We appreciate the thoughtful comments by Eisenberg et al regarding our article, and agree with their viewpoint that nonbiologic factors, such as socioeconomic status, access to care, social support, living environment, stress management, and other “situational” factors, could have contributed to the apparent racial disparity in the survival of patients with renal cell carcinoma (RCC). Although medullary RCC, an aggressive histologic subtype, occurs predominantly among African Americans with sickle cell trait, it is unlikely that this extremely rare subtype would have a major impact on the overall survival in different racial groups. Hypertension and related nephropathy, which are known risk factors for RCC that are common in African Americans, have been linked to genetic susceptibility, but their role in survival after a diagnosis of RCC is unclear. We agree with Eisenberg et al that a comprehensive examination of interacting factors is needed to fully understand health outcome disparities and to identify targets for intervention.
Supported by the Intramural Research Program of the National Institutes of Health.
CONFLICT OF INTEREST DISCLOSURES
The authors made no disclosures.
Wong-Ho Chow, PhD
Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
W. Marston Linehan, MD
Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
Susan S. Devesa, PhD
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland