HEALTH Research Institute

Lung cancer is the leading cause of cancer deaths in the U.S., according to the American Lung Association. Smoking tobacco is still the leading cause of lung cancer, according to the American Cancer Society.

Experiencing a significant health burden from tobacco use, Black Americans have higher mortality rates from tobacco-related causes and are also more likely to be exposed to secondhand smoke, according to the Centers for Disease Control and Prevention (CDC).

Racial inequities in lung cancer care are explored in a new NOSI study spearheaded by Dr. Isabel Martinez Leal and Dr. Maggie Britton. The study is entitled, “Addressing tobacco-related and lung cancer inequities among Black adults: A mixed methods pilot project” (MPI: Maggie Britton/Dr. Isabel Martinez Leal).

Britton explained that the research initiative will explore how to address tobacco-related and lung cancer inequities for Black American smokers who are receiving care at Federally Qualified Health Centers (FQHC) in Texas.

“We are looking to do that in two ways,” Britton said. “The first one is to increase the delivery of tobacco-related and lung cancer services by looking at what FQHC’s are already doing and creating some of the best practices for delivering the interventions. We want to find out what providers already know about addressing this, what do they already do with it, and then explore educational and training initiatives for health care providers specifically.”

The NOSI study addressing lung cancer disparities was funded $155,000 through an administrative supplement award from NIDA and HEALTH Center for Addictions Research and Cancer Prevention (HEALTH-RCMI; PI: Dr. Ezemenari M. Obasi).

One of the key objectives is to do focus groups with Federally Qualified Health Centers (FQHC) providers and patients across Texas.

“We want to make sure that we understand patients’ experiences with tobacco use disorder screening to make sure that we can tailor the intervention to the preferences and needs of the people in the community,” Dr. Martinez Leal said.

Perhaps the most striking challenge is the use of menthol cigarettes, which are easier to smoke and more difficult to quit. The disquieting truth is that the tobacco industry has aggressively targeted its marketing to certain populations, including young people, women, and racial and ethnic minorities, specifically Black Americans, according to the CDC.

In fact, nearly 90 percent of all Black American smokers use menthol cigarettes, and more than 39,000 Black Americans die from tobacco-related cancers each year, according to the Tobacco Control Resource Center.

“We need to figure out how to get more people screened.” Dr. Britton said. “Early detection of lung cancer is the only way to prevent cancer deaths—and the low dose computed tomography is very effective when it is used for early detection, but not enough people are being screened, specifically Black Americans.”

One of the reasons that Dr. Martinez Leal and Dr. Britton spearheaded this research initiative is that the U.S. Preventative Services Task Force has recently changed it guidelines and now recommends screening for smokers, aged 50-80 with at least a 20 pack-year smoking history.

“This change was intended to hopefully be addressing the fact that Black American smokers smoke lighter, so they don’t smoke as much but they also develop more tobacco related diseases and they do so at an earlier age, so this is a good time to address this,” Dr. Britton said.

Through the project’s collaboration with patients, Drs. Britton and Martinez Leal hope that they will gain more insight about the interventions that truly make a difference for Black American smokers.

“We want to know what their experience has been like receiving tobacco use disorder screening interventions and also lung cancer screening referrals and care,” Dr. Britton said. “It’s important that we can see what needs to be addressed in community-based initiatives to increase uptake. We want to increase delivery and uptake. Ultimately, we hope we can increase the number of [Black] Americans who are receiving these interventions in Texas.”

Early detection and screenings for lung cancer are essential, even though they are often overlooked in Texas, Dr. Martinez Leal explained.

“In Texas, only 2 percent of eligible people are being screened for lung cancer screening,” Dr. Martinez Leal said. “There’s a 20 percent chance that if you have lung cancer screening, it’s going to improve your detection rates, according to the National Lung Screening Trial. It’s an important thing to do.  It’s an important thing that has fallen off the radar with Federally Qualified Health Centers.”

Helping to bridge the gap of racial inequities in lung cancer care is at the heart of Dr. Martinez Leal’s and Dr. Britton’s vision and goal for this project.

“I’m a health disparities researcher, so this is the kind of work I’m interested in,” Dr. Martinez Leal said. “There’s a lot of work that needs to be done in trying to make healthcare equitable and accessible to everyone.”

By Alison Medley