Research Reveals the Role of Structural Racism in Lung Cancer Risk

A recent scoping review revealed the impact of structural racism on the unequal distribution of lung cancer risk factors among racial and ethnic minority groups. The comprehensive analysis, spanning 22 studies, illuminated housing disparities, occupational hazards, unequal health care access, economic inequality, and discriminatory industry practices and how they collectively contribute to heightened lung cancer risks.

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Key domains examined included housing and built environment, occupation and employment, health care, economic and educational opportunity, private industry, perceived stress and discrimination, and criminal justice involvement. A comprehensive search of the PubMed, Embase, and MedNar databases was conducted, covering English-language studies in the US from January 1, 2010, through June 30, 2022.

In the realm of housing and built environment, 12 studies exhibited racial residential segregation and concentrated neighborhood deprivation led to increased exposure among minority groups to air pollution, radon, asbestos, and secondhand smoke. African American and Hispanic populations, in particular, faced higher levels of environmental carcinogens such as PM2.5, nitrogen oxide, benzenes, and carbon monoxide.

Occupation and employment were explored in 3 studies, highlighting how racial and ethnic minority groups, especially African Americans, experienced elevated occupational exposure to carcinogens due to overrepresentation in manual work industries. Silica and asbestos exposures were notably higher for African American individuals, contributing to heightened lung cancer risk.

The impact of racial inequities in health care on lung cancer risk was investigated in 5 studies, demonstrating poor access to primary care services, discrimination, and bias reduced minority groups' access to tobacco cessation programming. African American and Hispanic patients faced challenges in obtaining high-quality medical insurance and accessing tobacco cessation services.

Three studies focused on economic and educational opportunity, identifying structural racism as a fundamental driver of racial inequities in economic mobility and educational attainment. These factors were linked to a higher risk of lung cancer among minority populations.

Private industry practices were examined in 2 review studies, uncovering discriminatory tactics by the tobacco industry that contributed to differential lung cancer risk by race and ethnicity. Targeted marketing, including menthol cigarette marketing, persisted in minority communities.

Perceived stress and discrimination were discussed in 1 study, revealing higher rates of stress and social discrimination among Black and Hispanic individuals, stemming from the social and economic consequences of racism. These factors were associated with an increased risk of lung cancer.

Criminal justice involvement was explored in 2 studies, indicating individuals with a history of criminal justice involvement, disproportionately African American and Hispanic, exhibited higher tobacco use rates due to economic precarity, stress, and limited access to tobacco cessation. Smoking rates remained elevated in this population despite an overall decrease in smoking rates for those with substance use disorders from 2010 to 2019.

“The findings of this scoping review suggest that structural racism contributes to unequal exposure to lung cancer risk factors and thus to disparate lung cancer risk among racial and ethnic minority groups,” the researchers concluded. “Addressing racial and ethnic inequities in lung cancer risk will require prioritization and investments in large-scale observation studies to allow for intervention creation by health care professionals, public health stakeholders, and policymakers.”

The study called for further research to identify specific mechanisms that contribute to these inequities, with the goal of tailoring preventive interventions. Recognizing structural racism as a fundamental contributor to health disparities is a crucial step toward promoting health equity and dismantling systemic barriers that perpetuate unequal health outcomes.

Reference

Bonner SN, Curley R, Love K, Akande T, Akhtar A, Erhunmwunsee L. Structural racism and lung cancer risk: a scoping review. JAMA Oncol. Published online November 30, 2023. doi:10.1001/jamaoncol.2023.4897