July 2, 2008
BIRMINGHAM, Ala. - Knowing that advances in genetics and social sciences have demonstrated that race usually is not a biologic factor in cancer survival, researchers at the University of Alabama at Birmingham (UAB) examined factors that might contribute to the racial disparity in lung cancer deaths and found that when given uniform staging, treatment and socio-economic status, the overall survival rates for African-American and Caucasian patients with non-small cell lung cancer were similar.
The study is published in the July 2008 issues of the Journal of Thoracic Oncology .
The study also found that differing external factors between the African-American patients and the Caucasian patients could have contributed to the higher mortality rate among African American patients.
More African-Americans die each year in the United States from lung cancer than any other ethnic group, and it kills more African-Americans each year than any other cancer, making it the second most common cancer among African-American men and third among African-American women UAB researchers, led by study lead author Ayesha Bryant, M.D., M.S.P.H., looked at factors, including annual income, insurance status, time to presentation to physician and education level to see if they were confounding factors in the poor survival rates of African-American patients.
The researchers assessed the survival difference between 930 African-American and Caucasian patients with non-small cell lung cancer who received comparable staging tests and procedures and similar treatment. The patients were matched on age, gender, comorbidities, performance status and stage and were followed from January 1997 to January 2007.
"When we controlled for their socioeconomic status, their level of education, cultural differences, amount of money they made, whether or not they would go see their doctor when they had an ache or pain, the time lag between symptom and surgery, their belief in surgery, etc., there was no difference in survival, they did the same," said study co-author and UAB Chief of Thoracic Surgery Robert J. Cerfolio, M.D.
Bryant added there were a number of differing external factors between the African-American patients and the white patients that could have contributed to the higher mortality rate among African-American patients. These included that African-American patients were more likely to be smokers, had a greater delay to treatment, and were less likely to agree to chemotherapy treatment.
"We also looked at other specific things to try to account for the differences," Cerfolio said. "We looked at the type of cigarettes that African-American patients used, which were more mentholated cigarettes that are worse for you and more likely to get lung disease from them. There also were differences in the way African-Americans felt about chemotherapy and they were less likely to agree to get chemotherapy either before or after surgery than white patients. African-Americans also were more likely to let symptoms persist before seeing a physician. All of these factors, along with access to care, need to be addressed if we are going to see any change in lung cancer mortality rates for the African-American population."