Sometimes, as clinicians, we forget low socioeconomic status within lung cancer; being an African-American male means that their survival is decreased. Even Hispanic patients are also less likely to get treatment. The point is, simply, our medical oncologists, surgical oncologists, and radiation oncologists need to understand that different patients have different hurdles.
In your lecture, you discussed “the Hispanic paradox.” Can you elaborate?
I love talking about that because it is so interesting, and it exposes the fact that we know so little. Here's the truth: there are risk factors and Hispanics are less likely to get treatment. They are more likely to have advanced stage lung cancer and they have higher rates of being disadvantaged. Those 3 things are powerful risk factors for poor health and poor survival.
However, lung cancer in Hispanic patients doesn’t reflect that. To me, that is just so interesting because it shows us that we don’t know everything. There certainly have been studies to try to understand “the Hispanic paradox” and some of the things that have come out. Hispanic patients smoke differently; there are lower rates of smoking in most Hispanic groups. Cubans smoke more than Mexicans, but Cubans have a much higher rate of lung cancer and mortality from lung cancer than Mexican because of that.
It is about the genetic differences, as well. Hispanic and Latino patients have a profile that appears to be more favorable. There have been some data that suggest that they frequently have adenocarcinoma and, sometimes, high rates of minimally invasive adenocarcinoma; we know that histology leads to longer survival. Also, I don’t know if this is as clear, but in many cohorts that have looked at Hispanic and Latino patients, many of those with lung cancer have been women—which is very different than in African Americans, Caucasian Americans, and other groups. We know that women live longer. When you have all of that [information], that at least, in part, explains the paradox.