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Chest. 2019 Jan;155(1):44-52. doi: 10.1016/j.chest.2018.07.011. Epub 2018 Jul 26.

Surgical Disparities Among Patients With Stage I Lung Cancer in the National Lung Screening Trial.

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Division of Pulmonary, Critical Care, and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA. Electronic address:
Division of General Internal Medicine, and Pulmonary, Critical Care, and Sleep Medicine, Mount Sinai School of Medicine, New York, NY.
Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA.



Low-dose CT scan reduces lung cancer mortality in high-risk patients fit to undergo surgical resection. Racial disparities in resection of lung cancer in nonscreening populations are well described. We describe surgical resection patterns of patients with early stage non-small cell lung cancer (NSCLC) in the National Lung Screening Trial (NLST) and examine whether racial disparities exist among blacks.


We identified all NLST participants with clinical stage I NSCLC. Covariates included demographics, smoking history, comorbidities, tumor characteristics, and timing of cancer detection. Using logistic regression, we assessed resection rates of blacks vs whites.


Among 752 patients with clinical stage I disease, 692 patients (92%) underwent resection. Unadjusted surgical resection rates for white men, white women, black men, and black women were 92%, 91%, 61%, and 90%, respectively. In adjusted analyses, compared with white men, black men had a 28% lower risk (relative risk, 0.72; 95% CI, 0.50-0.99) of undergoing surgery; however, white women and black women underwent surgery at comparable rates as white men. The odds of undergoing limited resection instead of full resection were 70% greater in white women than white men (OR, 1.69; 95% CI, 1.08-2.65).


Our study shows that disparities in the surgical treatment of lung cancer persist, even among NLST participants who were considered fit to undergo thoracic surgery. As lung cancer screening disseminates into clinical practice, efforts targeting black men should be prioritized.


carcinoma; health-care disparities; minority health; non-small cell lung

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