Gender in idiopathic pulmonary fibrosis diagnosis: time to address unconscious bias

Physicians have long incorporated gender into their diagnostic algorithms of pulmonary disease in an effort to use available clinical clues when a single confirmatory diagnostic test does not exist. Gender is thought to be a relevant patient characteristic in phenotyping lung disease with a female predominance noted in patients with adult-onset asthma and male predominance in idiopathic pulmonary fibrosis (IPF).1 2 Gender also may be of prognostic value in individual patients; severity of asthma is associated with female sex and increased mortality in interstitial lung disease (ILD) with male gender.2 3 While gender may increase diagnostic confidence, if the strength of the gender and disease association is not based on rigorously validated data, inaccurate diagnosis or underdiagnosis may result. In an earlier era, the failure to diagnose COPD in women was associated with gender bias when formally studied.4 More recently, the stereotype of the male smoker with lung cancer has been upended by the surprising data demonstrating higher lung cancer incidence rates in young women as compared with young men, not explained by differences in cigarette smoking.5 In this issue, Dr Assayag and colleagues investigate the role of gender in making a confident diagnosis of IPF, and conclude there is evidence for bias when …