Three decades later, racial gaps in curative lung cancer care persist in Medicare

When lung cancer is caught early, it can often be cured. But a study published online on March 2, 2026, in JAMA Network Open suggests that not all Medicare beneficiaries have equal access to those potentially life-saving treatments. Black patients with early-stage non-small cell lung cancer (NSCLC) were consistently less likely than White patients to receive curative therapy, and the gap has narrowed only modestly over the past three decades.

For early-stage NSCLC, defined as Stage 1 or 2 disease, curative surgery has long been the standard of care. Over the past 20 years, however, radiotherapy — particularly stereotactic body radiotherapy (SBRT) — has emerged as an effective alternative for certain patients. Because Medicare covers nearly all Americans age 65 years and older, prior findings of racial disparities in this population have raised concerns about structural barriers in healthcare delivery rather than insurance access alone.

Olivia F. Lynch, M.D., M.P.H., of the National Clinician Scholars Program at Yale School of Medicine and colleagues analyzed data from the Surveillance, Epidemiology, and End Results (SEER) Medicare-linked database. The retrospective cohort study included 28,287 non-Hispanic Black and non-Hispanic White beneficiaries ages 66 to 85 years diagnosed with Stage 1 or 2 NSCLC during three periods: 2005 to 2007; 2011 to 2013; and 2017 to 2019.

The primary outcome was receipt of any curative treatment, defined as surgery or radiotherapy. The investigators also examined receipt of surgery and radiotherapy separately and assessed use of preferred modalities: lobectomy among surgical patients and SBRT among those receiving radiotherapy.

Overall, 82.3% of patients received curative treatment. However, adjusted probabilities were significantly lower for Black beneficiaries in each time period studied. From 2005 to 2007, 73.9% of Black patients received curative therapy compared with 83.3% of White patients, a difference of 9.4 percentage points From 2011 to 2013, the rates were 76.3% vs 85.2%, a difference of 8.9 percentage points. And from 2017 to 2019, 78.4% of Black patients received curative treatment compared with 86.8% of White patients, a difference of 8.4 percentage points.

The differences in surgery were largely responsible for disparities in curative treatment. In 2005 to 2007, 52.3% of Black patients underwent surgery compared with 65.9% of White patients. Similar differences persisted in subsequent periods. In contrast, overall receipt of radiotherapy was not consistently different by race.

SBRT use increased sharply over time. During its early adoption, from 2011 to 2013, 39.6% of Black patients receiving radiotherapy underwent SBRT compared with 51.6% of White patients. By 2017 to 2019, that disparity was no longer statistically significant. Among patients who underwent surgery, receipt of lobectomy did not differ meaningfully by race.

In the discussion part of the paper, Lynch and colleagues write that the “persistence of disparities is particularly concerning given the substantial attention devoted to rectifying these differences over time.” Despite national public health initiatives and advocacy efforts dating back to the early 2000s, they report that racial differences in receipt of lung cancer treatment have narrowed by only approximately 4% over 30 years.

The authors note several limitations. The study was restricted to fee-for-service Medicare beneficiaries ages 65 years and older and may underestimate disparities in younger populations or those with other types of coverage. Administrative claims data may not fully capture frailty, comorbidities or the nuanced factors that influence treatment decisions. The analysis also could not directly assess structural barriers such as surgeon availability, transportation challenges or social support.

Even so, the findings suggest that expanding treatment options alone does not ensure equitable access. As new modalities emerge and standards evolve, the researchers conclude that addressing structural barriers within healthcare systems will be critical to narrowing persistent racial gaps in curative lung cancer care.