Reply: persistent racial disparities in lung cancer survival and the overlooked role of post-treatment care

We thank Gao and Tsai for their thoughtful response to our report on racial/ethnic disparities in non–small cell lung cancer mortality.1 We agree that the Black–White survival divergence, most evident after initial therapy, suggests that disparities extend beyond diagnosis and first-line treatment. While our analysis highlighted stage at diagnosis and access to surgery as key contributors, the delayed increase in risk is indeed consistent with disparities in follow-up, recurrence detection and comorbidity management. Although detailed post-treatment data were unavailable in SEER (Surveillance, Epidemiology, and End Results), we employed the Fine and Gray model to account for competing risks such as cardiovascular death, acknowledging that comorbidity burdens differ by race. Future research linking cancer registries with claims data will be essential to fully address survivorship care disparities.2 We also appreciate their emphasis on absolute versus relative disparities. Even modest absolute excess risk can translate into substantial numbers of additional deaths in a high-incidence cancer. In our study, relative hazard ratios for Black patients modestly attenuated over time, yet absolute 5-year cumulative mortality differences widened in recent periods—highlighting the policy relevance of absolute risk metrics for screening, follow-up and survivorship planning.