Non-Small-Cell Lung Cancer and Black People

Medically Reviewed by Minesh Khatri, MD on August 01, 2022
Written by Alyson Powell Key
5 min read

The yearly rate of new lung cancer cases in the United States continues to decline, and advances in screening and research are helping more people survive the disease. Over the 5-year period ending in 2021, the overall survival rate in the U.S. rose by 14% to a total of 23%.

Unfortunately, lung cancer is still the number one cause of cancer deaths in the U.S. and globally. But communities of color have a lower survival rate. For Black Americans, the 5-year survival rate is just 18%. And in the African American community, tobacco use is the top cause of preventable death.

Small-cell lung cancer (SCLC) and non-small-cell lung cancer (NSCLC) are the two main types of the disease. NSCLC makes up around 85% of all lung cancer diagnoses. NSCLCs are cancers that form in the cells lining your lung airways. They happen when abnormal cells in your lungs quickly multiply and grow unchecked. A significant number of NSCLCs (40%) have spread to different parts of the body by the time you get a lung cancer diagnosis.

The latest numbers from the CDC show that doctors diagnosed nearly 24,000 Black Americans with lung and bronchus cancer in 2019. Just over 15,000 Black people lost their lives to these diseases. Lung and bronchus cancer is the third leading type of cancer among Black Americans, behind prostate and breast cancers. It’s also the second deadliest form of the disease for this group.

In past years, Black Americans had the highest annual rate of new lung cancers across all races and ethnicities in the U.S. Today, this population has the second-highest rate, just slightly lower than white Americans. Here’s a breakdown by race and ethnicity:

  • White: 53.7 per 100,000
  • Black: 53.5 per 100,000
  • American Indian/Alaska Native: 37.3 per 100,000
  • Asian/Pacific Islander: 33.1 per 100,000
  • Hispanic: 27.5 per 100,000

When you look at the numbers by sex, Black men have the highest rate of lung and bronchus cancer in the U.S.

Smoking tobacco causes around 90% of lung cancer cases in the U.S. Other triggers include secondhand smoke, asbestos, and radon gas.

Overall, 14.6% of Black Americans smoke, compared to 15% of white Americans, 25.9% of American Indians/Alaska Natives, 7.4% of Asian Americans, and 9.8% of Hispanic Americans.

While Black Americans have a slightly lower smoking rate than white Americans, this group smokes menthol, or minty-flavored, cigarettes at much higher rates than any other race or ethnicity. Here’s a look at the percentage of smokers who say menthols are their cigarette of choice:

  • Black: 77.4%
  • Hispanic: 35%
  • Asian: 25.7%
  • White: 23%
  • American Indian/Alaska Native: 21.8%

Menthol covers up the harsh taste of cigarette smoke. This type of flavoring makes it easier to light up – and light up more often. People who smoke menthols tend to smoke more cigarettes and inhale more deeply than those who smoke unflavored types. It also makes it more challenging to quit – meaning you’re more likely to become dependent. All of these things can raise your chances of lung cancer and other smoking-related illnesses.

Similarly, tobacco companies use flavors like grape, cherry, and vanilla in cigars. Young Black people tend to smoke flavored cigars at higher rates than cigarettes.

In April 2022, the FDA proposed ending the sale of menthol cigarettes and flavored cigars. Once the proposal is approved, tobacco companies will have a year to remove these products.

Health inequities play a major role in many illnesses, including lung cancer. These imbalances, based on things like race and ethnicity, can determine your health and overall quality of life.

In certain communities, health inequities can begin even before a lung cancer diagnosis. For decades, tobacco companies have aimed cigarette marketing – particularly menthol cigarettes – toward the Black community. This has played a part in health disparities. Researchers estimate that if tobacco companies stopped selling menthol cigarettes, nearly 250,000 Black Americans would stop smoking within 17 months.

After a cancer diagnosis, Black Americans living with the disease have worse health outcomes than white Americans. According to the American Lung Association, when compared to white people, Black Americans are:

  • 18% less likely to get an early diagnosis
  • 23% less likely to have surgery
  • 9% more likely to go without treatment

Compared to other ethnic groups, Black Americans are:

  • About as likely as Hispanic or Asian Americans to get an early diagnosis
  • 23% less likely than Hispanic Americans and 41% less likely than Asian Americans to have surgery
  • Almost 17% less likely than Hispanic Americans and 4% more likely than Asian Americans to go without treatment
  • Statistically about as likely as Indigenous/Native Americans to get an early diagnosis, have surgery, or go without treatment

These numbers likely contribute to lower survival rates for Black people with early-stage non-small-cell lung cancer. This group is the least likely of any racial or ethnic group to live 5 years after diagnosis. Closing the health disparity gap would be a major step toward improving the health of Black Americans with lung cancer and other illnesses.

Researchers are finding new ways to detect lung cancer. We now know that screening for the illness every year can help doctors pinpoint tumors at an earlier stage and save more lives. Experts say annual low-dose CT scans can lower the rate of lung cancer deaths by up to 20%. One study found that while this type of lung cancer screening lowers the chance of death for everyone, it has an even larger impact on Black people.

In March 2021, the United States Preventive Services Task Force (USPSTF) updated its guidance for lung cancer screening. The task force now advises younger smokers (starting at age 50), those who have smoked at least one pack a day for 20 years (two packs a day for 10 years, and so on) and currently smoke, or who have quit smoking within the past 15 years to get an annual lung cancer screening. These updated guidelines have raised the number of Black Americans in the “high-risk” category for developing lung cancer and eligible for screening.