Lung Malignancy in the South Bronx: Racial, Socioeconomic, and Clinical Insights From a Safety-Net Hospital

Document Type

Conference Proceeding

Publication Date

10-2025

Publication Title

Chest

Abstract

PURPOSE: Lung cancer is the second-most diagnosed malignancy and the leading cause in cancer-related deaths in the United States. South Bronx has a minority population consisting of Hispanics and Blacks predominantly, while also comprising the poorest zip-codes in New York City that have been severely affected with substance-use disorder, comorbidities and higher social determinants of health (SDoH). METHODS: We present preliminary data from a single-center cross-sectional analysis of patients diagnosed with Lung Cancer at a safety-net hospital in the South Bronx between July 2022 and June 2024. We analyzed 1592 patients diagnosed with lung nodules/masses at any point of care (Emergency/In-patient/Ambulatory visit). Incidental nodules are determined as nodules identified during evaluation of other diseases excluding malignancy and metastatic diseases. Driver mutations such as EGFR, KRAS, ALK, and ROS were identified with next-generation sequencing. Descriptive and analytical statistics were used to characterize the population data. RESULTS: In our study of 1592 patients, 132 (8%) were newly diagnosed with lung malignancy, out of which 110 (83%) had a history of smoking, and 22 (17%) were nonsmokers. We observed a predominance of Hispanics (55%) and Blacks (36%) with 62% being males. We also noted that 10% had transportation needs, 7% reported food insecurity, followed by poor housing conditions (6%), and financial insecurity (4%) without statistical significance. A solitary lesion was diagnosed in 87% of the patients, with right upper lobe (30%) lesions being most common followed by left upper lobe (22%). Overall 52% of lesions were located in the upper lobes with the odds of developing an upper lobe nodule 6.04 times higher in smokers (p< 0.001). Lung nodules/mass were diagnosed incidentally in 89 (68%) lung cancer patients. On staging we observed that 38 (29%) patients were diagnosed with stage IV disease. Substance-use was identified in 41 patients (30%) with lung cancer. Among non-smokers, 91% had a history of substance-use disorder, whereas this prevalence was 18% among individuals in the smoker group. Driver mutations were tested in 118 patients and 65 (55%) were noted to have a positive result. 53% of smokers had a driver mutation compared to 64% in non-smokers. CONCLUSIONS: Our own hospital data shows that Blacks have a higher prevalence of smoking and COPD. However we observed that the rates of lung cancer were higher in Hispanics compared to Blacks in contrast to national data. Lung cancer was identified in early stages due to incidental findings of lung nodules/mass, aiding in early diagnosis. The non-smoker group exhibited fewer driver mutations compared to the national average, suggesting the need for further investigation into minority populations and environmental factors that may contribute to cancer susceptibility. We observed a predominance of nonsmokers with substance-use, highlighting the need for large-scale studies to explore the association and causality of lung cancer in this group. CLINICAL IMPLICATIONS: Our study highlights the need for large-scale research to explore racial disparities in lung cancer incidence, the impact of environmental factors on non-smokers, the association between substance-use and lung cancer, and the influence of SDoH across diverse populations.

Volume

168

Issue

4S

First Page

4832A

Last Page

4833A

Comments

American College of Chest Physicians CHEST Annual Meeting, October 19-22, 2025, Chicago, IL

DOI

10.1016/j.chest.2025.07.2715

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