NEW YORKFewer blacks than whites receive potentially curative
surgery for early stage lung cancer, and this disparity is
substantially responsible for lower survival rates for black
patients, according to researchers at Memorial Sloan-Kettering Cancer
Center and the National Cancer Institute.
In our study, black men and women were 13% less likely to have
surgery for early stage lung cancer, and this translated into lower
overall survival. It is a phenomenon that appeared independent of
socioeconomic status, said Peter B. Bach, MD, first author of
the study and an epidemiologist at Memorial Sloan-Kettering. We
believe that fewer blacks will die of this disease if more receive
the best available treatment.
The researchers analyzed data from nearly 11,000 patients age 65 and
older who were diagnosed with early stage non-small-cell lung cancer
Treatment of early stage NSCLC was chosen for analysis because
surgery offers the possibility of cure. The optimal strategy is
unambiguous, Dr. Bach said. An average of 40% of patients
undergoing surgery are alive after 5 years vs only 5% of patients who
do not have surgery.
Dr. Bach and his colleagues looked at the experience of 10,984
Medicare patients diagnosed with stage I or II non-small-cell lung
cancer between 1985 and 1993; 860 (8%) were black, and 10,124 (92%)
were non-Hispanic white. The patients all lived within one of 10
regions included in the NCIs Surveillance, Epidemiology and End
Results (SEER) database. All were covered by Medicare, either through
an HMO or a traditional indemnity plan.
By linking Medicare and SEER data, the researchers were able to
obtain comprehensive information about each patient, including
diagnosis, coexisting conditions, treatment, availability of health
care, and patient demographics.
The researchers found that 64% of the black patients in the study
underwent surgery, compared with 76.7% of the white patients (P <
This disparity translated into higher overall mortality for blacks.
At 5 years, 26% of the black patients were still alive, compared with
34% of the white patients (N Engl J Med 341:1198-1205, 1999). If
whites and blacks were to receive surgical treatment equally, the
authors estimate that the survival of black patients would rise to 31%.
Five-year survival rates were comparable for blacks and whites who
received surgery (39.1% and 42.9%, respectively, P = .10), and for
blacks and white who did not undergo surgery (4% and 5%,
respectively, P = .25).
Because the study did not examine the reasons why black patients
undergo surgery less frequently, it is difficult to know why
this disparity exists, Dr. Bach said. One explanation
could be that blacks are not offered the surgery as frequently;
another is that they are choosing not to have surgery.