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To the Editor: Dr Mahadevia and colleagues¹ concluded that helical computed tomography (CT) should not be used as a screening tool for lung cancer. They based their conclusion on the results of their cost-effectiveness analysis, which relied on several assumptions about the costs and benefits of helical CT screening. I believe that these assumptions were overly optimistic, however, and that helical CT is thus probably even less effective than the authors conclude.

First, the authors based their analysis on the maximal community effectiveness of helical CT. This is necessarily worse than its efficacy as a screening tool, ie, the maximum possible reduction in mortality achievable in carefully selected patients under ideal settings. Although demonstration of efficacy requires controlled studies, none have been performed to date. However, 2 controlled studies using plain radiographic imaging reported an increased mortality rate in the screened patients.²

Second, screening would be expected to result in . . . [Full Text of this Article]

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