I realize in the defense of the authors that socio-economic issues are not their area of expertise. But their total lack of stating that we have clear issues in our country that leave large areas of poor and under served populations receiving lesser education on medical issues (risk factors would be a prime example), less availability in the black and poor communities of access to medical care let alone early diagnostic screening, and populations with lower economic levels which translate into less ability to get to appropriate early diagnostic and then treatment management, leaves me wondering if they even considered any of this.

They write as if the US is one homogenous, equal opportunity environment, and stating “If we can identify these patients….” amazes me. Go into any undeserved inner city or rural environment and you will find the people that fit your question of who they are - identifying those at risk is not rocket science docs.

And to end all this by stating that identifying them “may improve patient satisfaction” really sits wrong with me, as I daily talk to people who are having worse/increased treatment related morbidity because of delays in diagnosis and treatment, and who are DYING at greater rates that the rest of the population, soly because they are part of thse under served populations. Raising “patient satisfaction” is a ridiculous way of putting this. How about stating this opportunity as raising patient SURVIVAL RATES…. the real issue here. I guarantee you those that are dead, or families who are left behind, are “dissatisfied” with the whole process and their place in it. Seeing them survive will certainly improve their “satisfaction.” There is no question that late diagnosis, and delays in getting to treatment is not always the fault of patients. And it is easily documented by just a cursory look at the SEER numbers that later staging (a result of later discovery and diagnosis as well as treatment delays) yields poorer long term outcomes.