Disparities in Lung Cancer Diagnosis and Treatment

Medically Reviewed by Sabrina Felson, MD on July 24, 2022
5 min read

With advances in treatment, fewer people are dying of lung cancer than they did in the past. It also helps that fewer people are smoking today and lung cancer screening for current and former smokers is catching lung cancer earlier. But lung cancer is the third most common cancer type. It’s also the leading cause of cancer death. The 5-year relative survival for people with lung cancer is 23%. Disparities, or preventable differences based on race, income, and other factors, also mean that not everyone is benefiting equally from advances in lung cancer diagnosis and treatment. Compared with white people, people of color are:

  • Less likely to get diagnosed early
  • Less likely to have surgery to remove lung cancer
  • More likely not to get any treatment for lung cancer
  • More likely to have worse outcomes

Research from 2021 confirms that people of color more often get a late diagnosis. They also get needed treatment less often compared with white people. One reason is that more people of color lack health insurance. When you don’t have health insurance, you’re less likely to get good medical care. Disparities in diagnosis and treatment exist between white people and people in all other racial groups. But the details vary.

Black Americans are:

  • 18% less likely to get an early diagnosis
  • 23% less likely to have surgery for lung cancer
  • 9% more likely not to get any treatment
  • 21% less likely to live for 5 years after diagnosis

Latino/Hispanic Americans are:

  • 16% less likely to get an early diagnosis
  • Equally likely to have surgery for lung cancer
  • 26% more likely not to get any treatment
  • 16% less likely to live for 5 years after diagnosis

Asian Americans and Pacific Islanders are:

  • 18% less likely to get an early diagnosis
  • 17% more likely to have surgery for lung cancer
  • 5% more likely not to get any treatment
  • 9% more likely to live for 5 years after diagnosis

American Indians and Alaska Natives are:

  • 17% less likely to get an early diagnosis
  • 25% less likely to have surgery for lung cancer
  • 11% more likely not to get any treatment
  • 13% less likely to live for 5 years after diagnosis

Disparities may arise from social factors that influence a person’s ability to access health care. These include differences among groups in:

  • Income
  • Access to health information
  • Access to doctors who screen for and diagnose lung cancer
  • Health insurance
  • Access to transportation
  • Paid medical leave
  • Participation in clinical trials
  • Environments where people live and work

It’s possible to cure lung cancers that are caught early, or before they’ve spread out of the lung, with surgery. More than 60% of people diagnosed with lung cancer before it spreads survive for at least 5 years. Once lung cancer has spread to nearby areas or more distantly, the chance of survival drops.

A 1999 study tried to measure the disparity between Black and white people in having surgery. It also tried to figure out if this disparity explained differences in survival with early lung cancer. The study found that Black people had surgery more than 12% less often than white people. They also had lower survival. But, when they looked at people who had surgery, survival between racial groups was about the same. The same was true when they looked only at people who didn’t have surgery. So, differences in survival between the groups was explained in large part by whether they had surgery or not.

Another more recent study also looked at disparities in survival with early lung cancer. The study found that Black people had worse survival than white people. Hispanics and Asians had better survival. But the findings suggest that disparities between Black and white people won’t go away just by improving access to surgery. That’s because other factors also explain why Black people with lung cancer may not do as well. They found that Black people with lung cancer more often died from other causes, including heart disease and other cancers. So, disparities in lung cancer survival will depend on better treatment for other health conditions, some of which may be related to smoking.

Another 2022 report on disparities in lung cancer treatment points to differences among racial groups in:

  • Social determinants of health (the conditions in which you are born into and live in)
  • Treatment patterns
  • Molecular testing to guide lung cancer treatment
  • Clinical trial involvement

Most lung cancers are diagnosed after they’ve already spread or advanced. Survival with advanced lung cancer is a lot less likely than when it’s caught early. But there are also many new treatment options and advances in treatment for advanced non-small-cell lung cancer. These advances include:

  • Biomarker or molecular testing
  • Targeted treatments
  • Immunotherapy
  • Palliative, or end of life, care

These advances mean more people with advanced lung cancer are surviving longer. They also have a better quality of life. But there are still disparities based on race and socioeconomic factors. A 2021 study reviewed 22 studies on disparities in advanced lung cancer. It found that disparities in treatment of advanced lung cancer are obvious and widespread. You’re less likely to get recommended care for advanced lung cancer if you are:

  • Black
  • Uninsured
  • Low income with Medicaid health insurance
  • From a rural area
  • Less educated
  • From a low-income area

Black and uninsured people were less likely to get:

  • Chemoradiotherapy that can sometimes cure stage III (three) lung cancer
  • Molecular testing to guide targeted treatment
  • Systemic treatment
  • Chemotherapy
  • Radiation to help with pain relief
  • Medicine to treat symptoms

The researchers said out-of-pocket costs are an important barrier for many people. New treatments for advanced lung cancer, including targeted treatments and immunotherapy, come at a high cost and insurance doesn’t always cover newer types of therapies. But more studies are needed to understand all the causes of disparities and ways to lower them.

If you are a person of color and are worried about disparities in your care, treatment, and chances of survival with lung cancer, there are steps you can take.

  • Try to find a regular doctor you trust. If you don’t have a regular doctor, you’re less likely to have someone you trust with lung cancer treatment. You also may find it harder to talk to your doctor.
  • Take care not to miss scheduled doctor’s appointments. If you miss appointments, you’re more likely to have symptoms overlooked.
  • Understand that you can do just as well with a lung cancer diagnosis if you get needed treatment.
  • Know that other health conditions you may have, such as heart disease or diabetes, don’t mean that you won’t do well with treatment for your lung cancer.

If you have a history of smoking and are at high risk for lung cancer, you should get informed about lung cancer screening to improve your odds of catching lung cancer sooner. Lung cancer screening can reduce your chances of dying from lung cancer by detecting it at an early stage. Early-stage lung cancer may be cured with surgery.

You’re at high risk for lung cancer if you are aged 50-80 and have “20 or more pack years.” That means you smoked a pack a day of cigarettes for 20 years or 2 packs a day for 10 years. You’re at high risk if you have this history and smoke now or quit less than 15 years ago. If you’re at high risk, talk to your doctor about lung cancer screening.