Department of Radiology
University of Wisconsin School of Medicine and Public Health

Suga 2010

 

Year: 2010

Title: Racial disparities on the use of invasive and noninvasive staging in patients with non-small cell lung cancer

Country: United States

Age: Adult Only

Sex: All Sexes

Population: Multiple Groups

Care Setting: Outpatient Ambulatory and Primary Care

Clinical Setting: Cancer Care

Data Level: State

Data Type: Disease Registry

Data Source: California Cancer Registry

Conclusion: No Disparities Based on Patient Race/Ethnicity

Health OutComes Reported: No

Mitigation: No

Free Text Conclusion: In patients with non-small cell lung cancer, there was no association between race and the use of CT, MRI, and PET scans.

Abstract: INTRODUCTION: 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.