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To the Editor: The I-ELCAP investigators¹ reported the results of a cross-sectional analysis of their series of 16 925 healthy smokers who underwent CT screening. This analysis indicated a higher prevalence of screen-detected lung cancers in women than in men. A prospective analysis indicated increased survival in women with lung cancer compared with men who had lung cancer. The authors interpret their findings as evidence that women are more susceptible to the carcinogenic effect of tobacco smoke on the lung.

There are alternative explanations for these results. The clinical relevance of the pulmonary nodules detected via CT screening has not been confirmed, so these findings may represent overdiagnosis of lesions that would not evolve into clinically important life-threatening tumors.² The prevalence of detection of such clinically irrelevant lesions might be higher in women than in men, either because of actual differences in their prevalence or because of characteristics of the screening . . . [Full Text of this Article]

Paolo Boffetta, MD, MPH
boffetta@iarc.fr
International Agency for Research on Cancer
Lyon, France

Robert E. Tarone, PhD; William J. Blot, PhD
International Epidemiology Institute
Rockville, Md

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