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To the Editor: I concur with Dr Petty¹ regarding lung cancer screening. Epidemiology is important, but it can sometimes obscure variations in individual disease. Survival is not only related to tumor size but also to tumor biology and behavior and individual immune responses.

In my own practice, I have had the opportunity to observe individual variations in the progression of malignant disease. I discovered a solitary 3-cm pulmonary nodule in 1 of my patients when she had a chest radiograph for suspected pneumonia. Needle biopsy was twice unsuccessful, and the patient refused open biopsy and removal. The mass remained stable for 6 years; we congratulated ourselves that this was a benign process. Then the nodule began to grow. In the seventh year after discovery of the nodule, the patient died of lung cancer.

Screening policies by governments or other third parties must be circumspect and based on strong evidence because, . . . [Full Text of this Article]

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