Impact of race in lung cancer - Analysis of temporal trends from a surveillance, epidemiology, and end results database

Study objectives: We analyzed data from a community-based cancer database o ver a 26-year period in order to characterize clinicopathologic differences between black and white patients with lung cancer, and to identify relevan t temporal trends in incidence and survival. Design, setting, and patients: Data on demographics, stage, histology and s urvival were obtained on all black and white patients with primary bronchog enic carcinoma registered in the community-based metropolitan Detroit Surve illance, Epidemiology, and End Results database from 1973 to 1998, Results: Of 48,318 eligible patients, 23% were black. Lung cancer incidence rates decreased for men of both races from 1985 to 1998, with a greater de cline occurring in black men (p < 0.0001), Although incidence rates decline d over time for men of both races < 50 years of age, this decrease was grea ter in white men, resulting in an increase in the racial differential in yo unger men. Temporal trends in incidence rates were similar for women of bot h races. The incidence of distant-stage disease was higher among blacks thr oughout the study period. The incidence of local-stage disease decreased fo r both races, though this decline was greater in blacks. A significant raci al difference in 2-year and 5-year survival rates developed during the stud y period, due to a distinct lack of improvement in black patients, In a mul tivariate model, the relative risks of death for black patients, relative t o white patients, were 1.24 (p < 0.0001) for local stage, 1.14 (p < 0.0001) for regional stage, and 1.03 (p = 0.045) for distant stage. Conclusion: Significant racial differences exist in the incidence and survi val rates for lung cancer in metropolitan Detroit, Since 1973, several dist urbing trends have developed, particularly with regard to the lack of impro vement in overall survival in black patients. Further study is required to determine the factors responsible for these temporal trends.