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To the Editor: Dr Mahadevia and colleagues¹ concluded that it is probably not cost-effective to use helical CT to screen for lung cancer. This conclusion is based on hypothetical models with many assumptions. Given the high costs of treating lung cancer,² I have argued that screening, or at least case finding, should take place in patients at highest risk, ie, smokers with airflow obstruction.³ It has been reported that the presence of airflow obstruction increases the likelihood of lung cancer by 4- to 6-fold with all other factors being equal.⁴

Although previous studies in the mid 1970s did not show a reduction in cancer mortality, the screened group did have improved survival. Strauss⁵ has criticized several inadequacies of the study design and conclusions.

In a prospective study in a community hospital, patients at highest risk (defined as heavy smoking and airflow obstruction, or an occupational or family history of lung . . . [Full Text of this Article]

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