To the Editor: The cohort study by Dr Cykert and colleagues1 investigated the decision to undergo surgery for patients with early-stage lung cancer. It may have underemphasized one of the more significant factors contributing to the poorer outcomes seen in African American patients.
There is a belief that exposure to air during surgery spreads lung cancer, perhaps the most common misconception about cancer in the United States.2 The study by Cykert et al noted in Table 3 that this belief was associated with a statistically significant lower proportion of participants who actually underwent surgery, much as we observed in a previous study.3 However, in Table 4 it appears that the authors found that this association was present only in white patients, not in African American patients, a finding that seems to contradict our multicenter study.
Margolis M, Kaiser L, Christie J. Patient Decisions to Undergo Surgery for Early-Stage Lung Cancer. JAMA. 2010;304(11):1165. doi:10.1001/jama.2010.1311