No matter the patient’s race, lung cancer is a formidable disease. According to the American Cancer Society (ACS), it is the leading cause of cancer death for both men and women, killing more people than colon, breast, and prostate cancers combined. About 170,000 Americans will be diagnosed with the disease this year.

According to the study, each year 73 out of 100,000 African Americans get lung cancer, compared with 54 out of 100,000 whites. In addition, African Americans develop the disease at a much younger age than their white counterparts. Black men ages 40 to 54 are two to four times more likely to develop lung cancer than white men.

Studies also have shown that African Americans with early-stage disease (Stage I) are less likely to undergo surgery, the primary curative option for early lung cancer. Their five-year survival rate is 35%, compared to a 46% rate for whites.

"I don’t think this is common knowledge," says John Stewart, MD, clinical associate at the National Cancer Institute and author of the article. "There’s been a lot of talk about disparities (between African Americans and whites) in health care with reference to cancer, heart disease, and diabetes, but this is the first work that consolidated the body of literature available in reference to lung cancer."

According to the ACS, more than eight out of 10 lung cancers are thought to result from smoking. Stewart’s research found more African Americans smoke than the general population in the US, but they smoke significantly fewer cigarettes than whites.

"If you look at the larger spectrum, a greater percentage of African Americans compared with whites are poor," says Robert Smith, PhD, director of cancer screening for the ACS. "We know that people who are poor tend to smoke fewer cigarettes, but much more intensely — in order to get a higher dose of nicotine within more of a budget."

Stewart’s article points out that the type of cigarettes could contribute to the disparity. Approximately 75% to 90% of African-American smokers prefer menthol cigarettes, compared with 20% to 30% of white smokers. Menthol cigarettes are higher in tar and carcinogenic materials (benzo-[a]-pyrenes), but Stewart says further research is needed to see if there’s a link.

Current research does not indicate a genetic predisposition to lung cancer among African Americans. Other factors that may account for the disparity between blacks and whites could be exposure to cancer-causing materials in the workplace, socioeconomic status, and access to health care, Stewart writes.

He says he would like to see more research on environmental exposure to cancer-causing agents, especially among African Americans. He also would like to find out why there is a disparity in early treatment.

"Patients need to have all of their options explained to them," Stewart notes. "If they are told that they have one nodule or early-stage lung cancer, they need to be aggressive in seeking resection (surgery)." But above all, Stewart says everyone needs to stop smoking.

Smith agrees, "The bottom-line message for any study about lung cancer is don’t smoke and if you do smoke, quit at the earliest opportunity. Because, even under the best of circumstances, our ability to cure lung cancer is very, very poor."