said Charles D. Connor, American Lung Association President and CEO, “much remains to be done. Reducing lung cancer needs a focused effort.”

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