The Wellness Gap: Dr. Erhunmwunsee on Ethnic Disparities in Lung Cancer
November 30, 2016 | by Samantha Bonar
Despite the fact that overall rates of lung cancer have been declining in the United States for some time, disparities in incidence and outcome along racial lines still exist, particularly among the African-American population.
African American men have the highest incidence and mortality rate of lung cancer, according to the latest statistics from the Centers for Disease Control and Prevention.
In addition, African-American patients, both male and female, are less likely than white patients to receive stage-appropriate cancer care, including surgery, radiation and systemic therapy. They are also more likely to die of the disease than their Caucasian counterparts.
Several factors account for this disparity, from socioeconomic to genetic or biologic to access to care.
Socioeconomic status in particular is closely tied to tobacco addiction and to poorer outcomes in lung cancer. Low income both increases the risk of lung cancer and heightens the chances of dying from lung cancer, likely from lack of access to appropriate treatment.
Erhunmwunsee is a specialist in minimally invasive cardiothoracic surgery and lung cancer, whose research focuses on eliminating health inequity in thoracic oncology patients.
Whites and blacks have significantly higher smoking rates than other racial groups in the U.S. For example, 16.2 percent of male Latinos smoke, compared to 24.8 percent of black men and 22.6 percent of white men, according to an April 2015 study in Frontiers in Public Health.
Data show that blacks are more likely to be diagnosed at a more advanced stage than whites (60 vs. 55 percent) and to thus be less likely to have the option of surgical resection, which may contribute to their lower five-year survival rate (13 vs. 16 percent), according to the study.
However, blacks are less likely to have surgical resection even when diagnosed with early-stage lung cancer. There are lower rates of recommendations for lung cancer surgery in blacks (67 percent for blacks vs. 71.4 percent for whites) and higher refusal rates after surgery is recommended (3.4 percent for blacks vs. 2 percent for whites).
“For resectable cancer, African Americans are not undergoing surgery as readily as Caucasians are,” Erhunmwunsee said. “So the therapies we use for cure, African Americans are receiving at much lower rates. And it’s not just African Americans. The poor also receive life-preserving therapies at lower rates.”
According to the latest CDC data, for every 100,000 non-Hispanic white males, 79.3 will be diagnosed with lung cancer. For every 100,000 non-Hispanic black males, that number is 93.4. Of those, 62.2 white males will die of lung cancer, whereas 74.9 black males will die of the disease.
“If we could understand the primary reasons for these disparities, we could devise interventions to eliminate them. Is the problem getting appropriate referrals from primary care physicians to surgeons? Are hospitals where the underserved obtain care providing gold-standard therapy with appropriate outcomes? Do certain patients need navigators to help them get successfully through the system? We know that lung cancer screening should help improve outcomes but are there barriers that will prevent minorities and the poor from benefiting from this measure?”
As minority groups increase in number in the United States, it’s becoming increasingly important to understand what’s making outcomes worse for them.
“You’d be hard pressed to find a disease state within oncology where African Americans or the poor aren’t impacted at worse rates,” Erhunmwunsee said. “In 10 or 15 years, if I’m able to say, ‘Here are some tangible reasons why the disparity exists and this is what we’re doing to address them,’ then I would feel successful.”
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