Race, Ethnicity, and Lung Cancer: Disparities, Risks, and Opportunities for Change
Understanding lung cancer disparities by race and ethnicity and strategies to deliver more equitable care, prevention, and outcomes.
Lung cancer is the leading cause of cancer death in the United States, consistently claiming more lives annually than any other cancer type. Despite improvements in overall survival and earlier diagnosis rates, comprehensive disparities remain across racial and ethnic lines—impacting incidence rates, access to healthcare, delivery of treatment, and patient outcomes. This article explores how lung cancer affects people of different races and ethnicities, why these disparities exist, and what strategies are being implemented to confront these challenges.
How Lung Cancer Affects Different Race and Ethnic Groups
Lung cancer does not affect all racial or ethnic groups equally. Rates of new cases and death, success of early diagnosis, access to optimal care, and outcomes after treatment vary significantly. These patterns reflect underlying differences in risk factors, health system structures, and societal inequities.
Lung Cancer Incidence by Race and Ethnicity
| Group | Incidence Rate | Notes |
|---|---|---|
| Non-Hispanic Black Men | Highest among all groups | 12% more likely to be diagnosed than White men |
| Hispanic Men | Varies by subgroup; Cubans particularly high | Leading cause of cancer death for men in Hispanic populations |
| Asian/Pacific Islanders | Lower incidence overall | Disparities in early diagnosis and treatment remain |
| American Indians/Alaska Natives | Elevated risk compared with national average | Survival rates are lower |
| White Americans | High overall burden | Reference group for most comparisons |
Within broad racial and ethnic categories, there is significant heterogeneity. For example, Cubans in Florida experience lung cancer rates far higher than other Hispanic subgroups such as Central Americans or Mexicans. Similarly, U.S.-born Black individuals have higher rates than Caribbean-born Blacks.
Survival and Stage at Diagnosis
Survival odds and likelihood of an early-stage diagnosis show marked differences among groups:
- Black individuals: 15% less likely to be diagnosed early, 19% less likely to receive surgery, 12% more likely to not receive any treatment, and 16% less likely to survive five years compared to White individuals.
- Latino individuals: 17% less likely to be diagnosed early, 30% more likely to not receive any treatment; however, survival rates after five years are similar to White individuals.
- Asian/Pacific Islanders: 17% less likely to be diagnosed early, but also 17% more likely to receive surgery and survival is equal to White individuals.
- American Indians and Alaska Natives: 12% less likely to be diagnosed early, 24% less likely to receive surgery, 20% more likely to not receive any treatment, and 15% less likely to survive five years.
Why Do These Disparities Exist?
Lung cancer disparities across racial and ethnic groups are driven by a combination of structural, socioeconomic, behavioral, and healthcare access factors. These influences span individual biology and social determinants, reflecting deeper injustices and systemic bias.
Root Causes of Disparities
- Smoking Rates: Smoking remains the largest risk factor. Historical targeting of certain groups, such as Black Americans and Cubans, by tobacco marketing means that risk—and resulting lung cancer rates—are disproportionately higher in these populations.
- Socioeconomic Inequality: Limited financial resources reduce access to preventive care, early screening, and best-available treatments. Rates of uninsured individuals are highest among people of color.
- Health System Barriers: Poorer insurance coverage, fewer local medical facilities, transportation challenges, and bias in medical decision-making all contribute to less frequent diagnosis and suboptimal treatment.
- Screening Inequity: Guidelines for lung cancer screening can miss high-risk individuals from some groups, such as African Americans.
- Trust and Communication: Distrust of medical providers, language barriers, and cultural differences can further impede access and willingness to seek care.
What others are reading
Heterogeneity Within Groups
Aggregating individuals into broad racial or ethnic categories hides important variations in risk, habits, and outcomes. For example, Cubans and Central Americans, or U.S.-born and Caribbean-born Blacks, have very different risk profiles, influenced by language, nativity, education, acculturation, and socioeconomic status.
Lung Cancer Screening: Gaps and Equity
Screening for lung cancer using low-dose CT scans can dramatically improve chances of early diagnosis—when treatment is most likely to be effective. Despite the potential, national guidelines do not fully account for racial and ethnic differences in risk, leaving some groups underserved.
- African Americans are more likely to develop lung cancer at younger ages and with less history of smoking, yet may not meet common screening criteria.
- Latino and Asian groups, with lower overall smoking rates, may be overlooked for screening despite other risk factors.
- Socioeconomic and health insurance barriers further deter access to screening facilities and follow-up care.
Efforts to refine and personalize screening recommendations—integrating factors like nativity, nuanced tobacco exposure, and social context—are ongoing but needed at a national scale.
Access to Care and Treatment: Disparities in Delivery
Receiving prompt and effective treatment depends heavily on health coverage and local healthcare infrastructure. Systemic issues still result in racial and ethnic minorities being less likely to receive:
- Early diagnosis—many are found at late stages where treatment is less effective.
- Surgical resection—rates are much lower for Black and Indigenous patients compared to White peers.
- Standard-of-care therapies, including chemotherapy, radiotherapy, and immunotherapy.
- Post-treatment support and survivorship care.
Key obstacles:
- Uninsured rates: Nearly two-thirds of the nation’s uninsured are people of color.
- Lower physician trust, discrimination, and implicit bias within clinical settings.
- Challenges navigating complex healthcare systems and securing referrals.
- Lack of culturally competent care, tailored to language and familial needs.
Diverse Experiences: Breaking Down the Data
Lumping populations together masks critical differences. Research published in Florida found a threefold difference in lung cancer rates among subgroups within the Black and Hispanic umbrella, emphasizing:
- Distinct risk from nativity (U.S.-born vs. foreign-born)
- Subpopulations: Cubans had markedly higher rates than other Hispanic groups
- Black Americans experienced much higher rates than Caribbean-born Blacks
These findings underscore the need for more granular public health data and tailored interventions.
Improving Equity: Steps Forward
Addressing disparities in lung cancer requires multifaceted action. Solutions range from research reforms and better data collection to patient-centered care models and community outreach programs.
Actionable Strategies
- Expand screening access: Adapt guidelines to capture younger and non-traditional high-risk groups.
- Improve coverage: Push for universal health insurance and remove financial barriers, especially for marginalized populations.
- Tailor prevention efforts: Invest in culturally relevant smoking cessation programs where rates are highest (e.g., Black and Cuban communities).
- Enhance data granularity: Collect and analyze data by detailed subgroup to inform targeted interventions.
- Increase community engagement: Employ trusted local advocates, patient navigators, and health educators to build trust and increase awareness.
- Address systemic bias: Mandate anti-bias training for providers and invest in diverse care teams familiar with patient communities.
Frequently Asked Questions (FAQs)
What are the main reasons certain racial and ethnic groups are more likely to die from lung cancer?
Higher rates of smoking, late-stage diagnosis, limited access to screening, and treatment disparities are the leading contributors to elevated death rates in Black, Indigenous, and some Hispanic populations.
Do genetics play a role in differences between groups?
While genetic factors can influence lung cancer risk and survival, research indicates that structural and systemic influences—such as economic status, exposure to tobacco marketing, and healthcare barriers—are the primary drivers of disparities.
Are screening guidelines effective for all groups?
Current U.S. screening guidelines do not fully account for group-specific risk factors, meaning individuals at risk in certain communities may not qualify for recommended early screenings.
Which racial group has the highest overall lung cancer risk?
Non-Hispanic Black men have the highest rate of lung cancer incidence and death. Certain Hispanic subgroups, particularly Cubans, also face elevated risk.
Can targeted programs make a difference?
Yes. Tailored interventions—including culturally adapted cessation programs, expanded screening, and improved community engagement—are shown to increase early diagnosis and improve lung cancer outcomes.
Key Takeaways for Public Health and Policy
- Understand subgroup differences: Race and ethnicity are not monoliths—interventions must be nuanced and data-driven.
- Expand and adapt screening: Eligibility must account for local risk profiles and intersectional factors.
- Improve healthcare access: Universal coverage, equitable funding, and outreach are essential for closing gaps.
- Culturally aware care: Community inclusion, trusted messengers, and language services are fundamental.
Confronting lung cancer disparities means investing in change at every level, from clinical guidelines and community programs to research funding and health policy. Every person—regardless of their race, ethnicity, or background—deserves equitable access to prevention, early detection, treatment, and hope.
References
- https://pmc.ncbi.nlm.nih.gov/articles/PMC10093016/
- https://www.lung.org/research/state-of-lung-cancer/racial-and-ethnic-disparities
- https://pmc.ncbi.nlm.nih.gov/articles/PMC12351699/
- https://www.healthline.com/health/health-disparities-in-the-black-community
- https://med.stanford.edu/news/all-news/2023/10/race-disparities-lung-cancer-screening.html
- https://ascopubs.org/doi/10.1200/JCO.24.00351
- https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2774850
Similar Articles
Read full bio of Sneha Tete
