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When faced with an early diagnosis of lung cancer, why do so many African Americans not have surgery--and thus forego a possible cure?
It's an alarming trend that's been noted by the American Cancer Society, which is funding multi-institutional research focused on finding out why.
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| Franklin McGuire |
"African Americans have a lower five-year survival rate from lung cancer than whites, and part of the reason is that 12 percent fewer African Americans have surgery for treatment," said Franklin McGuire, an assistant professor in the School of Medicine's internal medicine department and a practicing pulmonary medicine physician.
McGuire is participating with clinician/researchers at UNC, East Carolina University, and two large hospital systems in the study, which will interview 425 clients--black and white--who are diagnosed with early-stage lung cancer to determine what factors lead to the clients having or not having surgical intervention.
At this point, researchers know only that African Americans undergo less surgery for lung cancer--what's not known is whether they are declining the treatment, not being referred to surgeons, or not effectively understanding the diagnosis and dropping out of medical care.
Southern states have the highest rates of lung cancer diagnoses and deaths. Lung cancer itself is the No. 1 killer among all types of cancer, accounting for 30 percent of all cancer deaths.
Among patients diagnosed with lung cancer, only one-fourth are candidates for surgery; three-fourths of lung cancer patients are diagnosed with advanced stage disease for which surgery would be of no benefit.
"Of the one-fourth who qualify for surgery, only about two-thirds of that group among African Americans are having surgery," McGuire said. "That's sad because as a physician, I know that chemotherapy and radiation alone can't cure them--the only hope for a lung cancer cure is surgery."
McGuire hopes the two-year study will determine why more blacks than whites don't get lung cancer surgery and address those reasons in a planned DVD that will be produced for patient education.
"Most pulmonary doctors are like me: They've been around other professionals for so long who understand lung cancer, and now they can't imagine why anyone would not have surgery that offers some hope of a cure," McGuire said. "We just don't know what myths or misinformation or cultural biases are out there that might be steering people away from surgical treatment."
In a separate study, researchers in the University's Cancer Prevention and Control Program are investigating the higher incidence of African-American mortality rates associated with colon cancer.
Partnering with S.C. Oncology Associates, University researchers will conduct medical chart reviews of 200 European-American and 200 African-American patients, focusing on why some choose to discontinue medical therapy for their colon cancer.
"We don't know yet if a higher number of African Americans than European Americans is discontinuing treatment though that would partially explain the higher mortality rate among African Americans from the disease," said Swann Arp Adams, a research assistant professor in the epidemiology and biostatistics.
"We suspect that there are barriers to continuing treatment that are unrelated to quality of life--philosophical issues about why people discontinue treatment for cancer. There also are physical barriers such as access to care, financial status, and treatment side effects. We hope this study will illuminate some of that."
8/07
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