Ayanay Ferguson knew something was wrong with her body when she returned from vacation with her husband in April 2021. “My ankles were swollen, and I had difficulty breathing,” recalls 50-year-old Ferguson, a clinical psychologist from the Atlanta area. Initially, she thought her symptoms were due to vacation fatigue and her weight. As her symptoms persisted, she scheduled a telehealth consultation with a doctor who recommended she have her heart evaluated. An ECG in an emergency room at a nearby hospital showed normal results, but a medical resident had concerns about some of her blood test results and recommended further evaluations. “He said he had just read an article about how that specific blood test did not show abnormal results for African Americans when there was actually a problem, and that’s what motivated him to continue with evaluations,” Ferguson recalls. “That’s why he requested a chest CT scan.” The CT scan revealed a cancerous mass in her right lung, later diagnosed as stage 3A non-small cell adenocarcinoma. “I had cancer cells in some of my lymph nodes,” she said.
The lung cancer diagnosis came as a surprise to Ferguson, who had never smoked cigarettes or had a family history of the disorder. Nevertheless, she agreed to the aggressive treatment plan recommended by her thoracic surgeon. The plan involved removing the mass with surgery and four rounds of chemotherapy. Three years later, Ferguson proudly reports being cancer-free.
As more research reveals, being a Black individual, she is particularly fortunate to have overcome a disorder that kills more than 125,000 Americans each year, more than breast, colon, and prostate cancers combined. Lung cancer is more challenging to treat in advanced stages, so early detection through screenings significantly improves a person’s chances of survival. However, there are racial disparities. Studies show that Black lung cancer patients are 15% less likely than white patients to receive early diagnoses and have the lowest five-year survival rate of any racial group.
Black Americans tend to develop lung cancer at higher rates and younger ages than their white counterparts, despite smoking fewer cigarettes on average. According to the American Lung Association, the disorder claimed the lives of over 14,000 Black Americans in 2021, the most recent year for which data is available. Addressing persistent disparities in early diagnoses and lung cancer survival rates is the focus of the work by Melinda Aldrich, M.D., an associate professor at Vanderbilt University Medical Center.
Aldrich’s groundbreaking 2019 study with five colleagues found that screening eligibility guidelines exclude Black smokers more than individuals of other races. The healthcare industry has been slow to respond to increasing pressure to change that, including medical insurance companies that determine what is considered preventive care with reduced or free coverage. Aldrich’s research showed that the U.S. Preventive Services Task Force (USPSTF), the governmental group that sets screening guidelines, required individuals to be between 55 and 80 years old and have smoked the equivalent of a pack a day for 30 years to be eligible for a low-dose CT scan. In addition to those criteria, a person must be a current or former smoker, and former smokers must have quit within the past 15 years.
Aldrich’s analysis of over 84,000 adult smokers revealed that under those criteria, Black patients at relatively high risk of lung cancer were disproportionately excluded from the eligible screening group. More than two-thirds of Black smokers who received lung cancer diagnoses did not meet the age and smoking history criteria when diagnosed. “Based on those guidelines, we saw that of the people who were diagnosed with lung cancer, 68% of African Americans… did not meet the requirements for lung cancer screenings. And this contrasts with 44% of white Americans who also would not be eligible,” she said. “So, [there are] significant racial disparities in terms of eligibility and who has access to screenings.”
Aldrich’s work and her colleagues were mentioned in a 2021 USPSTF decision, which implemented two changes that nearly doubled the number of people eligible for lung cancer screenings by reducing the age from 55 to 50 and reducing the pack-years criteria from 30 to 20 in terms of smoking history. “They didn’t exactly do what we proposed: something that can be considered controversial, which is making a change for a specific race in the guidelines,” she said. “They made the guideline changes for everyone. So, in fact, the disparities still exist. They just made more people eligible.”
Aldrich said raising awareness about screenings that have been widely available for over a decade is critical to improving outcomes and survival rates for lung cancer patients, especially for Black patients. Nevertheless, she said, the medical industry must answer the call to take another step to allow people to be eligible for early screenings based on additional risk factors, such as race, ethnicity, and family history. “If you have a history of smoking, talk to your doctor about your eligibility for lung screenings,” Aldrich recommended. “We must also remove the stigma associated with smoking; we should unite the community instead of trying to find culprits.”
Ferguson said that while changes to screening guidelines for her specific race would likely not have helped her because she is a non-smoker, she supports the change to increase screening eligibility. “It doesn’t matter if you’re 30 or 70 years old. If you smoked every day for 10 years or more, you should be able to tell your doctor, ‘I want a lung cancer screening’ and you should get it,” she said. “It is money spent preventively, but it saves on larger treatment costs. And most importantly, it will save more lives.” This educational resource was prepared with the support of Merck.
