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Miles McAllister






Brigham and Women's Hospital




Anupama Singh, Yue Xie, Miles A. McAllister, Emanuele Mazzola, Fatemehsadat Pezeshkian, Michael T. Jaklitsch, Fatima Wilder

Principal Investigator


Multifactorial Impact of Age, Race and Female Sex on Management of NSCLC


Objective: Younger female patients are increasingly diagnosed with lung cancer. We sought to evaluate the impact of age, race, and sex on surgical management of NSCLC.

Methods: We retrospectively analyzed patients diagnosed with NSCLC from 2004-2018 in the Southern Community Cohort Study (SCCS) database, which encompasses one of the largest percentages of minority patients (~70%). Patients were stratified into Black vs. White and 55 years (B). Treatment variables were tabulated, and Kaplan-Meier curves estimated overall survival.

Results: In total, 1474 patients were included: 924 (63%) Black and 705 (48%) females. Encompassing all ages, fewer Black females (16%) were diagnosed with stage I disease compared to White females (23%) (P=0.02). Black females underwent surgery less often than White females (80% vs. 65%, P=0.002), and even when they did, Black females more often received inadequate lymphadenectomy (75% vs. 65%, P=0.02). Stratifying by age, fewer younger Black females (A) compared to older Black females (B) were stage I (11% vs. 18%, P=0.721), more underwent inadequate lymphadenectomy (81% vs. 74%, P=0.08), and more didn’t receive surgery (84% vs. 80%, P=0.649). When comparing younger (A) and older (B) White females, the former were diagnosed more often diagnosed with stage I (27% vs. 25%, P=0.253), received inadequate lymphadenectomy (63% vs. 65%, P=0.367), and underwent surgery less often (52% vs. 68%, P=0.114). Survival among females who underwent surgical resection did not differ based on race or age.

Conclusions: There is limited data on the complex interactions between race, age, and female sex on management of NSCLC. Our data highlights persistent disparities between Black and White females. Additionally, although not statistically significant, there is a trend towards younger female patients more often receiving inadequate management of their cancer, particularly among young Black females. However, when patients did receive appropriate management, survival was comparable.

Research Context

Recent studies during the last decade have started to highlight the differences between men and women who have been diagnosed with lung cancer. For instance, a greater proportion of women with lung cancer are never-smokers, and younger women are being diagnosed with lung cancer at an increased rate compared to men, suggesting perhaps a biological predisposition. Race and age in general play an invaluable role in the management of lung cancer; however, studies in this realm are limited, particularly those focusing on women. Using a database where over two-thirds of the participants are African Americans, our work highlights important trends and disparities in not only minority females but young minority females as well. Our data also demonstrates that further studies will be crucial as the proportion of women with lung cancer continues to rise.