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New lung cancer report finds large disparities in prevention, treatment among races and ethnic groups

"While we celebrate that more Americans are surviving lung cancer, too many people are being left behind, and the disease remains the leading cause of cancer deaths."

A view of a close up of a lung x-ray of a cigarette smoker in an undated photo. Getty Images/Getty Images North America

While the national lung cancer survival rate has been raised significantly over the past five years, it still remains considerably lower for communities of color.

This is especially true for Black Americans, according to the American Lung Association’s 2021 “State of Lung Cancer” report.

The national survival rate has increased to 23.7 percent, the report shows, an increase of 14.5 percent over the past five years. But for communities of color, that number has only increased to 20 percent. For Black Americans it’s even lower at just 18 percent, the report says.

This is the second year the report has taken into consideration how lung cancer affects BIPOC and ethnic groups differently than white Americans, both at the state and national levels, according to the report.

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“While we celebrate that more Americans are surviving lung cancer, too many people are being left behind, and the disease remains the leading cause of cancer deaths,” Trevor Summerfield, director of advocacy for the American Lung Association in Massachusetts said in a press release. “In Massachusetts we have clear disparities impacting Asian Americans and Pacific Islanders, which simply goes to show that there is much more work to do to prevent the disease and support those facing it. Ensuring that everyone — in every community — has access to quality and affordable healthcare is critically important if we want to save lives.”

For people of color it’s not just about survival rates, but treatment, too.

“In addition to lower survival rates, people of color who are diagnosed with lung cancer face worse outcomes compared to whites, including: less likely to be diagnosed early, less likely to receive surgical treatment and more likely not to receive any treatment,” the report says.

Lack of insurance

One of the major reasons why lung cancer survival, early diagnosis, surgery, and lack of treatment are so much worse for people of color is that millions of them remain uninsured, the report says.

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Of the 29 million people nationally who are not insured, more than half are people of color, according to the association, further noting that research shows lack of insurance leads to impacts on medical care and health outcomes.

Taking a look at just Black Americans, early diagnosis for them is 18 percent worse than white Americans, surgical treatment is 23 percent worse, lack of treatment is 9 percent worse, and survival is 21 percent worse,

For Latinos, early diagnosis was 16 percent worse than white Americans, surgical treatment was the same, lack of treatment was 26 percent worse, and survival was 16 percent worse. 

Asian Americans fared 18 percent worse in early diagnosis than white Americans, 17 percent better than whites in surgical treatment, 5 percent worse in lack of treatment, and 9 percent better than whites for survival.

For indigenous peoples, early diagnosis was 17 percent worse than white Americans, surgical treatment was 25 percent worse, lack of treatment was 11 percent worse, and survival was 13 percent worse than whites, the study said.

Differences by state

While the amount of new lung cancer cases has decreased by 10 percent across the country, each state has a different lung cancer rate, the report shows.

Massachusetts fell in the “average” range with 60.9 per 100,000 for its lung cancer rate, placing 29th nationally. Utah ranked the best — the top tier includes new case rates ranging from 26.4 to 37.2 per 100,000. Kentucky was the worst, according to the association — states at the bottom tier saw 82 to 89.4 new cases per 100,000 people in 2021.

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Massachusetts ranked first in terms of early diagnosis at 30.3 percent; Hawaii was last at 19 percent.

The Bay State also was at the top in terms of surgical treatment — 30.9 percent; New Mexico was the worst at 13.1 percent.

For lack of treatment, Massachusetts ranked in the top tier (13.8 percent-16.6 percent) with 15.1 percent of cases receiving no treatment, which is better than the national average of 21.1 percent of cases not receiving treatment. The worst was Arizona with 32.5 percent not receiving treatment.

Massachusetts was also at the top in terms of screening with 17.8 percent of high-risk patients receiving a screening. The worst states were California and Wyoming with 1 percent.

Medicaid in Massachusetts, plus in 39 other states covered lung cancer screenings, the report said.

As for survival rate, Massachusetts didn’t have data available.

In terms of differences among racial groups, there were stark differences between whites and Asian and Pacific Islanders. While 30.6 percent of white Massachusetts residents had an early diagnosis, that number fell to 21 percent for Asian and Pacific Islanders. For surgical treatment, it was 31 percent of white residents receiving surgery versus 28.6 of Asian and Pacific Islanders. Both groups were similar in terms of lack of treatment rates.

“The rate of new lung cancer cases is 40 per 100,000 population among Asian Americans or Pacific Islanders in Massachusetts, significantly higher than the rate of 34 among Asian Americans or Pacific Islanders nationally, and significantly lower than the rate of 63 among whites in Massachusetts,” the report said.

Room for improvement

In March 2021, with new research, the nation’s Preventive Services Task Force updated its screening recommendations to now include more people from a larger age range, and more smokers, both former and current.

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“This will dramatically increase the number of women and Black Americans who are considered at high risk for lung cancer,” the report said, noting that screening rates in the report are not updated yet to take the change into account.

There’s also more that can be done at the state level.

“The report found that lung cancer rates for every measure vary significantly by state, and that every state can do more to defeat lung cancer, such as increasing the rate of screening among those at high risk, addressing racial disparities that impact lung cancer outcomes, decreasing exposure to radon and secondhand smoke, and eliminating tobacco use,” the report said. 

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