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When a 65-year-old woman in Port Harcourt, Nigeria, arrives at a clinic, she finally learns that she has late-stage lung cancer. For months, her symptoms of breathlessness and exhaustion had been misdiagnosed. She has never smoked cigarettes, but she cooks over a charcoal stove daily, as have generations of women in her family.
Her story is not unusual. Whether in Accra, Kingston or New York City, people of African descent who have lung cancer are more likely to be diagnosed late, less likely to receive appropriate care and more likely than white people to die from the disease1. Yet these patterns are rarely acknowledged as a global phenomenon. Instead, they are treated as separate regional issues. African American, African and Afro-Caribbean people are considered distinct groups. This fragmentation obscures the truth: the same societal factors shape lung cancer outcomes across continents2.
Nature Outlook: Lung cancer
I understand these disparities not only through data, but also through grief. A close friend of mine in Nigeria died of colorectal cancer in his thirties because of failures in the health-care system. That loss caused me to pursue oncology and hardened my conviction that inequities in cancer treatment are systemic — and can be addressed.
Official global statistics continue to show a relatively lower lung cancer incidence in people of African descent compared with other groups3. But rarity is not the same as absence. And owing to limited pathology services and the dearth of population-based cancer registries (databases that typically track cancer cases, outcomes and risk factors), many cases go unrecorded2.
This raises an uncomfortable question: why have cancer researchers and clinicians tolerated data scarcity in Black populations in ways that they would not accept in other groups? If western Europe lacked cancer registries, it would be considered a scientific emergency. In much of Africa, a lack of population-wide data is treated as unfortunate but acceptable.
This double standard shapes research funding, therapeutic development and global health priorities. The result is a statistical illusion: Africa seems to have a low lung cancer burden because the systems in place to detect the disease are insufficient.
Precision oncology has transformed lung cancer care. But its benefits are unevenly distributed. Compared with other populations, people of African descent have lower rates of targetable mutations; as a result, therapeutics used to treat these types of cancer are less effective. And although distinct molecular patterns are increasingly being observed in people of African descent, there has been little research into therapies that target such mutations. Giving treatments to people without considering whether they will be beneficial is not precision medicine, it is extrapolation. The result is that individuals miss out on opportunities for targeted therapy and experience avoidable harm.
Exposure to environmental contaminants compounds these inequities. Black communities around the world are disproportionately exposed to carcinogens. In the United States, Black people who smoke inhale higher levels of toxic compounds, even when smoking fewer cigarettes4, than do white smokers. In Africa, many women and girls inhale smoke from burning biomass fuels such as wood and coal daily, a risk factor that is rarely acknowledged in global lung cancer discourse. In South America and the Caribbean, Black farmers, miners and industrial workers face high levels of carcinogen exposure attributable to differences in the safety of housing, economic marginalization and exposure to hazardous materials.
These socio-economic disparities extend beyond the clinic and into choices about what research is funded. Under-representation of people of African descent in clinical trials is often attributed to mistrust. But that emphasis obscures other socio-economic reasons for their exclusion: nations in Africa and the Caribbean often lack the infrastructure needed to run clinical trials, US trials often take place far away from Black communities and genomic studies continue to prioritize individuals with European ancestry. Black people are often willing to participate in trials, but the system is unwilling to include them5.
However, there are some promising ongoing developments. Cancer registries are expanding across Africa. The ACCURE trial — which deployed real-time electronic health-record alerts and nurse navigators who had attended racial-equity training and provided race-specific data to clinical teams — nearly eliminated the gap in treatment completion rates between Black and white people with early-stage lung or breast cancer. It offers a replicable model for equity-centred care6.
But these efforts remain fragmented. What is needed is coordinated, transcontinental action: a lung cancer consortium led by scientists of African descent that spans not just Africa but the whole world. Such an alliance could generate data broken down by ancestry, geography and exposure to carcinogens. It could drive genomic studies that are inclusive of African ancestry, develop locally tailored screening strategies and ensure that the development of therapeutics reflects global diversity.
Lung cancer treatment is not provided equitably around the world, and this trend demands a global response. Confronting the structural forces that shape lung cancer outcomes across continents will provide a path towards a future in which ancestry no longer predicts survival.
Competing Interests
The author declares no competing interests.
