Everyday Health: Working to Reduce Lung Cancer’s Impact on Hard-Hit Communities

From Everyday Health: Something seemed very wrong to Carmen Guerra, MD. It was 1996. She was a newly minted primary care physician practicing at the University of Pennsylvania Medical Center in Philadelphia, and her Black patients were being diagnosed with lung cancer at a higher rate than her white patients. Equally distressing, even when their ages and general health were similar, her Black patients were far likelier than her white patients to die from the disease, which had a dismal five-year survival rate of 18 percent to begin with. It was a revelation and a life-changer. Dr. Guerra retooled her career to address the problem. Today, armed with a master’s degree in clinical epidemiology alongside her other medical credentials, she battles health disparities at a lung cancer ground zero: a West Philadelphia community where it’s often the environments in which people live, work, and otherwise function (also known as the social determinants of health) that threaten their health and well-being. As part of Closing the Cancer Gap, a continuing series on cancer disparities, Guerra explains how her own background — the environments in which she lived and learned — informed her lifelong mission: to bring the best, most equitable lung cancer screening and treatment to everyone. This interview has been edited for length and clarity.  Everyday Health: Your family endured considerable hardships emigrating from Honduras. How did that affect you? Carmen Guerra: My family left Honduras for New York with limited resources, little familiarity with the United States, and no English. I remember being yanked out of my country and facing poverty, discrimination, and the feeling of being an outsider in America. For the first months in the United States, we experienced what is now called “housing insecurity” as my parents and I crashed on relatives’ sofas and crowded into small apartments in Queens, New York. The situation made accessing consistent family healthcare difficult. My father eventually found a job as a maintenance worker, and my mother worked as a house cleaner. Both had sixth-grade educations. Gradually, they saved enough to find an apartment and begin to dream about one day sending me to college. EH: How did your school experience lead to medical school? CG: In the beginning, I was constantly picked on because I didn’t speak English. I learned the language pretty quickly, but those early days always affected my self-confidence, even after I began to do quite well in school. I considered becoming, for example, the very first person in my family to go to college, but I wasn’t sure I could succeed. So I applied to the closest community college, a few blocks away. When my adviser found out, he scolded me. He said I could do better and should aim higher, since I was a good student. I applied to New York University, was accepted, and earned an undergraduate degree in psychobiology. Twenty years later, when I wanted a master’s degree in epidemiology, I attended the University of Pennsylvania. By then, I’d long ago finished medical school at the University of Rochester in upstate New York, which I discovered — would you believe — from a New York City subway tile, and I’d joined UPenn’s Perelman School of Medicine. EH: Why the focus on lung cancer inequities? CG: Partially because I grew up around a smoker, my father. When he was found deceased of unknown causes in Honduras, I suspected that smoking played a role. Partially because I was surprised about the percentage of my Black patients diagnosed with lung cancer. Even when their ages and general health seemed similar, these people had more lung cancers, were sicker, and had more advanced disease than white patients. I wanted to understand why and how to help. Read more at Everyday Health.