Racial disparities on the use of invasive and noninvasive staging in patients with non-small cell lung cancer.
BACKGROUND
Racial disparities have been reported in non-small cell lung cancer (NSCLC) staging and therapeutic outcomes. We investigated whether such disparities exist in the era of modern noninvasive staging modalities, including positron emission tomography scan use.


METHODS
NSCLC patients from the California Cancer Registry diagnosed between January 1, 1994, and December 31, 2004, were included. The likelihood of obtaining invasive (thoracoscopy, bronchoscopy, and mediastinoscopy) and noninvasive staging procedures (computed tomography, magnetic resonance imaging, and positron emission tomography scans), along with surgical resection, were analyzed using logistic regression adjusted for known confounders.


RESULTS
Of 13,762 NSCLC patients, 12,395 with adequate staging information were included. 10,217 patients (82%) were classified as white, 2178 patients (18%) were non-white, and 738 were black patients (6%). No association was seen between race and the use of either noninvasive (odds ratio [OR] = 1.02; p = 0.76) or invasive staging procedures (OR = 0.96; p = 0.44). However, compared with white patients, black patients had a lower likelihood of undergoing surgery, regardless of noninvasive (OR = 0.6; p <0.001) or invasive staging use (OR = 0.63; p = 0.02). There was no survival difference for those who underwent surgery between white and non-white patients, regardless of noninvasive (hazard ratio = 0.95; p = 0.45) or invasive staging (hazard ratio = 1.03; p = 0.79).


CONCLUSIONS
In contrast to prior published work, we found no difference in rates of both invasive and noninvasive staging between white and non-white patients. However, non-white patients-particularly blacks-were less likely to receive surgery. The reason for the apparent difference in surgical rates could not be explained by the variables we evaluated. Thus, other factors such as personal preference or access to care require further investigation.
Suga
Jennifer Marie
JM
UC Davis Cancer Center, Division of Biostatistics, Department of Public Health Sciences, UC Davis, California Cancer Registry, University of California Davis Health System, Sacramento, CA, USA.
Nguyen
Danh V
DV
Mohammed
Sandra M
SM
Brown
Monica
M
Calhoun
Royce
R
Yoneda
Ken
K
Gandara
David R
DR
Lara
Primo N
PN
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044383:Black People / Q000706:statistics & numerical data*; D002140:California; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging / Q000208:ethnology* / Q000473:pathology*; D015331:Cohort Studies; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000208:ethnology* / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008481:Mediastinoscopy; D008875:Middle Aged; D009367:Neoplasm Staging / Q000295:instrumentation / Q000379:methods; D049268:Positron-Emission Tomography; D011379:Prognosis; D013906:Thoracoscopy; D014057:Tomography, X-Ray Computed; D044465:White People / Q000706:statistics & numerical data*; D055815:Young Adult; D001741:Black or African American