Racial and ethnic disparities in lung cancer incidence and/or mortality remain a significant health care concern. Despite attempts at corrective measures, these disparities persist. Identifying the etiologies leading to cancer disparities, especially for patients with lung cancer, would improve the quality of life for millions of Americans, reduce human and health care costs, and improve health care delivery on a national scale. Potential causes to consider include access to care, environmental agents, molecular factors, and social contexts. In our analysis, it is important to emphasize that we sought to utilize the Survival, Epidemiology, and End Results (SEER) database to investigate a clinically relevant scenario1-5 regarding care for patients with lung cancer and understand what conclusion might be made from such a group. As in any analysis attempting to understand these factors, we recognize that a complex interaction of multiple variables and potential confounders is present.

Both Lin-Gomez et al and Pinheiro discuss the methods used, and are appropriate for doing so. They raise the epidemiologic argument that analysis of incomplete data should be included because missing data might be a potential indication of disparities. In our analysis, we excluded patients with incomplete information regarding staging, place of birth, and treatment. The intention of our analysis was to address a clinically relevant scenario, not a pure epidemiologic question. Furthermore, we included only certain histological subtypes that were consistent with the clinically relevant scenario of nonsmall cell lung cancer encountered by clinicians. The analysis as reported allowed for an accurate examination of therapies and outcomes. A complete description of the methods is limited by the word count in the article and further description of the patient selection used is worthwhile. Nonetheless, clinical analyses performed without carefully selected inclusion and exclusion criteria are subject to the bias. Our conclusion remains correct that for treated patients, based on an analysis of the SEER database, Hispanic ethnicity may be associated with an improved outcome.

Nonetheless, given that the study remains retrospective in nature, the findings are hypothesis-generating and need to be confirmed by future studies. In the last 10 years, studies have identified several critical molecular pathways involved in NSCLC.6, 7 We have initiated funded research studies to further investigate a panel of genomic markers within the NSCLC patients treated at our institution. We believe one important way to eliminate cancer disparities will be through the development of individualized treatment paradigms that account for all potential treatment-related factors.


Supported in part by a grant from the James and Esther King Grant Foundation (3KN03) and a Florida Biomedical grant.


The authors made no disclosures.


  1. Top of page
  • 1
    Saeed AM, Toonkel R, Glassberg MK, et al. The influence of Hispanic ethnicity on nonsmall cell lung cancer histology and patient survival: an analysis of the Survival, Epidemiology, and End Results database. Cancer. 2012;118:4495-4501.
  • 2
    Lally BE, Detterbeck FC, Geiger AM, et al. The risk of death from heart disease in patients with nonsmall cell lung cancer who receive postoperative radiotherapy: analysis of the Surveillance, Epidemiology, and End Results database. Cancer. 2007; 110: 911-917.
  • 3
    Lally BE, Geiger AM, Urbanic JJ, et al. Trends in the outcomes for patients with limited stage small cell lung cancer: an analysis of the Surveillance, Epidemiology, and End Results database. Lung Cancer. 2009; 64: 226-231.
  • 4
    Lally BE, Wright JL, Koniaris LG, et al. Is radiation therapy becoming more effective in treating non-small cell lung cancer? Int J Radiat Oncol Biol Phys. 2010; 78(3 suppl): S201.
  • 5
    Lally BE, Zelterman D, Colasanto JM, Haffty BG, Detterbeck FC, Wilson LD. Postoperative radiotherapy for stage II or III non-small-cell lung cancer using the surveillance, epidemiology, and end results database. J Clin Oncol. 2006; 24: 2998-3006.
  • 6
    Olaussen KA, Dunant A, Fouret P, et al; IALT Bio Investigators. DNA repair by ERCC1 in non-small-cell lung cancer and cisplatin-based adjuvant chemotherapy. N Engl J Med. 2006; 355: 983-991.
  • 7
    Zheng Z, Chen T, Li X, Haura E, Sharma A, Bepler G. DNA synthesis and repair genes RRM1 and ERCC1 in lung cancer. N Engl J Med. 2007; 356: 800-808.

Brian E. Lally MD*, Jennifer J. Hu PhD†, Leonidas Koniaris MD‡, * Department of Radiation Oncology, Miller School of Medicine, University of Miami, Miami, Florida, † Department of Epidemiology and Public Health, Miller School of Medicine, University of Miami, Miami, Florida, ‡ Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania