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Lung Cancer Disparities

 

Compared with White men, Black men are:

  • more likely to be diagnosed with lung cancer
  • less likely for lung cancer to be diagnosed at an early stage
  • less likely to receive optimal surgical treatment
  • more likely to receive no treatment
  • more likely to die from lung cancer

Compared with White women, Black women are:

  • less likely to be diagnosed with lung cancer
  • less likely for lung cancer to be diagnosed at an early stage
  • less likely to receive optimal surgical treatment
  • more likely to receive no treatment
  • less likely to die from lung cancer

Compared with White men women, Hispanic men and women are:

  • less likely to be diagnosed with lung cancer
  • less likely for lung cancer to be diagnosed at an early stage
  • more likely to receive no treatment
  • less likely to die from lung cancer
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    Data

    W=White 54.3, B=Black 45.6,
    NA=Native American 45.1, A=Asian/Pacific Islander 28.5, H=Hispanic 23.0
    Source: National Cancer Institute Cancer
    Stat Facts: Lung and Bronchus Cancer

    B=Black 71.6, W=White 64.0,
    NA=Native American 52.9, A=Asian/Pacific Islander  44.4, H=Hispanic 33.5
    Source: National Cancer Institute Cancer
    Stat Facts: Lung and Bronchus Cancer

    W=White 34.2, NA=Native American 31.0,
    B=Black 29.2, A=Asian/Pacific Islander 15.9, H=Hispanic 11.8
    Source: National Cancer Institute Cancer
    Stat Facts: Lung and Bronchus Cancer

    B=Black 54.0, W=White 47.0,
    NA=Native American 42.3, A=Asian/Pacific Islander 26.9, H=Hispanic 22.1
    Source: National Cancer Institute Cancer
    Stat Facts: Lung and Bronchus Cancer

    Men and Women Diagnosed with Lung Cancer

    Nat King Cole

    Musician and singer Cole smoked up to three packs of cigarettes a day because he believed it gave his singing voice a rich sound.

    After he was diagnosed with lung cancer in December 1964, he vowed to his wife that if he recovered he would go on television to urge people to stop smoking. However, three weeks after his entire left lung was surgically removed, Cole died in February 1965 at age 45.

    Duke Ellington

    When musician and composer Duke Ellington, a lifelong smoker, was hospitalized for influenza in January 1974, doctors found that lung cancer had spread through both his lungs. He died four months later at age 75. 

    Jesse Owens

    Three years after his historic performance at the 1936 Olympics in Nazi Germany, Jesse Owens became a lifetime smoker and later a promoter of smoking to the Black community.

    Owens developed an extremely aggressive and drug-resistant type of lung cancer and died in 1980 at age 66.

    Annette

    Annette lives in New York and is the mother of three. By the time she turned 20, Annette was a regular smoker. When she was 50, Annette finally heeded her granddaughter’s pleading and quit cold turkey after having smoked for more than 30 years. But it was too late.

    At 52, Annette went to the doctor because she was having difficulty breathing. “It took multiple doctor visits, all kinds of X-rays, and then a PET/CT scan to uncover lung cancer,”  she says. The cancer was so advanced that it was necessary to remove one of her lungs.

    Today, Annette is cancer-free, enjoys spending time with her loved ones, and lends support to smoking cessation groups.  “I talk to the smokers and let them know that this can happen to you.”

    Source: “Annette S.’s Story” on the CDC website.

    Lung Cancer Disparities

    Incidence

    Black men and women. During 2014-2018, incidence rates were 12% higher in Black men than in White men but 16% lower in Black women than in White women. Similar to White men, incidence rates in Black men increased rapidly until the mid-1980s because of widespread smoking uptake during the first half of the 20th century, but have since declined steadily due to reductions in smoking. In contrast, rates in Black women increased until the late 2000s before declining because of later and slower smoking uptake and cessation compared to men.

    Steeper smoking declines in Black people than in White people have resulted in a convergence in lung cancer incidence among young Black and White men and a crossover among women.  From 2009 to 2018, the annual decline in incidence was about 3% in Black and White men, 2% in Black women, and 1% in White women. 
    Source: American Cancer Society. Cancer Facts & Figures for African American/Black People 2022-2024.

    Effective smoking cessation campaigns over the past five decades have resulted in a steady decline in the overall lung cancer incidence with a steeper decline among Black adults, greatly reducing the disparity in lung cancer incidence between Black and White populations. Despite the narrowing disparities, lung cancer incidence rates in Black men were 12 percent higher than those in White men during 2014-2018.
    Source: American Association for Cancer Research Cancer Disparities Progress Report 2022.

    Hispanic men and women.  Lung cancer incidence rates among Hispanics are about half those of whites because of traditionally lower cigarette smoking prevalence and because Hispanic smokers are less likely to smoke daily and more likely to smoke fewer cigarettes overall. From 2006 to 2015, lung cancer incidence rates in men declined by 2.0% annually among Hispanics, similar to declines among whites. A recent study  reported a decline of about 1% annually for Hispanic women over the past five years, similar to the trend in white women. 
    Source: American Cancer Society. Cancer Facts & Figures for Hispanics/Latinos 2018-2020. 

    Hispanics have a lower rate of lung cancer compared with Whites. Because of the heterogeneity of the Hispanic population, the risk for different cancer types varies widely depending upon country or region of ancestral origin. Lung cancer incidence rates during 2014-2018 among Hispanics in Puerto Rico were 44 percent lower than among Hispanics in the mainland U.S.
    Source: American Association for Cancer Research Cancer Disparities Progress Report 2022.

    American Indian/Alaska Native (AI/AN).  Compared to White people, AI/AN people had a higher incidence rate during 2014-2018 for lung cancer. Furthermore, AI/AN populations living in different Purchased/Referred Care Delivery Area (PRCDA) regions (tribal areas or surrounding counties) have substantially different cancer risk and disparities compared to each other and to the White population.  AI/AN individuals living in the Northern Plains PRCDA region have five times higher incidence of lung cancer—the most diagnosed cancer in the AI/AN population—than those living in the Southwest PRCDA region. When compared to White individuals, the lung cancer incidence is 80 percent higher among AI/AN individuals living in the Northern Plains, but 64 percent lower in those living in the Southwest.
    Source: American Association for Cancer Research Cancer Disparities Progress Report 2022

    Native Hawaiians. Although Hawaii had among the lowest rates of lung cancer in the US in 2012-2016, lung cancer incidence was highest among Native Hawaiian men and women, and lung cancer mortality was highest in Native Hawaiian women compared to the other population groups in the state.
    Source: American Association for Cancer Research Cancer Disparities Progress Report 2022

    Smoking

    Hispanic men and women.  While smoking prevalence in Hispanics overall is substantially lower than in whites, among Puerto Ricans living in the States it is currently similar to whites.
    Source: American Cancer Society. Cancer Facts & Figures for Hispanics/Latinos 2018-2020. 

    Diagnosis

    Black men and women. Both Black men and women are more likely to be diagnosed with lung cancer at a younger age than Whites, with a median age at diagnosis of 67 versus 71, respectively. Localized-stage lung cancer is only diagnosed in 21% of Black people and 25% of White people because symptoms generally do not appear until the disease is advanced.
    Source: American Cancer Society. Cancer Facts & Figures for African American/Black People 2022-2024.

    For those with lung cancer, compared with white Americans, Black Americans were 16% less likely to be diagnosed early, Latinos 13% less likely, Asian Americans or Pacific Islanders 15% less likely, and American Indians/Alaska Natives 14% less likely to be diagnosed early with lung cancer.
    Source: American Cancer Society. Cancer Facts & Figures for Hispanics/Latinos 2018-2020. 

    While 25% of Whites are diagnosed with lung cancer in its early stages, only 21% of Blacks, 22% of Hispanics, 21% of  Asian Americans and Pacific Islanders, and 22% of Anerican Indians and Alaska Natives are. 
    Source: “State of Lung Cancer 2021 Report” (American Lung Association)

    Hispanic men and women.  Most Hispanic patients with lung cancer are diagnosed at an advanced stage. Only 17% of Hispanics are diagnosed with localized disease, for which the 5-year cause-specific survival is 63%, dropping to 34% and 6% for regional and distant stage disease, respectively. 
    Source: American Cancer Society. Cancer Facts & Figures for Hispanics/Latinos 2018-2020. 

    Clinical trials

    Black and Hispanics are under-represented in clinical trials that look at biomarkers which can help identify appropriate personalized treatments. Whites and Asians are over-represented in these trials. 

    Source: “Racial and Ethnic Disparities Among Participants in Precision Oncology Clinical Studies” by Christopher M. Aldrighetti et al. (November 8, 2021).s

    Treatment

    Black men and women.  Numerous studies have shown that even when lung cancer is diagnosed early, Black people are less likely than White people to receive surgery, which is the most effective treatment for survival. When treatment is equivalent, outcomes are similar between Black and White individuals. 
    Source: American Cancer Society. Cancer Facts & Figures for African American/Black People 2022-2024.

    One recent study of early-stage lung cancer patients found that surgery was less often recommended for black lung cancer patients compared to other racial/ethnic groups, and as a result, 47% of black patients did not receive surgical treatment compared to 38% of Hispanics and whites and 34% of Asians. In contrast, another study found that racial differences in receipt of surgery were eliminated in 2010 for early-stage lung cancer patients treated at Veterans Affairs facilities, and in fact there were no differences in survival outcomes between Blacks and whites in the equal access health care system.
    Source: American Cancer Society. Cancer Facts & Figures for African Americans 2019-2021. Atlanta: American Cancer Society, 2019.

    While 21% of Whites and Hispanics receive surgical treatment for lung cancer, only 17% of Blacks and 17% of Anerican Indians and Alaska Natives do. In contrast, 24% of Asian Americans and Pacific Islanders receive surgical treatment.
    Source: “State of Lung Cancer 2021 Report” (American Lung Association).

    Black Americans were 9% more likely, Hispanics 26% more likely, Asian Americans and Pacific Islanders 5% more likely, and Native Americans 11% more likely to not receive  treatment for lung cancer compared with White Americans. 
    Source: “State of Lung Cancer 2021 Report” (American Lung Association).

    5-year survival

    Black men and women. The 5-year relative survival rate for lung cancer is slightly lower in Black people than in White people overall, 20% versus 22%, with the largest difference for localized-stage disease (55% versus 60%). Localized-stage lung cancer is only diagnosed in 21% of Black people and 25% of White people because symptoms generally do not appear until the disease is advanced. 
    Source: American Cancer Society. Cancer Facts & Figures for African American/Black People 2022-2024.

    Blacks were 21% less likely than Whites to survive 5 years after diagnosis, Hispanics 16% less likely, and American Indians/Alaska Natives 13% less likely. ON the other hand, Asian Americans and Pacific Islanders were 9% more likely to survive 5 years.
    Source: “State of Lung Cancer 2021 Report” (American Lung Association).

    From 2000 to 2017, the median survival time for Black patients increased only about 25%, well below the 39% increase in White patients and the 98% increase in Asian and other non-White/non-Black patients. Among lung cancer patients diagnosed in 2017, Asian and other non-White/non-Black patients survived a median of about 20 months, White patients about 14 months, and Black patients 12 months.
    Source: Prognosis and Survival Analysis of 922,317 Lung Cancer Patients from the US Based on the Most Recent Data from the SEER Database (April 15, 2021)

    Hispanic men and women.  The 5-year cause-specific survival after diagnosis with localized disease is 63% for Hispanics, dropping to 34% and 6% for regional and distant stage disease, respectively. Similar to whites, Hispanic women have higher 5-year lung cancer survival than Hispanic men (25% versus 16%), partly because women are more frequently diagnosed at an early stage. However, women have higher survival rates than men for every stage of diagnosis.
    Source: American Cancer Society. Cancer Facts & Figures for Hispanics/Latinos 2018-2020. o

    Mortality

    Black men and women.  Lung cancer is the leading cause of cancer death in Black men and the second-leading cause in Black women.  After increasing for decades, lung cancer death rates have declined since 1990 at a generally faster pace in Black men than in White men, reducing the racial disparity from an excess of 40% in Black men in 1990-1992 to 15% in 2015-2019. In women, the downturn began about a decade later than that in men and is also steeper in Black than White women. Consequently, although Black and White women had similar lung cancer mortality until the early 1990s, in 2015-2019 rates were 15% lower in Black women.

    The more favorable trends among Black people reflect the steep decline in smoking initiation unique to Black youth from at least the mid-1970s until the early 1990s. During 2015-2019, the lung cancer death rate declined by about 6% per year in Black men, 5% per year in White men, and 4% per year in Black and White women. These accelerated trends reflect recent advances in lung cancer treatment, as well as reductions in smoking. 
    Source: American Cancer Society. Cancer Facts & Figures for African American/Black People 2022-2024.

    Lung cancer is also the leading cause of cancer-related mortality in Black men and the second-leading cause of cancer deaths in Black women. Encouragingly, the lung cancer-related mortality has declined at a faster pace in Black individuals than in White individuals over the past two decades. During 2015-2019, the most recent period for which such data are available, the lung cancer death rate declined by about six percent every year in Black men compared to five percent in White men, and four percent in Black and White women. These trends reflect a steep decline in smoking rates over the past five decades, thanks to effective public health policies.
    Source: American Association for Cancer Research Cancer Disparities Progress Report 2022.

    Hispanic men and women.  Lung cancer is the leading cause of cancer death among Hispanic men and the second-leading cause among Hispanic women. From 2007 to 2016, death rates for lung cancer declined by 3.5% per year among Hispanic men, very similar to declines among white men, and by 1.4% per year among Hispanic women, compared to 2.3% per year among white women. The steeper decline among men reflects earlier and larger reductions in smoking compared to women, who took up smoking in large numbers about 20 years after men. 

    Lung cancer death rates within Hispanic subpopulations vary substantially by country of origin, particularly among men, reflecting differences in historical smoking patterns. In one study in Florida, lung cancer death rates in Cuban men, who have the heaviest smoking history among Hispanic subgroups, were nearly 50% higher than those in Puerto Rican men during 2008-2012.
    Source: American Cancer Society. Cancer Facts & Figures for Hispanics/Latinos 2018-2020. 

    Asian Men and Women. Of the cancer types common in the overall U.S. population, lung cancer is the leading cause of cancer-related deaths in the Asian population. Furthermore, Asian individuals, particularly women without a history of smoking, have a uniquely high burden of lung cancer among never-smokers. Notably, more than 30 percent of lung cancer patients in Asia, including more than half of female patients with lung cancer, are never‐smokers. This observation has been attributed to a markedly increased rate of epidermal growth factor receptor (EGFR)–mutant lung cancer in Asian female nonsmokers. 
    Source: American Association for Cancer Research Cancer Disparities Progress Report 2022.

     

    Raymond U. Osarogiagbon, MD

    "Number one, disparities are preventable..."

    “Number two, disparities are incredibly costly. The third thing is that as we begin to focus on preventing, narrowing, and eliminating disparities, we have to understand that the solutions come from multiple levels,” says Raymond U. Osarogiagbon, MD, of the Baptist Cancer Center in Memphis, Tennessee.

    The least effective is the level of blaming the victims of disparities. Patients don’t go in with the idea that they will do something to hurt themselves. A patient with lung cancer who is poor, does not stand up in the morning and decide, “I am so going to make sure I get the wrong treatment today. I don’t care if I die.”

    Where is our intervention most successfully deployed? I think it is important to recognize that the level at which we can have the most impact is at the policy level. The second biggest level of impact is at the organizational level.

    When we talk about disparities, I think it is very important for us to get away from the traditional narrow lens that asks, “Who are these people or why do they have such terrible outcomes?” We should recognize that we have seen the enemy, and it is us [the medical establishment].”

    Source: “Addressing Disparities in Lung Cancer from a Geographic Perspective” by Tony Berberabe.

    See also “Unequal Resource Distribution Underlies Lung Cancer Disparities” by M. Alexander Otto.

    Patients go to the Doctor only when they're unwell, which is too late

    “Many people don’t think it’s cancer until they notice a problem,” says Illinois cancer physician Shaina Rozell.

    “So, it’s not until I’m coughing up blood or developing pain that I’m actually seeking care. Whereas lung cancer screenings are more for when you are feeling well and healthy. Most patients are not going to the doctor when they’re feeling healthy. They go to the doctor when they’re feeling unwell.”

    “Unfortunately, because of that, we’re diagnosing these lung cancer cases at later stages.”

    A 1-minute video from MD Newsline.

    A cure no longer exists for some of these patients at stage 3 and 4

    “The options for surgery during later stages of lung cancer are pretty limited,” says Illinois cancer surgeon Shaina Rozell. “You do surgery at stage one or stage two, but most of these patients, they’re presenting at stage three or stage four. So the potential for cure no longer exists for these patients.”

    “Because of that you see a major disparity between African Americans and non-African Americans in being diagnosed and having surgeries. Unfortunately, because of that, we’re diagnosing these lung cancer cases at later stages.”

    A 1-minute video from MD Newsline. 

    Voices About Lung Cancer

    Rapper and actor Common

    “Our community is more likely to develop advanced lung cancer than any other racial or ethnic group. Lack of access to health care, lack of clear resources for health and mistrust in the medical system are not helping us beat this.”  

    “Lung cancer continues to be the leading cause of cancer deaths among Black men and women. But there is a way for us to take back control of our health. Learn all that you can about cancer diagnosis and treatment options. Get more information on lung cancer screening and clinical trials.”

    A 1-minute Public Service Announcement from Stand Up to Cancer.

    Olugbenga Okusanya, MD

    “There’s not an aspect of lung cancer care in which there’s not a significant disparity that hinders the ability of minority patients to get better care,” says Olugbenga Okusanya, MD, of Thomas Jefferson University in Philadelphia.

    “Black patients are less likely to get surgical therapy for early-stage disease, which is the actual cure for early-stage disease. They are also less likely to get chemotherapy and be enrolled in clinical trials.”

    “It’s really disheartening to see this. There are lots of patients who have good options that never get them.”

    A 2-minute video from the Patient Empowerment Network

    Cigarette Marketing to the Black Community

    From the Centers for Disease Control and Prevention (CDC)

    What is menthol?

    Menthol is a chemical compound found naturally in peppermint and other similar plants. Menthol can also be produced in a lab. Almost all cigarettes sold in the U.S. contain at least some natural or lab-created menthol. Usually, there is more menthol in cigarettes marketed as “menthol” than in other cigarettes. According to federal law, tobacco manufacturers cannot market cigarettes with a distinct taste, except for cigarettes that taste like menthol or tobacco.

    Why is menthol in cigarettes?

    Menthol in cigarettes creates a cooling sensation in the throat and airways when the user inhales, making cigarette smoke feel less harsh on the user. Tobacco companies market menthol cigarettes as “smoother” than other cigarettes. However, menthol cigarettes are not less harmful than other cigarettes.

    Studies have shown that menthol in cigarettes likely leads people—especially young people—to experiment with smoking. It also could increase a young person’s risk of becoming dependent on nicotine.

    From their research, tobacco manufacturers knew that young people preferred smaller amounts of menthol in their menthol cigarettes, while older people who smoke preferred more menthol. The tobacco companies purposely lowered the menthol in some of their brands to make young people who smoke and those just starting to smoke want to use them.

    Why is menthol in cigarettes harmful?

    Menthol cigarettes contribute to tobacco-related health disparities in the U.S. This is because some groups of people are more likely to start smoking menthol cigarettes and keep smoking because of menthol cigarettes, which puts them at higher risk of getting tobacco-related diseases. Adults who smoke menthol cigarettes make more attempts to quit smoking and have a harder time quitting, compared to adults who smoke non-menthol cigarettes.

    Even though fewer people are smoking any kind of cigarette now than in the past, the percentage of people who smoke menthol cigarettes is going down more slowly than the percentage of people who smoke non-menthol cigarettes.

    Source: Menthol and Cigarettes (Center for Disease Control and Prevention)

    Update: FDA Proposes Ban on Menthol Cigarettes

    FDA proposes ban on menthol cigarettes

    The U.S. Food and Drug Administration on April 28 released proposed rules to ban menthol cigarettes and flavored cigars.

    “The proposed rules would help prevent children from becoming the next generation of smokers and help adult smokers quit,” U.S. Health and Human Services Secretary Xavier Becerra said. 

    FDA Commissioner Robert Califf declared that the proposed bans would “reduce the mortality risk of current smokers of menthol cigarettes or flavored cigars by substantially decreasing their consumption and increasing the likelihood of cessation.”

    Source: “FDA Proposes Ban on Menthol Cigarettes, Flavored Cigars” by Dennis Thompson on the HealthDay website.

    Could save hundreds of thousands of lives

    “To see an issue that disproportionately affects African American smokers, women, LGBT people who smoke, lower-income individuals and to say that these lives count just as much as any other life, that gives me real, real hope,” said Richard Besser, MD, former director of the U.S. CDC and now president of the Robert Wood Johnson Foundation, a public health advocacy organization.

    More than half of kids who smoke use menthol cigarettes, according to the CDC. A survey of adults who smoke found that the majority started with menthols.

    Cutting out menthol in cigarettes and cigars could have a significant effect on the number of smokers, the FDA said. By one estimate, it could even prevent 650,000 premature deaths over the next 40 years.

    Source: “Ban on menthol cigarettes and flavored cigars could save hundreds of thousands of lives, experts say” by Jen Christensen on the CNN website.

    Tobacco company funds anti-ban groups and community leaders

    Since the summer of 2021, the Bureau of Investigative Journalism and the Los Angeles Times have tracked how tobacco giant Reynolds American has been trying to keep menthol cigarettes in the hands of smokers.

    The company has sought to stoke fears among Black communities about what the bans could mean for them, hiring a team of Black lobbyists, consultants and public figures, and donating to civil rights activist Rev Al Sharpton’s organization. They have exploited genuine concerns about police brutality and even invoked the murder of George Floyd.

    This investigation has uncovered new details about how the individuals and organisations who have aided the company’s objectives have failed to publicly declare their links to Reynolds American’s tobacco money. Protesters were even paid $80 each to attend a rally organized by a group with close ties to the tobacco company.

    Source: “Paid protesters, free lunches and backroom chats: Inside the menthol lobbying machine” by By Ben Stockton, Emily Baumgaertner, and Ryan Lindsay on the Bureau of Investigative Journalism website.

    Study suggests menthol ban could backfire

    A Vanderbilt University study could not confirm the FDA’s stance that menthol cigarettes are harder to quit. The study tracked more than 16,000 smokers, two-thirds of whom were African American, from 2002 to 2017. The average annual quit rate from those surveys was 4.3% for menthol smokers and 4.5% for non-menthol smokers. Prior research by this Vanderbilt research group has shown that non-menthol smokers are at higher risk for lung cancer. They also noted a study conducted in Canada, which has banned menthol-flavored cigarettes, that revealed that most menthol smokers tend to switch to non-menthol brands rather than quit.

    Critics: Ban could lead to conflicts with police

    The move to ban menthol cigarettes has the Black community split, with its critics arguing the ban would unfairly target Black Americans and could lead to injustices and policing issues.

    Opponents include law enforcement groups who warn it could put undue pressure on police grappling with higher crime rates. However questions have also come up over the financial ties between these groups, as well as big-name political leaders opposing the ban, and the tobacco industry.

    “It’s not a coincidence that just as the tobacco industry targeted the African American community with its marketing, it has used its money to persuade key members of the community to speak up in its defense,”said Matthew Myers, president of the Campaign for Tobacco-Free Kids.

    Source: “Biden’s planned ban on menthol cigarettes divides Black Americans” by Alex Gangitano and Julia Manchester on The Hill website.

    How banning menthol cigarettes can Help Black families

    “For Black families, cigarette smoking leads to premature deaths that translate into generations of lost parents and grandparents, our built-in support systems,” says Martha Dawson, president and CEO of the National Black Nurses Association.

    “Due to the cost of cigarettes, tobacco industries are pulling wealth out of Black families, contributing billions to health care cost, and reducing family income due to lost work productivity.

    While Black Americans constitute 12% of the U.S. population, they represent 15% of the extra smokers, 41% of the extra deaths, and 50% of the years of life lost due to menthol.

    “If the same data and alarming results were demonstrated in the larger population, menthol cigarettes would be labeled a ‘public crisis’ and steps would be taken to reverse these trends. Smoking is a preventable chronic disease and the best solution is to not start; plus stop marketing and targeting the Black population.”

    Source: “How Banning Menthol Cigarettes Can Help Black Families” by Noel Cody on the Essence magazine website. Article sponsored by the Campaign for Tobacco-Free Kids.

    The only legal cigarette flavor is menthol

    “Menthol is the only flavored cigarette not outlawed by the 2009 Family Smoking Prevention and Tobacco Control Act.

    The tobacco industry has a well-documented and long history of of developing and marketing menthol brands to racial and ethnic minorities and youth.

    What followed in the Black community was a massive influx of Black people buying and consuming this particular flavor of cigarette, a trend that continues today.

    A 3-minute video from Newsy.

    "Don't delay! Ban menthol cigarettes"

    “The tobacco industry has systematically targeted Black communities and kids with marketing for menthol cigarettes for over 60 years, and our community has paid a horrific price in health and lives,” says David Satcher former Surgeon General of the United States.

    “Tobacco use is the top cause of preventable death for Black Americans, resulting in the deaths of more than 45,000 annually. Lung cancer – most of which is caused by smoking – is the leading cause of cancer deaths in the Black community.”

    See “Don’t delay! Ban mentol cigarettes” on the Georgia Health News website (August 18, 2021)

    Tobacco industry targeted Black communities with predatory marketing

    It was very troubling how the tobacco industry targeted our communities, says Delmonte Jefferson, Executive Director of The Center for Black Health & Equity.

    To target our communities with free cigarettes, sampling vans, with the sponsoring of our concerts and events, and paying off some of our elected officials and church officials to promote their cause.

    There are a few issues with menthol in particular with regards to public health. It does make nicotine more addictive. It masks the harshness of the smoke to make it easier to get the poison down and makes it easier for people to start smoking.

    A 6-minute video from the PBS NewsHour.

    "Marketing coup" transformed menthol cigarettes into the Black cigarette

    “It’s no accident that African Americans smoke more menthol cigarettes. One of the greatest marketing coups in the 20th century was transforming menthol cigarettes into the Black cigarette,” says filmmaker Lincoln Mondy. 

    Following World War II, many African Americans had moved to the North. There were specialty products being developed for them, certain hair creams, certain food stuffs. The tobacco industry began to realize that they could market a particular brand of cigarette to this group of people.

    The tobacco company Brown & Williamson began to use Black images on television and in their ads. In 1953, 5% of African Americans used menthol tobacco products compared to 3% for Whites. By 1968, that had tripled to 14%, by 1976 it tripled again to over 42%. In the 2000s it was above 80%.

    That’s the African Americanization of menthol cigarettes in the United States, the targeted marketing for over half a century towards Black folks.

    From “Black Lives/Black Lungs,” a 15-minute by Lincoln Mondy documenting Big Tobacco’s 50+ year campaign transforming the menthol cigarette into a “Black cigarette.”

    Black celebrities advertising cigarettes and cigars

    About Lung Cancer

    Learn about the risk factors for lung cancer and what you might be able to do to help lower your risk. Find out how lung cancer is tested for, diagnosed, and staged.

    Learn what lung cancer is, what the symptoms are, how to lower your risk, and who should be screened for lung cancer.

    Explore the links here to learn more about lung cancer treatment, prevention, screening, statistics, research, clinical trials, and more.

    What you need to know about lung cancer. What to do after a lung cancer diagnosis. What to do when a loved one is diagnosed.

    Signs and Symptoms of Lung Cancer

    “If somebody is experiencing these symptoms, it’s very important to contact your doctor, whether that’s a primary care doctor or a pulmonologist, to let them know about these symptoms or let them know you’re having concerns,” says says Mark Awad, MD, a thoracic oncologist at the Dana-Farber Cancer Institute in Boston.

    A 2-minute video from the Dana-Farber Cancer Institute.

    Cigarettes are the # 1 Risk Factor for Lung Cancer

    Cigarette smoking is the number one risk factor for lung cancer. In the United States, cigarette smoking is linked to about 80% to 90% of lung cancer deaths. Using other tobacco products such as cigars or pipes also increases the risk for lung cancer.

    People who smoke cigarettes are 15 to 30 times more likely to get lung cancer or die from lung cancer than people who do not smoke. Even smoking a few cigarettes a day or smoking occasionally increases the risk of lung cancer. The more years a person smokes and the more cigarettes smoked each day, the more risk goes up.

    Source: “What Are the Risk Factors for Lung Cancer?” from the Centers for Disease Control and Prevention”

    Lung Cancer Leading Cause of Cancer Death

    “Lung cancer is the leading cause of cancer death for both men and women in the United States.

    There are two main types of lung cancer, small cell lung cancer and non small cell lung cancer. The cancer cells of each type grow and spread in different ways.

    Smoking is the single most important risk factor for lung cancer. Quitting smoking greatly reduces but does not eliminate your risk of developing lung cancer. Lung cancer can also occur in people who have never smoked.

    Other risk factors for lung cancer include HIV infection, family history of lung cancer and exposure to secondhand smoke Rayden asbestos arsenic chromium, nickel suit tar radiation or air pollution.  

    A 5-minute video from the National Cancer Institute.

    Lung Cancer Screening

    The U.S. Preventive Services Task Force changed its lung cancer screening guidelines in 2021 because the previous guidelines left out too many African American smokers who were at risk of lung cancer.

    The previous guidelines were based on White smoking habits and recommended CT screening for smokers age 55 to 80 with a 30 pack-year history who still smoke – or quit only within the past 15 years. African American smokers, however, tend to smoke fewer cigarettes overall compared to white smokers, but their lung cancer risk remains high.

    In a study of 48,364 people who were or had been smokers, 84 percent of White smokers with lung cancer met the 30-pack-year bar, but only about half of Black smokers with lung cancer did. The Task Force has now lowered the pack-year requirement from 30 to 20 and lowered the minimum age from 55 to 50.

    See “Updated Guidelines for Lung Cancer Screening Aim to Reduce Disparities” on the Vanderbilt University Medical Center website (May 5, 2021)

    U.S. Preventive Services Task Force (2021)

    The USPSTF recommends annual screening for lung cancer with low-dose computed tomography (LDCT) in adults aged 50 to 80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years. Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery.

    This recommendation replaces the 2013 USPSTF recommendation on screening for lung cancer. In 2013 the USPSTF recommended annual screening for lung cancer with LDCT in adults aged 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years.

    Source: U.S. Preventive Services Task Force. Lung Cancer: Screening (2021)
    The U.S. Preventive Services Task Force is an independent, volunteer panel of national experts in disease prevention and evidence-based medicine who make evidence-based recommendations about clinical preventive services. Most private insurance plans are required to cover without a copay recommended preventive services that receive a grade of A or B from the Task Force.

    American Lung Association (2021)

    If you meet the following criteria, you are considered to be at “high risk” for developing lung cancer and screening is recommended:

    • 50-80 years of age
    • Have a 20 pack-year history of smoking (this means 1 pack a day for 20 years, 2 packs a day for 10 years, etc.)
    • AND, are a current smoker, or have quit within the last 15 years

    At this time, there is not enough evidence to show that screening is recommended for other groups.

    Source: American Lung Association: Questions and Answers About Lung Cancer (2021)

    American Cancer Society (2013)

    The American Cancer Society recommends annual lung cancer screening with a low-dose CT scan (LDCT) for certain people at higher risk for lung cancer who meet the following conditions:

    • Are aged 55 to 74 years and in fairly good health, and
    • Currently smoke or have quit within the past 15 years, and
    • Have at least a 30-pack-year smoking history, and
    • Receive smoking cessation counseling if they are current smokers, and
    • Have been involved in informed/shared decision making about the benefits, limitations, and harms of screening with LDCT scans, and
    • Have access to a high-volume, high quality lung cancer screening and treatment center.

    Source: American Cancer Society Lung Cancer Screening Guideline (2013)

    Quick scan can find treatable lung cancers

    Almost 80 percent of lung cancers are detected where they’ve already spread to other parts of the body. So, at that point, surgery is not an option. If you do an annual low-dose chest CT, youll find nodules or small cancers early where they can be treated for a cure.

    A 2-minute video from the University of Virgina.

    Waiting for symptoms may be too late

    You quit smoking and thought that’s that. But here’s the thing about lung cancer: by the time you see the symptoms, it could be too late. But now, there’s a new scan that can detect lung cancer early when it’s more cureable.

    A 30-second video from the American Lung Association.

    New lung scan takes only 10 minutes

    What lung cancer screening is like: It’s fast and painless. Watch this video to learn what to expect during a screening.

    A 5-minute video from the Go2 Foundation for Lung Cancer.

    "That billboard saved my life"

    “When I first saw the ‘Saved By The Scan’ billboard, I didn’t know what a low-dose CT scan was,” says Denise. “I was a former smoker and didn’t know that early detection was available. I thought that the only way to find lung cancer was through a chest X-ray.”

    Her doctor didn’t initially order the test for her, so Denise persisted. The scan led to a biopsy “and the next day I learned that I had a malignant tumor that was stage IB.”

    Denise had surgery and chemotherapy and later joined a clinical trial. “The clinical trial examined the role of immunotherapy in helping to prevent recurrence for those like me who had been tested for the PDL-1 protein.”

    “I always encourage others who may be eligible for lung cancer screening to speak with their physician about screening. I often say- one of the things that prompted me to get screened was that I knew that lung cancer is often not detected until it has spread. Early detection is key—regardless of the cancer.”

    Source: “Denise’s ‘Saved By The Scan’ Story” on the American Lung Association website

    "I sing because I am saved by the scan"

    “Look, I was a 45-year long smoker,” says Milli. “I never thought I’d get lung cancer.  My mother had passed 20 years ago from lung cancer. My brother 19 years.  They were both diagnosed at stage four, but I never thought I’d get it. You never think it will be me.”

    “One day I was watching television and saw a public service commercial that advertised early detection and I listened really closely and found out that I might meet the criteria. So I got in touch with my doctor.”

    “I got the results back. Not only did I have lung cancer, but it was a huge 6 centimeter  mass in my upper right lobe.  I was so scared I wouldn’t be able to sing again. I was so scared that it had spread somewhere else.”

    “I had the right upper lobe removed.  They took out 17 lymph nodes, all negative. The margins around the cancer were negative.  So, I ended up having stage one lung cancer. I no longer smoke. My family, we’ve all quit smoking.”

    “I’m a very emotional person, but this emotion is joy because I’ve been given another chance.  I sing because I’m happy.  I sing because I am ‘Saved by the Scan’.”

    Source: How “Saved By The Scan” Saved Milli’s Life, a 3-minute video from the American Lung Association

    Lung Cancer Risk Calculator

    Do you want to know if you should be screened? Use this calculator developed by the University of Michigan to see your personalized lung cancer risk.

    Lung Cancer Screening Locator Tool

    You should only be screened at an accredited facility. Use this locator tool developed by the American College of Radiology to find a facility in the U.S. 

    Insurance Coverage of Lung Cancer Scanning

    US Preventive Services Task Force recommendations for lung cancer screening were updated in early 2021. Insurance companies are required to provide certain recommended screenings free of charge, but these changes may not be reflected yet in company insurance coverage.

    Contact your insurance provider to confirm whether lung cancer screening would be covered for you if you are: i) between 50 and 54 years old with a smoking history of more than 20 pack-years; or ii) between 55 and 80 years old with a smoking history of 20-29 pack-years.

    Details from the University of Michign about current coverage by employer-sponsored plans, state insurance marketplace plans, Medicare, Medicaid, and individual plans

    How Lung Cancer is Diagnosed After Scanning

    “When you find out you have a spot on the lung, it is very scary,” says Elisabeth Dexter, MD, thoracic surgeon at Roswell Park Comprehensive Cancer Center in Buffalo, New York.

    “It doesn’t always mean that it’s going to a cancer. So we would like to do the correct testing in the correct order to make sure that we have the right diagnosis and then specify, if it happens to be a cancer, what cell types and whether it has spread or not so we can recommend the right treatment.”

    A 3-minute video from Roswell Park Comprehensive Cancer Center.

    Cutting Edge Treatment:

    Genomic Testing and Personalized Medicine

    Advice from two leading cancer centers

    “Personalized medicine” in recent years has begun to bring new hope to people with lung cancer, especially non-small cell lung cancer.

    Personalized medicine involves looking at the cells obtained from a biopsy to see if there are any genetic mutations — changes in your genes — that could be linked to the type of cancer you have. For example, tumors in approximately 60 percent of patients with lung adenocarcinoma have been found to be linked to specific mutations.

    Because certain chemotherapy drugs are either more or less effective than others against tumors with specific mutations, molecular analysis of your tumor, also called genomic testing, can help determine which therapies will be most likely to benefit you.

    Based on which mutations are found, there may be a drug that has been approved for the changes in your specific tumor. Or you may be able to join a clinical trial that is testing a new drug.

    Genetic information about your tumor can also help predict the chances that your cancer will return after surgery and make other treatment decisions about surgery or radiation therapy.

    Genetic testing is now a routine part of diagnosis and staging for every patient with non-small cell lung cancer seen at Memorial Sloan Kettering Cancer Center. “We are one of only a handful of centers in the world to include this step.”

    Source: Lung Cancer Genomic Testing (EGFR, KRAS, ALK) on the Memorial Sloan Kettering Cancer Center website.

    For some patients with non-small lung cancer, chemotherapy isn’t the most effective treatment option. But based on a tumor’s molecular profile or biomarker testing results, lung cancer treatment can be customized to target the tumor’s unique cellular characteristics.

    The molecular abnormalities of a cancer – such as changes in its DNA, RNA and proteins – are what drive its growth. New treatments like targeted therapy and immunotherapy can attack these abnormalities to slow or stop a cancer’s growth. By knowing a tumor’s genetic makeup, we’re better able to predict which treatment is going to be most effective for each patient.

    It’s especially important that lung cancer patients who’ve never smoked undergo molecular profiling, but all lung cancer patients should have biomarker testing. 30% of lung cancer cases can be more effectively treated with targeted therapies versus standard chemotherapy, and being in that 30% can make a dramatic difference in survival times and quality of life.

    Don’t feel rushed or pressured to start treatment. A single chemotherapy infusion can alter your targeted treatment options – and sometimes make you ineligible for certain clinical trials. 

    You’ll have the best chance for successful treatment if you take the time to undergo molecular profiling before starting treatment. We encourage you to seek out a specialized cancer center like MD Anderson that has the resources to conduct the tests – and do so quickly.

    Source: Do lung cancer patients need molecular profiling? on the MD Anderson Cancer Center website

    Support Groups

    LUNGevity seeks to empower lung cancer patients to be active decision makers in their treatment process through our extensive educational resources, online peer-to-peer support, and in-person survivorship programs. We are dedicated to funding scientific research because the link between research spending and improved survival is clear. “

    “Founded by patients and survivors, GO2 Foundation for Lung Cancer, transforms survivorship as the world’s leading organization dedicated to saving, extending, and improving the lives of those vulnerable, at risk, and diagnosed with lung cancer. We work to change the reality of living with lung cancer by ending stigma, increasing public and private research funding, and ensuring access to care.”

    Lungcancer.org is a service of CancerCare, a non-profit organization providing free, professional support—including counseling, support groups, financial assistance, educational workshops and publications—to anyone coping with lung cancer.”

    Active Lung Cancer Facebook Pages

    American Lung Association

    LungCancer.net

    Lung Cancer and Caregivers Support Group

    Lung Cancer Foundation of America

    Lung Cancer Research Foundation

    Lung Cancer Support Community

    Lung Cancer Awareness & Support

    Lung Cancer Awareness Support Group

    Lung Force

    GO2 Foundation for Lung Cancer

    Lungevity

    Lvng with Lung Cancer

    Downloads

    This booklet explains the risk factors for lung cancer, how lung cancer differs in Black Americans, the importance of early screening, the next steps after screening, and lifestyle choices to reduce the risk of getting lung cancer. From the Lung Cancer Research Foundation and the African Methodist Episcopal Church International Health Commission.
    Free download here

    A short and simple guide to non-small cell lung cancer from the American Cancer Society.

    Free download here

    A short and simple guide to small cell lung cancer that covers diagnosis, treatment, questions to ask your doctor, and follow-up visits after treatment is complete from the American Cancer Society.

    Free download here

    Reports

    American  Association for Cancer Research: Cancer Disparities Research Report 2020

    American  Lung Association.
    State of Lung Cancer 2020
    New this year are disparities in lung cancer burden by racial and ethnic groups at the state and national levels.

    American Cancer Society. Cancer Facts & Figures for Hispanics/Latinos 2018-2020. Atlanta: American Cancer Society, 2018

    American Cancer Society. American Cancer Society. Cancer Facts & Figures for African American/Black People 2022-2024.

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