African-Americans' attitudes about lung cancer may hinder prevention

These attitudes among blacks may help explain the puzzling racial disparities in lung cancer treatment outcomes that have been documented over the past 25 years, and highlight the need for clearer, more direct public health messages directed at African-Americans, say the scientists.

Christopher Lathan, MD, MPH, an oncologist in the Division of Population Sciences at Dana-Farber, is the first author of the report in the journal Cancer. Senior author is Gary Bennett, PhD, of Duke University's Global Health Institute.

Both whites and blacks in the survey “grossly underestimated” the bleak outlook associated with a diagnosis of lung cancer – only 15 percent of patients survive for five years. Lung cancer is the most lethal cancer in the United States, and among people diagnosed with the disease, African-American men have the highest incidence and mortality. Blacks tend to be diagnosed later than whites, when the disease is more advanced.

Federal data quoted in the paper say that the 2001-2005 incidence rate of lung cancer for white men was 79.3 per 100,000 vs. 107.6 per 100,000 for African-American men, and the mortality rate for white men with lung cancer is 71.3 per 100,000 vs. 93.1 per 100,000 for African-American men. This survival gap was first detected in the early 1980s, and continues today.

Previous studies have suggested that the disparity may be due in part to differences in access to care, rates of surgery, and patient preferences, Lathan says. The current study was undertaken to find out “if African-Americans think about lung cancer in a different way,” explains Lathan.

Using a random-digit phone dialing method, the investigators queried patients who had been participants in the National Cancer Institute's 2005 Health Information National Trends Survey (HINTS).

Both black and white respondents greatly overestimated the percentage of lung cancer patients who survive 5 years or longer – many said 50 percent when the true number is 15 percent.

There were three survey questions on which blacks and whites diverged significantly. African-Americans were more likely than whites (53 percent vs. 37 percent) to say they were confused by too many recommendations on how to prevent lung cancer. “This is shocking,” says Lathan. “There is only one recommendation to decrease the chance of getting lung cancer. Stop smoking and avoid tobacco smoke.”

When asked whether the disease is caused by lifestyle and behavior, 73 percent of blacks agreed, compared to 85 percent of whites.

Among blacks, 22 percent said they would be reluctant to be checked for lung cancer symptoms out of fear of receiving bad news. Only 9 percent of whites agreed with this statement. In addition, 51 percent of African-Americans believed that they would have symptoms before a diagnosis of lung cancer, versus 32 percent of whites.

The researchers concluded, “African Americans are more likely to hold beliefs about lung cancer that could interfere with prevention and treatment.”

“We really need to target out lung cancer education to communities of color,” says Lathan. “And we need to deliver really clear messages: Stop smoking if you want to prevent lung cancer. You should go to see your doctor. And we should let people known that lung cancer is deadly – more deadly than breast, prostate and colon cancer combined.”

Other authors of the report are Cassandra Okechukwu, DSc, of the University of California at San Francisco and Bettina F. Drake, PhD, MPH, formerly of the Center for Community-Based Research at Dana-Farber and now at the Siteman Cancer Center at Washington University in St. Louis.

The research was funded by the National Cancer Institute.

Dana-Farber Cancer Institute (www.dana-farber.org) is a principal teaching affiliate of the Harvard Medical School and is among the leading cancer research and care centers in the United States. It is a founding member of the Dana-Farber/Harvard Cancer Center (DF/HCC), designated a comprehensive cancer center by the National Cancer Institute. It is the top ranked cancer center in New England, according to U.S. News & World Report, and one of the largest recipients among independent hospitals of National Cancer Institute and National Institutes of Health grant funding.