Lung cancer is the leading cause of cancer death in the United States, and it hits Black men especially hard. Black men are more likely than White men to develop and die from lung cancer, even though they smoke fewer cigarettes per day and often start smoking later in life. African Americans are also diagnosed at a younger age, and many develop lung cancer as light or intermittent smokers.
Please stop smoking
Smoking is by far the main cause of lung cancer, and quitting at any age lowers your risk. Other contributors include secondhand smoke, radon gas in homes, air pollution, and on-the-job exposures. If you have tried to quit before, don’t give up: see my article on why smoking is an addiction, and ask your doctor about medicines that double your chances of quitting.
Vitamin D and lung cancer
Several studies have linked vitamin D deficiency with increased lung cancer risk, and another study found that people with higher vitamin D levels had a lower risk. In people who already have lung cancer, higher vitamin D levels have been linked to better survival. About 4 out of 5 African Americans have low vitamin D.
These studies show associations, not proof. In the large VITAL trial, vitamin D supplements did not lower the number of people who developed cancer, though there was a hint of fewer cancer deaths. Still, if you smoke or used to smoke, keeping your vitamin D in a healthy range is a reasonable, low-risk step (there are no guarantees!), and if you have cancer, making sure your level is normal is important. Read more about low vitamin D in African Americans.
Vitamin E and beta-carotene: skip the supplements
Studies of vitamin E and lung cancer have been inconsistent: some found vitamin E increased risk, while others found it decreased risk. Beta-carotene is clearer: in two large trials, beta-carotene supplements increased lung cancer in smokers. Until scientists have clear answers, people who smoke or used to smoke should avoid vitamin E and beta-carotene supplements. Foods naturally rich in these nutrients are perfectly safe.
Living near industrial pollution increases risk
Living near industrial pollution, such as factories, refineries, and busy highways, has been linked to higher lung cancer death rates. African Americans are more likely to live near these sources, and Black residents in these areas have even higher lung cancer rates than smoking alone would predict. The worst combination is living near industrial pollution and smoking. If you live in an older home, test it for radon, the second leading cause of lung cancer; kits are inexpensive.
Get screened for lung cancer
A yearly low-dose CT scan can find lung cancer early, when it is most curable. The American Cancer Society now recommends yearly screening for adults 50 to 80 years old with a 20 pack-year smoking history (for example, a pack a day for 20 years or half a pack a day for 40 years), whether they still smoke or quit long ago (ACS, 2023). The U.S. Preventive Services Task Force recommends the same ages and pack-years for people who smoke now or quit within the past 15 years.
We need to make sure the people who need to get screened get screened. Amazing therapies have been developed for lung cancer, and finding these cancers early makes all the difference!! If you have a significant smoking history, ask your doctor to screen you.
If you have a significant smoking history, ask your doctor to screen you. Amazing therapies have been developed for lung cancer, and finding these cancers early makes all the difference!
The precision medicine connection
Lung cancer is one of the best examples of precision medicine at work, and of how Black patients can be left behind.
1. Screening rules built around heavy smokers missed Black smokers
Older screening rules required 30 pack-years and age 55 or older. Because Black smokers typically smoke fewer cigarettes per day and develop lung cancer younger, many were excluded even at high risk. Lowering the threshold to age 50 and 20 pack-years was designed in part to close that gap, roughly doubling the number of Black adults who qualify. If you were told you did not qualify years ago, ask again.
2. Menthol and how your body handles nicotine
Most Black smokers use menthol cigarettes, which make smoke easier to inhale deeply and can make quitting harder. Many Black smokers also break down nicotine more slowly because of differences in the CYP2A6 gene, so they take in more of each cigarette. That means “a few cigarettes a day” can still carry serious risk. Read more in my article on smoking and diabetes.
3. Ask for biomarker testing of the tumor
Today, many lung cancers are treated with targeted pills or immunotherapy chosen by testing the tumor’s genes and proteins (biomarker testing). In one study, only 14% of eligible Black patients with advanced lung cancer received this testing, compared with 26% of White patients (American Lung Association). If you or a loved one is diagnosed, ask: “Has my tumor had comprehensive biomarker testing?”
These are the kinds of differences covered in Better Black Health, written for patients and families, and Precision Medicine for African Americans (Springer Nature), written for clinicians.
