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Black Americans and Lung Cancer: Disparities, Treatment and What Patients Need to Know
Black Americans and Lung Cancer: Disparities, Treatment and What Patients Need to Know. Black Americans diagnosed with lung cancer continue to experience worse outcomes than White Americans.
But one of the most important things for patients to understand is this:
The disparity is not simply about biology or genetics. Access to early detection, accurate staging, surgery, biomarker testing, modern treatments and experienced cancer centers can make an enormous difference.
Research has repeatedly shown that when Black and White patients with lung cancer receive comparable treatment, differences in survival can narrow substantially. That makes this an important—and potentially empowering—issue for patients.
If you or someone you love is Black and has been diagnosed with lung cancer, don’t simply ask:
“What treatment am I being offered?”
Also ask:
“Am I receiving every diagnostic test and treatment opportunity that someone with my exact cancer should receive?”
Have you been diagnosed with Lung Cancer? What stage? Please scroll down the page, post a question or a comment, and I will reply to you ASAP.
Thank you,
David Emerson
- Cancer Survivor
- Cancer Coach
- Director PeopleBeatingCancer
Key Takeaways
- Lung cancer remains the leading cause of cancer death among Black Americans.
- Black men have a higher lung-cancer incidence than White men.
- Black patients remain less likely to have lung cancer diagnosed early.
- Black patients are less likely to undergo potentially curative lung-cancer surgery.
- Black patients are more likely to receive no treatment.
- Comprehensive biomarker testing is particularly important for non-small cell lung cancer (NSCLC), yet testing disparities persist.
- Black patients remain underrepresented in lung-cancer clinical trials.
- Studies suggest that when Black and White patients receive similar treatment, survival differences can become much smaller or disappear.
- Patients can advocate for themselves by asking about staging, surgery, biomarker testing, targeted therapy, immunotherapy, clinical trials and second opinions.
How Large Is the Lung-Cancer Disparity?
The statistics have improved considerably since the original version of this PeopleBeatingCancer article was written—but disparities remain.
The American Cancer Society estimated that approximately 24,940 Black Americans would be diagnosed with lung cancer in 2025 and about 13,600 would die from the disease.
Importantly, the disparity differs between men and women.
During 2017–2021:
- Lung-cancer incidence was about 10% higher among Black men than White men.
- Lung-cancer incidence was about 17% lower among Black women than White women.
Smoking patterns explain part—but not all—of this difference.
Research: American Cancer Society — Cancer Statistics for African American and Black People, 2025
The larger problem becomes apparent when we look at what happens after someone develops lung cancer.
According to the American Lung Association’s 2025 State of Lung Cancer report, compared with White Americans, Black Americans with lung cancer were:
- 13% less likely to receive an early diagnosis
- 19% less likely to receive surgical treatment
- 11% more likely to receive no treatment
- 13% worse survival
Research: American Lung Association — 2025 Lung Cancer Disparities Report
Those numbers tell us something important:
Lung-cancer disparities are also disparities in cancer care.
Equal Treatment Can Mean More Equal Outcomes
This is perhaps the most important finding in this article. For decades researchers have asked whether poorer lung-cancer survival among Black Americans primarily reflects biological differences or differences in diagnosis and treatment.
An influential study of patients with early-stage NSCLC found that Black patients underwent surgery less frequently than White patients. But among patients who actually underwent surgery, survival was similar.
Research: PubMed — Racial Differences in the Treatment of Early-Stage Lung Cancer
Later research reached a similar conclusion. A study examining stage I NSCLC found that Black patients were less likely to receive treatment and less likely to receive surgery. However, once researchers accounted for the type of treatment received, there was no significant racial difference in survival.
Research: PubMed — Persistence of Racial Disparities in Early-Stage Lung Cancer Treatment
Research involving the Veterans Affairs healthcare system provides another interesting perspective. Investigators found no racial difference in overall or lung-cancer-specific survival in an equal-access healthcare system.
Research: PubMed — Impact of Race on Treatment and Survival Among U.S. Veterans With Early-Stage Lung Cancer
This does not mean biology never matters. Tumor genetics absolutely matter in modern lung-cancer treatment.
But race should not be treated as destiny. Access to appropriate care matters enormously.
1. Make Sure Your Lung Cancer Is Accurately Staged
Treatment depends on stage. A patient cannot make an informed treatment decision without knowing whether the cancer is:
- Localized
- In nearby lymph nodes
- Locally advanced
- Metastatic
Depending on the situation, staging may involve:
- CT
- PET/CT
- Brain MRI
- Bronchoscopy
- EBUS
- Lymph-node sampling
- Biopsy
Ask your oncologist:
“What is my exact stage, and how was that stage established?”
Do not settle for simply hearing “early lung cancer” or “advanced lung cancer.” You need to understand why your oncology team believes that is your stage.
For a broader overview, see:
2. If Your Cancer Is Potentially Operable, Ask About Surgery
Surgery can potentially cure selected patients with early-stage NSCLC. Unfortunately, racial disparities in lung-cancer surgery have persisted for decades.
Research has found that Black patients with early-stage NSCLC are less likely to undergo surgery even after researchers adjust for clinical and demographic differences. That is particularly important because survival differences often become substantially smaller when comparable treatment is delivered.
If you have stage I, stage II or selected stage III NSCLC, ask:
“Is my cancer potentially resectable?”
Then ask:
“Have I been evaluated by a thoracic surgeon who specializes in lung cancer?”
Being told by a medical oncologist that surgery probably isn’t appropriate is not necessarily the same thing as being evaluated by an experienced thoracic surgeon.
Patients should also understand that modern lung surgery does not automatically mean removing an entire lobe. Selected small, peripheral, node-negative cancers may be treated with lung-sparing approaches such as segmentectomy.
See:
Lung Cancer Surgery: What Patients Need to Know
3. If You Can’t Have Surgery, Ask About SBRT
Some patients cannot safely undergo lung surgery because of:
- Poor pulmonary function
- Cardiovascular disease
- Frailty
- Other medical conditions
- Tumor location
- Other surgical risks
That does not necessarily mean that potentially curative treatment is impossible.
Stereotactic body radiation therapy (SBRT) can be an important treatment for selected patients with early-stage NSCLC who cannot undergo surgery.
Ask:
“If I am not a surgical candidate, am I a candidate for SBRT?”
See:
Radiation for Lung Cancer: What Patients Need to Know
4. Ask for Comprehensive Biomarker Testing
This is one of the biggest changes since the original version of this article was written. Lung cancer is no longer treated simply as:
“You have lung cancer, therefore you receive chemotherapy.”
Particularly in NSCLC, oncologists increasingly need to understand the molecular characteristics of the tumor. Biomarker or genomic testing may identify alterations that can influence treatment. Testing can also include proteins such as PD-L1, which can help guide immunotherapy decisions.
The problem? Black patients are less likely to receive comprehensive biomarker testing.
One real-world study found that among patients with nonsquamous NSCLC, next-generation sequencing before first-line treatment occurred in approximately:
- 36.6% of White patients
- 29.7% of Black patients
At any point during treatment, testing occurred in:
- 54.7% of White patients
- 43.8% of Black patients
Research: PubMed — Disparities in Biomarker Testing and Clinical Trial Enrollment
The American Lung Association has likewise highlighted persistent racial disparities in biomarker testing.
Research: American Lung Association — Biomarker Testing and Lung Cancer
Ask:
“Has my tumor undergone comprehensive biomarker testing, and do we have the results before choosing systemic therapy?”
For many patients with advanced NSCLC, this could be one of the most important questions they ask.
5. Ask Whether Targeted Therapy Is an Option
Biomarker testing matters because some lung cancers contain molecular alterations that can be treated with targeted drugs. Rather than treating every lung cancer identically, precision oncology attempts to identify what is driving an individual patient’s cancer. That can sometimes mean treatment with a targeted therapy rather than—or before—traditional chemotherapy.
Your oncologist should be able to explain:
- Which biomarkers were tested
- What abnormalities were found
- Whether an FDA-approved targeted therapy applies
- Whether a clinical trial applies
- Whether additional tissue or liquid-biopsy testing is necessary
The important question is not:
“Do Black patients have different lung-cancer genes?”
The better question is:
“What molecular alterations does MY cancer have?”
That is precision medicine.
6. Ask About Immunotherapy
Immunotherapy has transformed the treatment of lung cancer. Checkpoint inhibitors such as pembrolizumab and other immunotherapies are now used in multiple NSCLC and small-cell lung cancer settings.
Depending on the cancer, immunotherapy may be used:
- Alone
- With chemotherapy
- Before surgery
- After surgery
- After chemoradiation
- For metastatic disease
The appropriate treatment depends on factors including:
- Cancer type
- Stage
- PD-L1 expression
- Molecular biomarkers
- Previous treatment
- Overall health
See:
Lung Cancer, Keytruda and Your Gut Microbiome
and
Chemotherapy for Lung Cancer: What Patients Need to Know
7. Consider Where You Receive Treatment
Where you receive lung-cancer care can matter. Research examining early-stage NSCLC has found that Black patients treated at academic facilities had better survival than Black patients treated at community facilities. Black patients were also more likely to undergo surgery at academic centers.
Research: PubMed — Racial Disparities in Lung Cancer by Facility Type
That doesn’t mean every patient needs to transfer all of their care to a major academic hospital.
It does mean that a second opinion from a high-volume multidisciplinary lung-cancer center may be valuable, particularly if:
- Surgery has been ruled out
- Your cancer is stage III
- Your tumor has an unusual molecular profile
- You have been told there are no additional treatments
- Biomarker testing has not been performed
- You are considering a clinical trial
- Your treatment options are unclear
See:
Where You Treat Your Lung Cancer Makes a Difference
8. Ask About Clinical Trials
Clinical trials provide access to therapies and treatment strategies that may not yet be widely available. Unfortunately, Black Americans remain underrepresented. A national study of NSCLC clinical-trial enrollment found that, after adjustment for demographic and clinical factors, Black patients were substantially less likely to enroll than White patients.
The study also found lower participation among patients with:
- Lower socioeconomic status
- Medicaid
- No insurance
- Treatment at community cancer programs
Research: PubMed — National Enrollment of Lung Cancer Clinical Trials by Race and Healthcare Access
The National Cancer Institute maintains an extensive database of active NSCLC trials.
National Cancer Institute — Non-Small Cell Lung Cancer Clinical Trials
Ask your oncologist:
“Are there clinical trials for my stage and molecular subtype of lung cancer that I should consider?”
You don’t have to enroll. But you should have the opportunity to know that the option exists.
9. Lung Cancer Screening Matters
The best opportunity to cure lung cancer usually comes when it is found early.
The U.S. Preventive Services Task Force recommends annual low-dose CT screening for adults who:
- Are 50–80 years old
- Have at least a 20 pack-year smoking history
- Currently smoke or quit within the past 15 years
Research: USPSTF — Lung Cancer Screening Recommendation
Importantly, the current screening criteria expanded eligibility compared with the older criteria and substantially increased eligibility among Black Americans. If you meet the screening criteria but have never been offered a low-dose CT scan, ask your doctor about it. Screening is not the same thing as getting a chest X-ray.
10. If You Smoke, Quitting Still Matters After Diagnosis
A diagnosis of lung cancer does not mean that quitting smoking is pointless. Stopping smoking can improve treatment outcomes and reduce complications associated with surgery, radiation and other cancer therapies.
Quitting can also reduce the risk of:
- Second cancers
- Cardiovascular disease
- Pulmonary disease
- Surgical complications
- Long-term mortality
See:
The Fourth Pillar of Cancer Treatment: Why Quitting Smoking May Help Cancer Treatment Work Better
The goal should not be to blame people who smoke. Nicotine dependence is difficult to overcome. The goal is to make smoking cessation part of cancer treatment and provide medications and behavioral support when necessary.
What About Complementary and Integrative Therapies?
PeopleBeatingCancer supports an integrative oncology approach. That means using evidence-based complementary therapies alongside—not instead of—appropriate conventional lung-cancer treatment.
Depending on the individual patient, supportive strategies may include:
- Exercise
- Prehabilitation
- Adequate protein and calories
- Maintaining muscle mass
- Evidence-based nutrition
- Sleep optimization
- Stress management
- Smoking cessation
- Pulmonary rehabilitation
- Management of treatment side effects
See:
Integrative Oncology: Combining Conventional and Natural Cancer Therapies
and
Managing Cancer Treatment Side Effects: An Evidence-Based Guide
Complementary therapy should not delay potentially curative surgery, radiation, chemotherapy, targeted therapy or immunotherapy. And supplements should always be discussed with the oncology team because some can interact with cancer treatments.
10 Questions Black Lung-Cancer Patients Should Ask
Bring these questions to your oncology appointment:
- What exact type and stage of lung cancer do I have?
- Has my cancer been completely staged, including my lymph nodes where appropriate?
- If my cancer is potentially operable, have I been evaluated by an experienced thoracic surgeon?
- If surgery isn’t recommended, why not?
- Would SBRT or another form of radiation be appropriate?
- Has comprehensive biomarker/genomic testing been performed?
- Do I have a biomarker that can be treated with targeted therapy?
- What is my PD-L1 level, and could immunotherapy be appropriate?
- Are there clinical trials appropriate for my cancer?
- Would you recommend a second opinion at a multidisciplinary or NCI-designated cancer center?
These are reasonable questions for every lung-cancer patient. But given the documented disparities in lung-cancer care, they may be particularly important for Black patients.
PeopleBeatingCancer Evidence Rating
| Issue | Evidence Rating | What the Evidence Shows |
|---|---|---|
| Racial disparities in lung-cancer care | 🟢 Strong | Black patients remain less likely to receive early diagnosis, surgery and some elements of modern cancer care. |
| Equal treatment can reduce survival disparities | 🟢 Strong | Multiple observational studies show similar or substantially closer outcomes when comparable treatment is received. |
| Low-dose CT screening | 🟢 Strong | Recommended for eligible high-risk adults and can detect cancer earlier. |
| Surgery for appropriate early-stage NSCLC | 🟢 Strong | Potentially curative standard treatment for selected patients. |
| Comprehensive biomarker testing | 🟢 Strong | Essential to identify many targeted-treatment opportunities in NSCLC. |
| Targeted therapy | 🟢 Strong for actionable biomarkers | Effectiveness depends on the molecular characteristics of the tumor. |
| Immunotherapy | 🟢 Strong in appropriate settings | Established treatment across multiple stages and types of lung cancer. |
| Clinical-trial participation | 🟢 Strong rationale | Important treatment option, but Black Americans remain underrepresented. |
| Integrative supportive care | 🟡 Moderate–Strong depending on therapy | Exercise, nutrition, smoking cessation, rehabilitation and symptom management can support treatment and quality of life. |
How to Interpret This Table
A Strong rating does not mean a therapy is appropriate for every lung-cancer patient.
Treatment depends on:
- NSCLC versus SCLC
- Stage
- Tumor location
- Molecular biomarkers
- PD-L1 expression
- Lung function
- Other medical conditions
- Previous treatments
- Patient preferences
The objective is individualized treatment—not treatment based simply on race.
The Bottom Line
The original version of this article asked whether genetic differences explained why Black Americans experienced poorer lung-cancer outcomes. Years of additional research have made the answer clearer.
Tumor biology matters. Race alone should not determine treatment or prognosis.
Black Americans continue to experience important disparities in:
- Early detection
- Accurate and timely care
- Surgery
- Biomarker testing
- Access to specialized cancer centers
- Clinical-trial participation
- Treatment delivery
And there is another side to this story that deserves emphasis.
Research repeatedly suggests that when Black patients receive appropriate, comparable lung-cancer treatment, outcomes can become much more similar to those of White patients.
That is why patient education and self-advocacy matter.
- Know your stage.
- Know whether surgery is possible.
- Know your biomarkers.
- Ask about targeted therapy.
- Ask about immunotherapy.
- Ask about clinical trials.
- And when the treatment recommendation doesn’t make sense to you, consider getting a second opinion.
- The goal isn’t simply to receive lung-cancer treatment.
The goal is to make sure you have access to the right treatment for your particular lung cancer.
Medical disclaimer: This article is educational and is not a substitute for individualized medical advice. Lung-cancer treatment depends on cancer type, stage, molecular characteristics, overall health and other individual factors.
African-American genetic mutations pose Rx challenge
Lung cancer is not a discriminate disease, but the disease burden is especially high on African Americans in the U.S. The statistics are stark: African-American men are 37% more likely to develop lung cancer than white men and are 22% more likely to die of it. In addition, only 12% of African Americans live longer than five years after a diagnosis of lung cancer, compared with 16% of whites, according to a recent report by the American Lung Association (see Fact box).
One suggested the reason for this gap in outcomes is differences in race-based genetics. In the era of personalized medicine and treatments that target specific disease pathways, identifying genetic differences among populations is becoming increasingly important to optimize benefit.
Given the current discrepancies in treatment for African Americans, pinpointing which therapy will serve them best is crucial. According to the ALA report, blacks are less likely to undergo staging. In addition, they are less likely to have surgery (34% vs 61.6% of whites) and are less likely to receive chemotherapy (28.6% vs 46.9%). A recent study of more than 83,000 Medicare patients found that the disparity was relatively unchanged over the 12-year course of the study (Cancer 115:2199-2211, 2009; J Clin Oncol 24:413-418, 2006).
“These differences in treatment for African Americans are more important than the genetic differences,” Dr. Hicks said. “As a consumer advocate, I am suggesting that when faced with lung cancer, you certainly want to be treated by an institution or individual who has significant experience and a track record with that illness. Adequate staging to pick the best treatment is very important.””
Black Americans and Lung Cancer