Lung Cancer Surgery Rarer for Blacks
Black-White Gap Persists Even With Equal Access to Care
Dec. 29, 2005 -- Many older blacks with lung cancer don't get the same
treatment as whites, even when they have equal access to specialized care.
The finding comes from experts at Boston's Dana-Farber Cancer Institute. The
report by Christopher Lathan, MD, and colleagues appears in the Journal of
Lung cancer is the No. 1 cause of cancer deaths. Lung cancer is a burden for
all races, but it's most common and deadliest among black men, the researchers
They aren't the first to note
The problem has been around for a long time.
In Lathan's study, blacks and whites had equal access to cancer care. Still,
the gap didn't budge. Black patients had potentially lifesaving surgery for
lung cancer far less often than whites.
The issue is complex, but better communication between doctors and patients
might help, the researchers suggest.
Using a national cancer database, the researchers tracked more than 21,000
lung cancer patients.
The patients were older than 65 and only got their health care through
Medicare. They had been diagnosed in the 1990s with the most common type of
lung cancer (nonsmall cell lung cancer).
Black patients differed from whites in these important ways:
- They were 25% less likely to get invasive tests to check the stage of their
- Those who got invasive tests were 45% less likely than whites to get lung
- Surgery was less often recommended to medically eligible blacks.
- They were more likely than whites to turn down recommended surgery.
All in all, more than 14,200 patients got the invasive tests and nearly
7,000 had surgery. Both were much rarer for blacks. For instance, more than
nine out of 10 patients who got the invasive tests were white.
The results didn't match the researchers' expectations.
"We thought that if all the patients had been staged -- which suggests
that they had access to the appropriate specialists and implies some level of
trust in the medical system -- that they would have the same rate of
surgery," Lathan says in a news release.
"We were quite surprised to find this was not the case," he
The data didn't show why more blacks than whites turned down recommended
surgery (3.4% of blacks, compared to 2% of whites). Mistrust of the medical
system might be a possibility, the researchers note.
It's also not clear why surgery wasn't always recommended for medically
eligible black patients.
"Efforts must continue to ensure the appropriate quality care is
available for all patients, regardless of race and ethnicity," the
Talking It Out
The findings should be confirmed and might not apply to younger patients,
write Lathan and colleagues. They call for greater emphasis on the
Patients should "make sure they're getting all the resources they need,
even if it means challenging their physicians a little bit," Lathan says in
the news release.
He also wants doctors to step up their efforts.
"It's really important that we spend as much time thinking about how we
communicate with our patients as we do about how to treat them," Lathan