Why are African-Americans so susceptible to lung cancer? For years, doctors and medical researchers have been puzzled by this dilemma. Black people are more likely to die from lung cancer than people of any other race or ethnicity…although they are not more likely to smoke than anyone else.
Findings from the Cancer Prevention and Treatment Fund indicate that the percentage of African-American men diagnosed with lung cancer each year is at least 30% higher than among White men, even though they tend to have similar rates of smoking as White men.
Further research has revealed that Black men actually smoke fewer cigarettes per day than White men. African-American women are less likely to smoke than White women, but are about as likely to develop lung cancer and die from the disease as White women.
Over the years, scientists have identified several genes that are linked to lung cancer. People who have these genes and smoke are more likely to develop lung cancer than other smokers. Somehow, these specific genes cause a person to metabolize nicotine differently, which could be a factor common with people of African ancestry. This suggests that genetics may play a role in the higher rates of lung cancer among African-Americans.
The type of cigarette matters. Tobacco companies have a long and sordid history of targeting the Black community with ads (in this case point-of-purchase) for menthol cigarettes. The American Lung Association has reported that about 80% of African-American smokers light up menthol cigarettes, compared with only 20% of White smokers.
Some researchers have theorized that the “cooling” effect of menthol cigarettes allows smokers to inhale more deeply, which could cause more damage to their lungs. Others have speculated that the long history of sophisticated advertising (i.e. using Black celebrities) to pitch menthol cigarettes makes them more “attractive” or “cool” among Black teens and young adults than regular cigarettes.
What’s more, the higher lung cancer risk among African-Americans could be attributed, in part, to differences in smoking behaviors. Black people tend to smoke each cigarette longer, thereby increasing their potential exposure to the toxic components in tobacco smoke.
Smokers of menthol cigarettes do not, on average, smoke any more cigarettes in their lifetime than regular cigarette smokers. The obvious problem with menthol cigarettes, researchers contend, is that the menthol flavor makes cigarette smoke less harsh for first-time users.
And while smoking has declined across all age and ethnic groups over the past 40 years, menthol cigarettes (and flavored tobacco in general) are becoming increasingly popular among Black kids ages 13 to 18 years.
Clinical trials often bypass African-Americans because of lack of medical outreach and a historical distrust of such scientific procedures. The National Cancer Institute believes current recommendations may need to be reviewed when it comes to African-Americans who smoke.
“There’s evidence that African-Americans have a higher baseline risk for [developing] lung cancer compared to Whites,” said Dr. Melinda Aldrich of Vanderbilt University who led a 2019 study on racial disparities in lung cancer reported in JAMA Oncology. “Too often, race-related differences in risk and smoking behaviors aren’t accounted for in current lung cancer screening recommendations.”
Smoking is far from the only reason why African-Americans contract lung cancer more often. Industries that produce heavier air pollution (post-war factories, oil refineries, chemical plants, etc.) are frequently located in Black communities (the inner city) nationwide.
Exposure to pollution from working or living near these industries can increase a person’s risk for lung cancer. A person who smokes and is exposed to air pollution in densely populated areas such as South Los Angeles, are at a higher risk for lung cancer than a smoker who is not exposed daily to air pollution from vehicles.
The Florida Cancer Registry conducted a study 10 years ago and found that the survival time for African-American patients diagnosed for lung cancer was shorter than that of White patients. Researchers found that the entire difference in survival time is likely attributed to the fact that White patients tend to receive more timely and appropriate treatment.
If Black patients could begin their treatment as early as White patients — and received the best treatment for their condition — they could live as long as White patients.
“Of all the ethnic/racial and gender groups in the United States, African-American men are the most likely to develop lung cancer and also to die from the disease,” said Dr. Christopher S. Lathan with the Dana-Farber Cancer Institute in Boston, Mass. A nationally recognized oncologist specializing in lung disease, Lathan has submitted numerous papers on racial disparities in lung cancer treatment. He said smoking alone cannot explain the high incidence and mortality from the disease in African-American men…but it is a primary culprit.
“My research suggests that African-Americans are less likely than Whites to think that changing their behavior or lifestyle would decrease their risk of developing lung cancer,” Lathan said. “This concerns me because getting people to quit smoking is critical for making progress against this disease.”
Lathan is a big advocate for proper screening for lung cancer. When detected at an early stage, he said, lung cancer can be treated with surgery, radiation and chemotherapy.
“Unfortunately, the disease is frequently found at more advanced stages (among African-Americans) when it cannot be cured.” Lathan explained that the new treatments — including “personalized medicine” — are making it easier to identify lung cancer patient subgroups and their probability of responding to targeted treatments.
However, he is disheartened that too many African-Americans have confided to him that they don’t believe their community is significantly affected by lung cancer — despite the fact that the disease indeed has a wider impact on African-Americans.
“These new therapies are often better at controlling cancer and have fewer side effects than traditional chemotherapy,” he said. “All of these things make me hopeful that things are going to get better with this disease. We just have a ways to go.”