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TooManyCases,
Too Many Deaths:
Lung CancerinAfrican Americans
Too ManyCases,
Too Many Deaths:
Lung CancerinAfrican Americans
Disparities inLung Health Series
Preface
Professor of Clinical Medicine Division of Hematology and Oncology, The Ohio State University Comprehensive
Cancer Center and Richard J. Solove Research Institute; Co-Director Diversity Enhancement, Columbus, OH
Too ManyCases,TooManyDeaths:LungCancerin African
Americans
Diane B.K.’s Story
Michael R.’s Story
The numbers say a lot in this report, but lungcancer affects individual people and their friends and families:
Introduction
1
Too ManyCases,
Too ManyDeaths:
Lung Cancerin
African Americans
Health Disparities in the
United States
Unequal Treatment: Confronting Racial and
Ethnic Disparities in Healthcare
Too Many Cases
2
Too ManyCases,TooManyDeaths:LungCancerinAfrican Americans
“The real challenge lies not in debating whether disparities exist, but in
developing and implementing strategies to reduce and eliminate them.”
– Alan R. Nelson, MD, Chair,
IOM Committee on Understanding and Eliminating
Racial and Ethnic Disparities in Health Care
3
American Lung Association www.LungUSA.org 1-800-LUNG-USA
Definition
Causes
Types
Diagnosis and Treatment
Stigma
“Everyone assumes I’m a
breast cancer survivor
because I am a woman.
Then, when I say lung
cancer, the person’s
expression changes and
they are either shocked
or say something like,
‘you don’t look like a
smoker’ or ‘you don’t
look like the type
that would have
lung cancer.’”
– Diane B.K.
About Lung Cancer
Smoking Prevalence by Percent
Tobacco Use
4
Too ManyCases,TooManyDeaths:LungCancerinAfrican Americans
Smoking Prevalence
by Race and Ethnicity and Sex, 2008
Figure 2
Smoking Prevalence
Incidence Rate Per 100,000
74.7
64.4
44.9
Smoking Prevalence
by Race and Ethnicity and Sex, 2008
Figure 1
Lung Cancer Incidence Rates
Race and Ethnicity
Source: SEER CSR, 2006. Source: NHIS, 2008.
Race and Ethnicity
25.5
18.0
23.6
20.6
42.3
22.4
5
American Lung Association www.LungUSA.org 1-800-LUNG-USA
Figure 3
Menthol Cigarette Smokers
“The tobacco industry has done a lot to court the black
community, including buying good will at all levels.”
– William Robinson, Executive Director,
National African American Tobacco Prevention Network
Source: NSDUH, 2009.
Race and Ethnicity
82.6%
32.0%
23.8%
Preventive Behavior
2005 Health Information National
Trends Survey
Socioeconomic Status
6
Too ManyCases,TooManyDeaths:LungCancerinAfrican Americans
Figure 4
Median Household Income 2007
Source: U.S. Census Bureau, 2008.
African American White
Figure 5
Unemployment Rate
$33,916
$52,115
African American White
12.0%
5.4%
Source: ACS, 2006–2008.
Environmental Exposures
7
American Lung Association www.LungUSA.org 1-800-LUNG-USA
Figure 6
Education Levels
Source: U.S. Census Bureau, CPS, 2008.
African American White
13%
56%
48%
17%
Genetics
8
Too ManyCases,TooManyDeaths:LungCancerinAfrican Americans
“Initially they were not
able to identify where
my cancer originated.
I knew that there was a
long history of cancer in
my family and I knew I
had to do something
about the fact that I
didn’t feel well and, once
diagnosed, do something
about the cancer.”
– Diane B.K.
[...]... a Toxic Air Contaminant Executive Summary June 2005 52 Flenaugh EL LungCancer Disparities inAfrican Americans: Health versus Health Care Clinics in Chest Medicine 2006 27: 431-439 19 TooManyCases,TooManyDeaths:LungCancerinAfricanAmericans 53 Ward E, Halpern M, Schrag N, et al Association of insurance with cancer care utilization and outcomes CA: A Cancer Journal for Clinicians Jan–Feb 2008... http://report.nih.gov/rcdc/categories/ 77 Molina JR, yang P, Cassivi SD, et al Nonsmall cell lung cancer: epidemiology, risk factors, treatment and survivorship Mayo Clin Proc 2008 83: 584594 American Lung Association www.LungUSA.org 1-800 -LUNG- USA Acknowledgements TooManyCases,TooManyDeaths:Lung Janice Nolen and Erika Sward who contributed CancerinAfricanAmericans is the first in a se- research findings and reviewed... like the people about the encounter, the African at the James Cancer Clinic African American patients, and Americans perceived their doctors to work with it rather than really have a concern as less supportive, less partnering against it in treatment for me, personally, and my well-being.” – Michael R 13 TooManyCases,TooManyDeaths:LungCancerinAfricanAmericans Racism and Social Stress “If you... advanced lungcancer and palliative treatments for later-stage disease that can extend and improve quality of life.77 Researchers are working hard to develop tests that can detect lungcancerin its early stages, when it can be treated more successfully Researchers are also seeking new treatments to increase the survival time and even cure lungcancer 15 TooManyCases,TooManyDeaths:LungCancerin African. .. R 17 TooManyCases,TooManyDeaths:LungCancerinAfricanAmericans Works Cited 1 U.S National Institutes of Health National Cancer Institute: SEER Cancer Statistics Review, 1973-2006 2 U.S Dept of Health and Human Services, Office of Public Health and Science, Office of Minority Health Changing Outcomes Achieving Health Equity, The National Plan for Action (Public Comment Draft) Office of Minority... because his lungcancer interfered with his ability to limited resources that affect their thereof, inlungcancer disparities is work With his income cut in ability to provide standard-ofpoignantly illustrated by the findings half, he worries about the future and being able to care medical therapy.52 In a of a recent study of lungcancer afford ongoing care recent review of lungcancer cases in the military... menthol cigarettes • Federal agencies, including the Department of Housing and Urban Development and the Department of Defense, should test and correct radon health hazards in housing that they own and manage • The National Institutes of Health should increase funding for lungcancer research Additional research on health disparities, including lungcancerinAfrican Americans, is needed • The Health Care... Program supports clinical, laboratory and epidemiological research on lungcancer Along with other advocacy organizations, the Lung Association continues to fight for increased funding on prevention and treatment of lungcancer with the goal of increasing five-year survival rates and reducing death and disease Although the prognosis for patients with lungcancer remains poor, early-stage lungcancer is curable... all Lung Association reports, Too Ohio State University Comprehensive Cancer Cen- ManyCases,TooManyDeaths:LungCancerin ter and Richard J Solove Research Institute; Co- AfricanAmericans was a collaborative undertak- Director Diversity Enhancement, Columbus, OH ing, and we gratefully acknowledge the many Lovell Jones, MD, Director, Center for Re- contributors who made it possible search on Minority... EGFR Pathway inAfrican American Patients with Non–Small-Cell LungCancer Journal of Clinical Oncology November 20, 2009 27(33): 5620-5626 47 Du W, Gadgeel SM, Simon MS Predictors of enrollment in lung cancer clinical trials Cancer Jan 15, 2006 106(2): 420-5 48 Trauth JM, Jernigan JC, Siminoff LA, et al Factors Affecting Older African American Women’s Decisions to Join the PLCO Cancer Screening Trial . Too Many Cases,
Too Many Deaths:
Lung Cancer in African Americans
Too Many Cases,
Too Many Deaths:
Lung Cancer in African Americans
Disparities in Lung. Cases
2
Too Many Cases, Too Many Deaths: Lung Cancer in African Americans
“The real challenge lies not in debating whether disparities exist, but in
developing