{"doi":"10.1093/jnci/djaf082","title":"Response to Zhou, Cui, Sun et al.","abstract":"We are pleased that our study has generated discussion around the need to dismantle barriers to molecular diagnostic testing prior to medical treatment of non-small cell lung cancer, and we thank Dr Pengxiang Zhou and team for their interest in our work.1 Disproportionate uptake of molecular diagnostic testing is an understudied topic, which we’ve attempted to shed light on using the Surveillance, Epidemiology, and End Results (SEER) dataset linked to Medicare claims, a population-based data source covering the elderly US population. Although SEER-Medicare is a powerful resource, potential limitations exist; most of those highlighted by Zhou et al. have already been addressed in our discussion.1 Firstly, receipt of molecular diagnostic testing was based on having a claim for any type of molecular diagnostic test immediately after lung cancer diagnosis, but given the nature of the data, the outcome of this test is unknown. Zhou et al. suggest that defining treatment eligibility based on comprehensive next-generation sequencing (NGS) would be more appropriate,1 however, although undoubtedly more informative, in the United State tumors next-generation sequencing is not standard practice nor would those results be reflected in the type of claims data used for this analysis. Second, an observational study carries the chance of unmeasured confounding; however, information on most of the potential confounders suggested by Zhou et al. is not available in the SEER-Medicare dataset (ie, smoking history, tumor mutation burden) and thus cannot be addressed in this analysis.1 Finally, Zhou et al. suggest that insurance status (private, Medicaid, Medicare) may influence the relationship between race and molecular diagnostic testing;1 although this is possible, this analysis was specifically based on patients covered by Medicare and no health maintenance organization. Granular stratification of patients based on insurance type, tumor characteristics, and health-care facility type may be informative, but unfortunately this is not possible using the SEER-Medicare dataset. In conclusion, SEER-Medicare is a cancer registry database linked to billing claims, with inherent strengths and limitations that we list in our discussion. We encourage Zhou et al. and others to repeat our analyses using datasets from other countries, such as China, to generate data for comparison.","journal":"JNCI Journal of the National Cancer Institute","year":2025,"id":563477,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.947,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1250299,"name":"Wiley M Turner","orcid":null,"position":1,"is_corresponding":false},{"id":385914,"name":"Emanuela Taioli","orcid":"0000-0001-5734-4806","position":2,"is_corresponding":false},{"id":429431,"name":"Stephanie Tuminello","orcid":null,"position":0,"is_corresponding":true}],"reference_count":1,"raw_metadata":null,"created_at":"2026-07-19T02:56:13.374766Z","pmid":"40152257","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}