CHEST Guidelines-Are-We-There-Yet-

Are-We-There-Yet-_chest (1)

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The article "Are We There Yet? Understanding Differences in Rates of Resection of Clinical Stage I Lung Cancer" by Frank C. Detterbeck examines racial and gender disparities in the surgical resection rates for stage I non-small cell lung cancer (NSCLC) among participants of the National Lung Screening Trial (NLST). Previous studies indicated that black patients with early-stage NSCLC have lower cancer-specific survival rates linked to lower rates of surgical resection. Balekian et al. attempted to address these disparities in a “clean” cohort with minimal confounding factors, such as access to healthcare, by examining data from the NLST, which is composed of individuals presumably healthy and engaged with their health.<br /><br />The study found that black men had significantly lower resection rates (61%) compared to white men (92%), white women (91%), and black women (90%). Logistic regression analysis, controlling for variables such as age, education, and comorbidities, confirmed that black men were 28% less likely to undergo surgery than white men. Despite comprehensive adjustments, the study suggests partial adjustments might have missed critical factors due to variations in tumor characteristics, center-specific resection rates, and cancer detection modes. <br /><br />Detterbeck critiques the study's assumptions and points out the limitations of using multivariate regression analysis, which may not account for all confounding factors. He argues that labeling disparities purely by race oversimplifies the complexities and misses potential causal factors driving differences in resection rates. The study adds to efforts to improve lung cancer outcomes but calls for deeper investigation into the true drivers behind these disparities, attempting to go beyond race as a simplistic marker. This reflects a need for more understanding and appropriate application of advancements in lung cancer treatment.

Keywords

lung cancer

racial disparities

gender disparities

surgical resection

NSCLC

National Lung Screening Trial

black patients

healthcare access

multivariate regression

tumor characteristics