We seem to ask the same questions, I asked her this last week. Her answer was that in almost all patients there are collateral issues that dictate their place on the overall survival curve. Clearly tobacco use diminishes overall health, and impacts our bodies on a cellular level systemically. So that is a biggie. But when you look at any cancer patient, things like age, cardiovascular health, diet, etc. etc. (enter long list of things that we have done wrong, we're doing wrong, co-morbidities, or are just part of our genetic make up) move a particular person up and down the curve of overall survival. Pack years of smoking in this particular study, but likely in all studies that look at survival, diminish it. For sure years out from those pack years help, but they do not wipe it out. It was looked at in this study specifically because of it's enormous impact. But on a positive note that impact was not enough to completely diminish or eliminate the survival advantage of HPV+ status.

Maura crunches numbers because that is the didactic norm to prove something. But I think as a treating physician, which she is besides being a researcher, that her beliefs are less like her papers. She fully understands in my opinion (knowing her some) that individuals are all unique in their response to treatments even with the same etiology, and absolutes are not possible in cancer. A saying that I use all the time, but which she drilled into my science nerd mind 10 years ago. Since trying to wrap my rather small mind around this disease for ten years, the one thing that I have had to come to accept is that for every science or evidence based expectation, there is someone with an exception. Hence my tendency to not speak of things in absolutes in my lectures regardless of what the SEER numbers, a particular study etc. say.