Study objectives: We analyzed data from a
community-based cancer database over a 26-year period in order to
characterize clinicopathologic differences between black and white
patients with lung cancer, and to identify relevant temporal trends in
incidence and survival.
Design, setting, and patients:
Data on demographics, stage, histology, and survival were obtained on
all black and white patients with primary bronchogenic carcinoma
registered in the community-based metropolitan Detroit Surveillance,
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 decline occurring in black men (p < 0.0001).
Although incidence rates declined over time for men of both races< 50 years of age, this decrease was greater in white men, resulting
in an increase in the racial differential in younger men. Temporal
trends in incidence rates were similar for women of both races. The
incidence of distant-stage disease was higher among blacks throughout
the study period. The incidence of local-stage disease decreased for
both races, though this decline was greater in blacks. A significant
racial difference in 2-year and 5-year survival rates developed during
the study period, due to a distinct lack of improvement in black
patients. In a multivariate model, the relative risks of death for
black patients, relative to 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.
Significant racial differences exist in the incidence and survival
rates for lung cancer in metropolitan Detroit. Since 1973, several
disturbing trends have developed, particularly with regard to the lack
of improvement in overall survival in black patients. Further study is
required to determine the factors responsible for these temporal