Lung Cancer in Black Men: The Disparity and Who Should Screen

Lung cancer is the leading cause of cancer death among Black men, and Black men die from it at a higher rate than any other group in the country. The cruel part is that many of these deaths are preventable. A yearly low-dose CT scan finds lung cancer when it is small, before symptoms start, when surgery can still cure it. The problem is that Black men have historically been less likely to get screened, less likely to be diagnosed early, and less likely to get the surgery that saves lives. Some of that gap traces back to screening rules that were written around how White men smoke, not how Black men do.

Lung cancer starts when cells in the lungs grow out of control. There are two main types. Non-small cell lung cancer is the most common, accounting for roughly 8 in 10 cases. It tends to grow more slowly and, when caught early, is often treated with surgery. Small cell lung cancer is less common, grows and spreads faster, and is strongly tied to smoking. Knowing the type matters because it changes the treatment plan, and modern care now also tests the tumor itself for specific gene changes that open up targeted drugs.

The American Cancer Society's 2025 report on cancer in Black Americans found that Black men have about 4% higher lung cancer incidence than White men but 16% higher lung cancer death rates over the most recent five years. Lung cancer is the single deadliest cancer for Black men, causing about 1 in 5 cancer deaths. The death gap is wider than the diagnosis gap, which points squarely at later diagnosis and gaps in treatment, not just at who gets the disease.

Here is the paradox at the center of this story. Black men, on average, smoke fewer cigarettes per day and start later than White men, yet they get lung cancer at higher rates. A landmark New England Journal of Medicine study that followed more than 180,000 people found that among people who smoked less than 20 cigarettes a day, Black smokers had a substantially higher risk of lung cancer than White smokers at the same level of smoking. The risk gap was widest among lighter smokers. Smoking patterns alone do not explain the disparity.

The gap continues into treatment. In a National Cancer Database study of nearly 221,000 patients with non-small cell lung cancer, Black patients were about twice as likely to not undergo recommended surgery (adjusted odds ratio 2.06). The same study found that when Black patients did get surgery, their five-year survival matched that of White patients. The outcome is equal when the care is equal. The problem is getting to the operating room in the first place.

Lung cancer screening eligibility is based on "pack-years," a number you get by multiplying packs per day by years smoked. The old 2013 rules required a 30 pack-year history starting at age 55. Because Black men tend to smoke fewer cigarettes per day, many never hit 30 pack-years even after decades of smoking, so they were ruled out of screening while their cancer risk was just as high or higher.

In 2021 the US Preventive Services Task Force lowered the bar to age 50 and 20 pack-years, in part to reduce this inequity. It helped, but it did not close the gap. A 2025 analysis in the journal Cancer found that among patients aged 50 to 54 who were diagnosed with lung cancer, only 47.4% of Black patients would have qualified for screening under the 2021 rules, compared with 80.3% of White patients. Among Black patients in that age group who were ineligible, essentially all of them were ruled out for a single reason: they had not smoked 20 pack-years. The threshold still does not fit how many Black men smoke.

The current USPSTF recommendation is an annual low-dose CT scan for adults who meet all three of these:

• Age 50 to 80
• A 20 pack-year smoking history (for example, one pack a day for 20 years, or two packs a day for 10 years)
• Currently smoke, or quit within the past 15 years

This is a Grade B recommendation, which means most insurance plans, Medicare, and Medicaid cover it with no out-of-pocket cost. The scan is fast, painless, and uses a low radiation dose. Screening matters because it works: catching lung cancer early, before it spreads, is the difference between a curable surgery and a cancer that has already moved. If your pack-year count is close to 20 but not exactly there, ask anyway. The rules are a floor, and a doctor who knows your history can make the case.

Smoking is the biggest driver, and menthol is a Black-community-specific layer on top of it. About 85% of Black adults who smoke use menthol cigarettes, compared with roughly a third of White smokers, the result of decades of tobacco-industry marketing aimed at Black neighborhoods. Menthol cools the smoke and masks the harshness, which makes cigarettes easier to start and harder to quit. If you are trying to stop, menthol is part of why it feels so hard, and naming that is the first step. We cover the quitting playbook in menthol cigarettes and quitting in the Black community.

Other risks matter too. Secondhand smoke raises risk for people who never smoked. Radon, an odorless radioactive gas that seeps into homes from the ground, is the leading cause of lung cancer in people who do not smoke; a cheap home test kit tells you if your levels are high. Family history of lung cancer raises your odds. And it is worth stating plainly: nonsmokers get lung cancer too. A persistent cough or unexplained symptom deserves attention even if you never touched a cigarette. Long-term lung damage also overlaps with smoking risk, which is why we wrote about COPD in Black adults.

Early lung cancer usually has no symptoms, which is exactly why screening exists. When symptoms do appear, they often mean the cancer has grown. Watch for:

• A cough that does not go away or gets worse
• Coughing up blood or rust-colored phlegm
• Chest pain that is worse with deep breaths, coughing, or laughing
• Shortness of breath or wheezing
• Unexplained weight loss
• Feeling tired or weak
• Chest infections like bronchitis or pneumonia that keep coming back

If a scan or symptom raises a concern, the next steps usually include a CT scan, sometimes a PET scan, and a biopsy that takes a small tissue sample to confirm the cancer and its type. Treatment has changed dramatically in the last decade. Beyond surgery, chemotherapy, and radiation, two advances have moved survival: targeted therapy, which uses drugs aimed at specific gene mutations in the tumor, and immunotherapy, which helps your own immune system attack the cancer.

Both depend on one step that gets skipped too often for Black patients: biomarker testing. This is a lab test on the tumor tissue that looks for mutations like EGFR and ALK that determine whether a targeted drug will work. Research has documented that Black patients have been less likely to receive complete molecular testing before treatment, which means some never get matched to a drug that could help them. If you or a family member is diagnosed, ask directly: "Has my tumor had complete biomarker or molecular testing, and what did it show?" That one question can change the treatment plan.

Start with a primary care visit. Tell the doctor your smoking history in pack-years and ask whether you qualify for a low-dose CT scan. If you smoke, ask for a referral to a cessation program; quitting at any age lowers your risk and improves treatment outcomes. If you have been diagnosed, ask whether your tumor has had full biomarker testing and whether a specialist or clinical trial is an option. Bias in care is real, and a clinician who takes your history seriously changes outcomes. You can find a Black or Black-serving clinician in our directory who will.