Ann Thorac Surg 2004;78:215
© 2004 The Society of Thoracic Surgeons
Invited commentary
Douglas Mathisen, MD
General Thoracic Surgical Unit, Massachusetts General Hospital, 55 Fruit St, Blake 1570, Boston, MA 02114-2696, USA
e-mail: dmathisen{at}partners.org
Lung cancer is the leading cause of cancer deaths in men and women in the United States. Overall, survival has gradually increased over the last 40 years, but remains at a disappointing low level around 15%. Many would argue that despite the high frequency and lethal nature of lung cancer, it has attracted far too little attention, research dollars, and screening programs compared to less common and less lethal malignancies.
Even the most basic issues still lack clarity. Visbal and colleagues have conducted a careful, thorough, and prospective study to answer a basic question regarding nonsmall lung cancer (NSCLC): Is there a gender difference in survival? In their study population of mostly Caucasian (96%) patients from a major tertiary referral center, gender did have a negative impact on survival for men. Having answered the question, the real challenge is "why", being able to answer this, however, is the more important question.
One must be certain that there is not some inherent bias in their study such as the impact of referrals to their institution, cumulative smoke exposure, smoking habits, or health care habits of men versus women. It will be important to determine if there is a genetic, hormonal, or biologic explanation for a gender difference in survival for NSCLC. If there is a real gender difference, then finding the "why" may unlock some of the secrets of lung cancer that may improve our understanding and ultimately our treatment of this deadly disease.
