Part 1: Disparities in Care
Lung cancer treatment has made astounding progress in the past 10 years. With the discovery of numerous targeted therapies, some lung cancer patients may be eligible to take a pill that “targets” their specific type of lung cancer. Testing to see if a patient is eligible for a targeted therapy is called biomarker testing and involves looking at changes or mutations in a person’s genes. Biomarker testing can also provide information about whether or not a patient will be eligible for immunotherapy by looking at levels of certain proteins in the cells.
The lung cancer advocacy community has united to raise awareness about the need for biomarker testing for lung cancer patients. Results of biomarker testing help physicians plan the most appropriate treatment for a patient, which is sometimes called precision medicine. Precision medicine involves selecting a treatment option that takes into account a person’s genes, environment and lifestyle.
Unfortunately, there are many health disparities in cancer care. Historically underrepresented populations, including Black Americans, have worse lung cancer outcomes when compared to white Americans. Black men are more likely to get and die from lung cancer than their white counterparts, despite lower smoking rates. Black Americans with lung cancer are less likely to be diagnosed at an early stage, less likely to receive surgical treatment and more likely to not receive any treatment compared to white Americans.
Because biomarker testing is such an important part of lung cancer treatment decision making, I wanted to learn what is known about biomarker testing in the Black community. I spoke with a variety of experts to help understand the role of tumor biology and race in relationship to biomarker testing for lung cancer.
A Documented Disparity
In many parts of the country, Black people face barriers to receiving high-quality cancer care, including access to precision medicine. A recent study in the Journal of the National Medical Association found that when looking at metastatic non-small cell lung cancer, 26% of eligible white patients were receiving biomarker testing compared to 14% of eligible Black patients.1
And receiving biomarker testing is just one step in a multi-step process to get a patient on the right treatment for them. For a patient to know if they are eligible for a targeted therapy, the physician needs to get enough tumor tissue through a biopsy, send it to a lab for testing, and then integrate the results into a treatment plan. Unfortunately, this whole process can sometimes take several weeks. Studies have followed patients over time and found the more appointments or “events” in the sequence from diagnosis to completing treatment, the less likely it is that Black patients will complete the sequence when compared to white patients.2
Looking at documented treatment disparities for Black patients with lung cancer and all cancers for that matter, we can fairly confidently acknowledge that a disparity exists: Eligible Black lung cancer patients are likely not receiving biomarker testing and tailored treatment as often as their white counterparts.
However, because precision medicine takes into account a person’s genes or tumor biology, it is important to understand if people with different ancestries have differences in their genes which may impact cancer.
Read on to Part 2 where we look at how genes play a role in tumor testing
Support provided by Amgen, AstraZeneca, Blueprint Medicines, Bristol Myers Squibb, Genentech, Lilly Oncology, Merck, Novartis and Pfizer.
- Kehl KL, Lathan CS, Johnson BE, Schrag D. Race, poverty, and initial implementation of precision medicine for lung cancer. J Natl Cancer Inst. 2019;111(4):431-434. doi:10.1093/jnci/djy202 .
- J Natl Med Assoc. 2019 Mar 27;S0027-9684(18)30191-3. doi: 10.1016/j.jnma.2019.03.001.
Blog last updated: December 7, 2020