Geographic disparities at the state-level are leading to increased rates of death from lung cancer, according to an expert.
Despite a decrease in lung cancer rates across the country, significant differences in disease rates and outcomes remain at the state level, according to a presentation at the 2021 World Conference on Lung Cancer.
In the presentation, Dr. Raymond U. Osarogiagbon, a medical oncologist at the Baptist Cancer Center in Memphis, discussed the geographic disparities in lung cancer mortality rates across the United States.
“We know that (lung cancer) is the oncologic challenge of our age. If one takes the perspective of the sheer cost in terms of human life, (it is) the number-one killer of men and women in the United States, and in a lot of countries around the world. … In the United States, the good news is it has been going down sequentially over time,” explained Osarogiagbon in an interview with CURE®. “The bad news, though, is in the United States, if you dug in a little bit deeper, you will find very different picture. At the state level, if we disaggregated lung cancer as a cause of death, you will find a huge difference between the states … with the cluster of highest per capita death risk in the southern and Midwestern United States.”
States with the worst mortality rate from lung cancer include Kentucky, Mississippi, Arkansas, Tennessee, West Virginia, Alabama, North and South Carolina and Louisiana, according to Osarogiagbon.
“At the county level, the difference is even worse,” he said, noting that there are some that have rising numbers of death due to lung cancer such as the Appalachian Regional Authority and Delta Regional Authority, while others have plateaued with no decrease.
Disparities that come into play here include women being at a higher risk for lung cancer at a lower tobacco exposure compared to men. Racial minorities are also at a higher risk, even at lower levels of tobacco exposure. But, according to Osarogiagbon, what is of primary concern “is from the point of onset on whether it is finding (lung cancer) early, whether it is receiving optimal treatment for it, whether it is receiving the proper surveillance for it after diagnosis and treatment…there are highly preventable differences. … It is people who live in parts of the world, or parts of the country that have resources that are organized in a certain way, who do well and not others. It is white people who do well better than racial minorities. It is oftentimes when we're talking about interventions themselves and access to them, it is men who do better than women. And these are all things that are all necessary — things that significantly inhibit the full benefits of discovered innovations.”
Osarogiagbon gives the example of lung cancer screenings. By keeping up with yearly screenings, which are usually covered by insurance, the risk of dying from lung cancer is reduced by 20%.
“You would think that with such an exciting discovery that suddenly everybody at risk would be lining up to get these tests and every healthcare provider and every healthcare organization,” he emphasizes. “If you look at the places where the screening facilities are available, and the places where people who are eligible for screening have gone on and received the screening test, the best states are in the Northeast, where up to 15% to 17% of eligible people have been screened. In the places at the heart of the lung cancer kills zone of America, it is consistently less than 5% of eligible people who have — as low as 2% in some of those states, the only exception being Kentucky… with 15% to 16% of the eligible patients.”
The lack of screenings taking place in those states with higher cases of death from the disease may also lead to later-stage diagnoses. In this circumstance, that means that not as many patients with lung cancer will be able to be cured with surgery. For example, 50% of patients with lung cancer in Wyoming can be cured by surgery versus the 90% in states like New Jersey, Massachusetts and Utah.
“Now, if you drill further down and go to the county level, it's even uglier than that. There are counties at the low end as low as 12% — 12% of patients with early-stage lung cancer that can be cured by surgery,” he added.
Geographic disparities can even affect access to clinical trials, which would provide patients with lung cancer more opportunities for treatment and screenings.
“Once again, huge disparities, geographic in the same patterns, demographic in the same patterns, socio economic in the same patterns,” Osarogiagbon said. “So, lung cancer is a major public health problem. It is a major victim of disparities. And I think there's increasing awareness of the need to make that problem go away.”
Approaching these disparities must come from a multi-pronged approach, according to Osarogiagbon.
“We (need to) begin to focus on preventing, narrowing, eliminating disparities. We have to understand that the solutions come from multiple levels. The least effective is the level of directly hectoring, nagging, blaming the victims of disparities. (Patients) don't go in with the idea that they will do something to hurt themselves. A (patient with) lung cancer who is poor does not stand up in the morning and decide 'yippee, I am so going to make sure I get the wrong treatment today. I don't care if I die.'” He concludes. “So, when we talk about disparities, I think it is very important for (providers) to get away from the traditional narrow lens of who are these people or why do they have such terrible outcomes, and recognize that we have seen the enemy. It is us.”
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