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Advanced Presentation of Lung Cancer in Asian Immigrants^*

A Case-Control Study

^* From the Pulmonary and Critical Care Division and the Tupper Research Institute (Drs. Finlay, Rodrigues, and White), Department of Medicine, New England Medical Center, Tufts University School of Medicine; Medical Records Department (Ms. Joseph), New England Medical Center; and Clinical Care Research Department (Dr. Griffith), Tufts University School of Medicine, Boston, MA.

Correspondence to: Alexander C. White, MD, Pulmonary and Critical Care Division, New England Medical Center, NEMC #257, 750 Washington St, Boston MA 02111; e-mail: Awhite1{at}Lifespan.org

Study objectives: To determine if Asian immigrants to the United States present with more advanced lung cancer compared to non-Asians.

Design: A 5-year retrospective case-control study (January 1, 1992, to December 31, 1996) of patients with lung cancer identified using the New England Medical Center cancer center database. A 2-year follow up was obtained in all subjects.

Setting: A tertiary level care hospital providing all levels of medical care to the local Asian population in the Boston area.

Patients: Forty-two Asian immigrants with lung cancer diagnosed over the study period were matched for age and sex with 42 non-Asian control subjects.

Results: Asians presented more frequently with advanced stage (stage III or IV) and less frequently with early stage (stage I or II) lung cancer compared with the non-Asian control group (p < 0.05). Asians were more likely to present with hemoptysis or constitutional symptoms (p < 0.01) and had a longer duration of symptoms prior to presentation (p < 0.01) compared with non-Asians. There was no difference in the length of time elapsed between diagnosis and start of treatment (approximation of workup time) between the two groups. The utilization of tests and procedures for clinical disease staging was not significantly different between the two groups. The incidence of large cell carcinoma (p < 0.05) was higher in Asians compared with non-Asians. Asians were more likely to receive radiotherapy and less likely to receive combination therapy compared with non-Asians (p < 0.05). The treatment of stage I and II lung cancer did not differ between the two groups. The median 2-year survival was significantly reduced in Asians compared with non-Asians: Asians, 7 months (95% confidence interval [CI], 3.1 to 10.9); non-Asians, 15 months (95% CI, 12.0 to 17.5) [p < 0.001].

Conclusions: Asian immigrants with lung cancer appear to present with more advanced stage of disease, have more prolonged symptomatology, and have reduced survival compared with non-Asians. These data suggest that ethnicity may play a role in the presentation and outcome of lung cancer in the Asian immigrant population.

Key Words: Asian immigrants • lung cancer • survival

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