Black Mesothelioma Patients Less Likely to Receive Surgery

Black mesothelioma patients are less likely to receive potentially-life saving surgery than white patients, even though they have worse short-term mortality.  

That is the finding of a new study published in the Journal of Immigrant and Minority Health. 

Mount Sinai researchers used data from the National Cancer Institute to compare mesothelioma treatment trends among 2550 patients. 

They concluded that both white and black mesothelioma patients live longer with surgery, but white patients tend to get the most benefit.

Surgical Options for Malignant Mesothelioma

Malignant mesothelioma is a membrane cancer. It can occur in different places in the body. The type of treatment varies depending on where the cancer occurs. For mesothelioma in the abdomen (peritoneal mesothelioma), surgery with a rinse of heated chemotherapy is the gold standard treatment. 

For mesothelioma around the lungs (pleural mesothelioma), chemotherapy is the primary treatment. Surgery is an option in the healthiest of white or black mesothelioma patients. 

The two types of mesothelioma surgery are EPP and P/D. EPP is the more radical approach. During EPP, surgeons remove the mesothelioma tumor along with one lung, all or part of the diaphragm, and other at-risk tissues. P/D surgery leaves the lungs intact.

Both surgeries are risky but patients tend to have more complications after EPP. Even so, some studies suggest that EPP offers the best chance of long-term survival for black mesothelioma patients. 

Treatment Disparities in Black Mesothelioma Patients

The new study included data on 2550 people with malignant pleural mesothelioma. There were 88 black mesothelioma patients in the dataset. 

The study found that these patients tended to have worse 30 to 90 day mortality than their white counterparts. Black mesothelioma patients were also less likely to have any type of surgery. They were much less likely to have the more extensive EPP surgery..

“Surgery conferred a survival benefit, but it varied by race,” notes study author and population health expert Naomi Alpert. “Although there was an overall survival benefit noted with surgery, this was not consistent across races, despite trends towards worse short-term mortality in black patients.”

An Ongoing Trend

This is not the first time researchers have noted outcome disparities among white and black mesothelioma patients. 

A 2015 New York study found that, even though mesothelioma incidence is much lower among African Americans, black people who do get asbestos cancer tend to have worse survival rates.

That study included 688 black mesothelioma patients. Like the current study, it found that these patients were less likely than white patients to undergo cancer-directed surgery. 

Neither study addresses the reason for the disparity. But both studies suggest that black mesothelioma patients should educate themselves about the standard of care for their disease. If possible, it is best to seek treatment at an academic medical center. 

Malignant mesothelioma affects an estimated 2,500 people in the US each year. Most were exposed to asbestos on the job decades earlier. This often happened because of inadequate protective gear or lack of training.

Sources:

Alpert, N, et al, “Racial Disparities in Treatment Patterns and Survival Among Surgically Treated Malignant Pleural Mesothelioma Patients”, June 11, 2020, Journal of Immigrant and Minority Health, https://link.springer.com/article/10.1007%2Fs10903-020-01038-x

Taioli, E, et al, “Frequency of Surgery in Black Patients with Malignant Pleural Mesothelioma”, April 30, 2015, Disease Markers, https://www.researchgate.net/publication/275889699_Frequency_of_Surgery_in_Black_Patients_with_Malignant_Pleural_Mesothelioma