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JAMA Oncology
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This Issue
Review
November 30, 2023
Sidra N.Bonner,MD, MPH, MSc1,2; RichardCurley,DrPH3; KyraLove,MMLIS4; et al TolaAkande,BA3; AamnaAkhtar,BA3; LorettaErhunmwunsee,MD3,5
Author Affiliations Author Information
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1Department of Surgery, University of Michigan, Ann Arbor
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2National Clinician Scholars Program, University of Michigan, Ann Arbor
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3Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, California
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4Library Services, City of Hope, Duarte, California
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5Department of Populations Sciences, City of Hope National Medical Center, Duarte, California
JAMA Oncol. 2024;10(1):122-128. doi:10.1001/jamaoncol.2023.4897
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Abstract
Importance Structural racism is associated with persistent inequities in health and health outcomes in the US for racial and ethnic minority groups. This review summarizes how structural racism contributes to differential population-level exposure to lung cancer risk factors and thus disparate lung cancer risk across different racial and ethnic groups.
Observations A scoping review was conducted focusing on structural racism and lung cancer risk for racial and ethnic minority groups. The domains of structural racism evaluated included housing and built environment, occupation and employment, health care, economic and educational opportunity, private industry, perceived stress and discrimination, and criminal justice involvement. The PubMed, Embase, and MedNar databases were searched for English-language studies in the US from January 1, 2010, through June 30, 2022. The review demonstrated that racial and ethnic minority groups are more likely to have environmental exposures to air pollution and known carcinogens due to segregation of neighborhoods and poor housing quality. In addition, racial and ethnic minority groups were more likely to have exposures to pesticides, silica, and asbestos secondary to higher employment in manual labor occupations. Furthermore, targeted marketing and advertisem*nt of tobacco products by private industry were more likely to occur in neighborhoods with more racial and ethnic minority groups. In addition, poor access to primary care services and inequities in insurance status were associated with elevated lung cancer risk among racial and ethnic minority groups. Lastly, inequities in tobacco use and cessation services among individuals with criminal justice involvement had important implications for tobacco use among Black and Hispanic populations.
Conclusions and Relevance The findings suggest that structural racism must be considered as a fundamental contributor to the unequal distribution of lung cancer risk factors and thus disparate lung cancer risk across different racial and ethnic groups. Additional research is needed to better identify mechanisms contributing to inequitable lung cancer risk and tailor preventive interventions.
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Health Disparities Cancer Epidemiology Environmental Health Health Inequities Equity, Diversity, and Inclusion Lung Cancer Oncology
Citation
Bonner SN, Curley R, Love K, Akande T, Akhtar A, Erhunmwunsee L. Structural Racism and Lung Cancer Risk: A Scoping Review. JAMA Oncol. 2024;10(1):122–128. doi:10.1001/jamaoncol.2023.4897
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