Blacks Lose Out On Lung Cancer Surgery-Study
U.S. blacks are far less likely than whites to undergo surgery for lung cancer and the result is 44 unnecessary deaths for every 1,000 blacks who develop lung tumors, Thursday's New England Journal of Medicine reports.
Lung cancer kills 150,000 Americans each year. About a third of the 170,000 people annually diagnosed with lung cancer can be treated with surgery because they have an early stage of small-cell lung cancer.
When the operation is performed, the survival rate after five years is 40 percent. Without surgery, the survival rate drops to 4 percent.
Researchers led by Dr. Peter Bach of the Memorial Sloan-Kettering Cancer Center in New York, reported that the survival rate for blacks and whites who underwent surgery was essentially the same.
However, for every 77 whites who received the operation, only 64 blacks had surgery, even though everyone in the study was covered by Medicare -- the federal elderly health-care program.
The findings may explain why blacks diagnosed in the early stages of non-small-cell lung cancer have a lower survival rate than whites, researchers said.
``If black patients were to undergo surgery at a rate equal to that of white patients,'' they said, ``their survival rate would probably be substantially improved and would approach that of white patients.''
In an accompanying editorial, Dr. Talmadge King and Dr. Paul Brunetta of the University of California, San Francisco, said, ''if the poor statistics on survival for the leading cause of cancer deaths in the United States are partially due to racial discrimination ... then the medical establishment begins to share a portion of the tobacco industry's culpability.''
There is overwhelming consensus that cigarette smoking causes cancer. The tobacco industry has been under intense legal pressure since 1994 when 46 state attorneys general began filing multibillion suits against the cigarette makers. Those suits were resolved last year as part of a $206 billion national agreement.
Now, the federal government is also seeking to recoup billions of dollars it has spent on smoker's health.
King and Brunetta said the study also revealed more than one-third of all patients were never evaluated to see if surgery would be an option.
``Many physicians either do not know or fail to adhere to established standards for the diagnosis'' of lung cancer and rating its severity, they contended.
Bach and his colleagues calculated that for every 1,000 white patients and 1,000 black patients, there are 77 excess deaths among the black group compared to whites.
``These figures suggest that of the 77 more deaths per 1,000 black patients,'' they said, ``the majority -- 44 -- can be attributed to the failure to provide surgical treatment for a curable disease.''
Researchers based their work on a National Cancer Institute registry which covers about 14 percent of the U.S. population, including Detroit, Atlanta, Seattle, Los Angeles County, the San Francisco-Oakland-San Jose area, Connecticut, Utah, New Mexico, Iowa and Hawaii.