Background: Cancer is the leading cause of death in Asian Americans (AA), the fastest growing racial/ethnic group in the US. Lung cancer is a leading cancer diagnosis and cause of cancer death in AA. Yet data on the quality of lung cancer care in AA are limited. This retrospective study examines racial disparities in lung cancer care at an urban academic medical center serving a large proportion of Asian patients. Methods: Newly diagnosed patients with lung cancer from 01/01/2014 to 12/31/2019 were identified in the Tufts Medical Center cancer registry; clinical data were collected through 05/31/2022. Patient demographics, smoking status, utilization of screening low dose CT (LDCT), disease characteristics (diagnosis stage, histology, driver mutation presence), and treatment history were compared between Asian and White patients. The influence of race on presenting stage was evaluated via ordinal logistic regression. Time to treatment initiation (TTI) and overall survival (OS) in Asian and White patients were analyzed via log-rank tests. Multivariable Cox regression adjusting for baseline patient characteristics, tumor histology and stage was performed to evaluate the impact of race on OS. Results: Of 145 Asian and 476 White patients, the Asian cohort had significantly (p < 0.001) older age (72 vs 68 years), more male representation (74.5% vs 43.9%) and never-smokers (31.0% vs 9.7%). Of 45 Asian never-smokers, women comprised 75.6%. Of 216 patients eligible for lung cancer screening by the 2013 USPSTF criteria, the Asian cohort had relatively lower LDCT utilization (11.9% vs 21.3%, p = 0.198). Asians were 2.13 times (p = 0.003) more likely to be diagnosed with lung cancer at a later stage than White patients, adjusting for age, sex, income, smoking status, and histology. No difference was found in presence of CNS metastasis at diagnosis. Driver mutations were more often found in Asians (45.5% vs 29.4%). Of 206 patients with detected oncogenic mutations, EGFR alterations comprised 62.1% vs 15.0% in Asian and White cohorts, respectively. Asian patients had longer median TTI (1.13 vs 0.83 months, p = 0.005) and more often did not receive cancer directed therapy (12.6% vs 6.1%, p = 0.016). Of 536 patients who received cancer directed therapy, Asians more often received upfront targeted therapy (16.1% vs 2.2%, p < 0.001). No difference was seen in median OS between Asian and White (not reached vs 78.43 months, p = 0.410). Multivariable Cox regression suggested that Asians tended toward better OS (hazard ratio = 0.66, p = 0.091). Conclusions: This study done in Boston shows that Asian patients are diagnosed with lung cancer at more advanced stages and experience longer delays prior to treatment initiation, compared to White patients. Racial disparities persist in lung cancer care, particularly in detection/diagnosis and early management. Yet Asian patients, in aggregate, do not have inferior survival, warranting further research.