Introduction:
Cancer is one of the top causes of death in the world, but there are big differences between regions in both the overall rate of occurrence and the rate of screening in certain groups. A global age-standardized cancer rate list can help to find the countries and regions where a certain type of tumor is most common. These differences usually show that exposure to different environmental factors causes harm. Descriptive epidemiology tells how common cancer diseases are and helps in deciding how to use resources, plan health services, and keep people from getting sick.
Everyone has the right to get the opportunity to lead a complete and healthy life. But unfortunately, systemic issues contribute to health disparities, including the people who develop lung cancer. It is observed that in countries like the USA (United States of America), the people who belonged to the black race population remained underdiagnosed with lung cancer as compared to white people. They underwent late diagnosis and late disease identification, and thus, late or no treatment reached them. Racial or ethnic disparities in healthcare coverage are crucial issues to be addressed in terms of lung cancer care.
What Is Lung Cancer?
Lung cancer is the leading and one of the most frequently occurring cancers. Lung cancer is seen in the lungs and frequently begins in the airways (bronchi or bronchioles) or small air sacs (alveoli). It is primarily caused by the lungs' harmful cells whose growth occurs unchecked. These cells form masses or clusters termed tumors, which impair the functioning of the lungs. The symptoms of lung cancer mainly observed are a persistent cough, shortness of breath, sometimes discomfort in the chest or pain, coughing with blood, hoarseness, loss of appetite, weight loss, and more.
Treatments can be done by surgery, chemotherapy, immunotherapy, radiation, and targeted drugs. Screening is recommended when the person is at high risk. Now, modalities in treatments have shown a huge decline in lung cancer deaths in recent years.
What Are the Racial and Ethnic Disparities in Lung Cancer Screening and Early Detection?
Lung cancer is seen as the leading cause of death in both men and women in the United States, but certain high-risk populations are seen to fall under greater morbidity and mortality. Racial disparities are predominant, as black males have the highest rates of age-adjusted lung cancer incidence among all U.S. racial or ethnic groups, particularly 73.5 per 100,000 versus 63.5 per 100,000 for white males.
Lung cancer screening (LCS), which is done annually with low-dose chest computed tomography for high-risk individuals, declines lung cancer mortality, with a huge decline observed in black participants in clinical trials. While racial disparities in lung cancer mortality are present, less is known about disparities in participation of LCS. A systematic study was organized to explore LCS participation in black compared with white patients in the USA.
This racial disparity incidence is present in both smokers and people who have never smoked. Black males are seen to have the highest lung cancer mortality in comparison to other racial or ethnic groups (age-adjusted overall mortality). Black individuals are seen to catch lung cancer at an earlier age than white individuals (median age can be 67 vs. 70 years) and are more susceptible to present with advanced-stage disease (53 percent among black individuals vs. 49 percent among white individuals). The racial differences in mortality rates narrow when people are adjusted for stage at diagnosis and equal access is provided to care. However, little progress has been made in diagnosing lung cancer at an earlier stage over the past decades.
Latino people who had lung cancer were 16 percent less likely to get screened for lung cancer early, 30 percent more likely to not get any treatment, and 9 percent less likely to live for five years when compared to white individuals in America. However, they were two percent more likely to get surgical treatment as compared to white individuals.
It has been observed that Hispanics have a lower rate of smoking and lung cancer mortality than black individuals and white individuals, whereas American Indians or Alaskan natives have the highest overall rate of cigarette smoking. Still, the American Indians or Alaskan natives possess lower incidence and mortality rates than white individuals and black individuals. Further research should emphasize other racial or ethnic groups so that there can be a reduction in the burden of lung cancer. The focus is primarily on white individuals and black individuals, as these groups possess the highest incidence and mortality rates. Other populations like HIV (human immunodeficiency virus)-positive patients are also susceptible to get and experience lung cancer incidence three times more than the general population. Gender disparities are also seen to exist in lung cancer risk, screening, and outcomes but are outside the scope of this review.
Socioeconomic inequities are also a contributing factor to cancer incidence and mortality, and the largest socioeconomic disparity has been observed in lung cancer. Low socioeconomic populations frequently have greater environmental exposures and subsequently increased lung cancer cases and mortality. Likewise, rurality is another reason for further disparities, as black individuals in rural areas have a higher number of lung cancer cases than those in urban areas.
How to Eliminatethe Racial and Ethnic Disparities in Lung Cancer Screening and Early Detection?
A multipronged approach can be made to address some of the underlying causes of these disparities and might help to reduce them. One such initiative was taken by NCI, which reduced the gap in screening and treatment between black and white people. The three-pronged approach comprises a real-time warning system tied to electronic health records to keep the patients from falling through the cracks; feedback given to clinical teams on treatment completion rates for black and white patients; and trained and experienced nurse navigators to indulge with patients to check and resolve hindrance to care.
Conclusion:
Health disparities occur when two or more groups of the population are differentiated in providing care and treatment for any disease. For lung cancer, black LCS-eligible patients are being screened at a lower rate when compared to white patients. More studies are needed to identify barriers to LCS referral and form interventions to increase awareness of the importance of LCS in black patients as well.
