This audit of secondary care management in Auckland and Northland of lung cancer patients diagnosed in 2004 aimed to assess whether management differences exist according to different ethnic groups, which may contribute to ethnic survival disparities. Of 565 eligible cases, 378 were European (67%), 95 were Mäori (17%), 56 Pacific Peoples (10%), 23 Asian (4%), and 13 other or unknown ethnicity (2%). Multivariate analyses adjusted for tumour and patient factors including comorbidity revealed that Mäori were 2.5 times more likely to have locally advanced disease than localised disease compared with Europeans (p<0.01), and four times less likely to receive curative rather than palliative anticancer treatment compared with Europeans (p<0.01). Mäori had longer transit times from diagnosis to treatment (p<0.001). Mäori were more likely to decline treatment and miss appointments than Europeans, although this only partially explained management differences.