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Background: Patients at the Philadelphia Veterans Affairs Medical Center frequently voice concern that air exposure during lung cancer surgery might cause tumor spread. Several African-American patients asserted that this belief was common in the African- American community. Objective: To assess the prevalence of the belief that air expo- sure during lung cancer surgery might cause tumor spread and gauge the influence of this belief on the willingness of African- American and white patients to have lung cancer surgery. Design: Prospective questionnaire survey. Setting: Philadelphia Veterans Affairs Medical Center and University of Pennsylvania, Philadelphia, Pennsylvania; Los Angeles Veterans Affairs Medical Center, Los Angeles, California; and Medical University of South Carolina, Charleston, South Carolina. Patients: 626 consecutive patients in pulmonary and lung cancer clinics. Measurements: None. Results: 38% of patients (61% of whom were African American and 29% of whom were white) stated that they believe air expo- sure at surgery causes tumor spread. The most significant predictor of belief was African-American race (odds ratio, 3.5 [95% CI, 1.9 to 6.5]), even after controlling for other relevant variables in a multivariable analysis. Nineteen percent of African Americans stated that this belief was a reason for opposing surgery, and 14% would not accept their physicians' assertion that the belief is false. These rates were also statistically significantly higher among African-American than white patients. Conclusions: Belief in accelerated tumor spread at surgery is prevalent among general pulmonary outpatients and lung cancer clinic patients facing lung surgery, particularly among African- American patients. Our findings may pertain to key racial disparities in lung cancer surgery and survival rates and suggest. [ABSTRACT FROM AUTHOR]