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To the Editor: We feel obliged to comment on the study of CT screening and lung cancer outcome by Dr Bach and colleagues¹ because we are responsible for the conduct and follow-up of the Italian trial carried out by the European Institute of Oncology, from which data were used in this study.

Their analysis is based on the unproved belief that lung cancers can be divided into 2 distinct groups of indolent and aggressive tumors, while lung cancer aggressiveness is largely correlated, on a continuous scale, to the size of the tumor.² Aggregating stage III with stage IV tumors also constitutes an arbitrary oversimplification since patients with stage III tumors and minimal nodal invasion are amenable to curative treatment.³

In addition, the prediction model derives from data from the Beta-Carotene and Retinol Efficacy Trial (CARET), which was conducted in the United States from 1989-1994. Since then, cardiovascular mortality, which constitutes . . . [Full Text of this Article]

Lorenzo Spaggiari, PhD; Giulia Veronesi, MD
giulia.veronesi@ieo.it

Massimo Bellomi, PhD; Patrick Maisonneuve, Eng
European Institute of Oncology
Milan, Italy

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