In a recent review of the roles of elastase in lung cancer, Sun and Yang (2004) posed the question of “why there are more neutrophils or released neutrophil elastase in aggressive or late-stage tumours compared with less aggressive or early stage tumours?” They also pointed to the fact that the interplay between elastase and alpha-1-antitrypsin, rather than each one individually, needs to be addressed. This evidence concerns the gene SERPINA1 and lung cancer.