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To the Editor: We believe that the conclusion reached by Dr Bach and colleagues¹ was based on an analysis that was flawed due to inadequate exclusion of participants. If only 5 of the 39 deaths had been excluded, this would have resulted in the observed number of deaths being statistically significantly lower than that predicted by their model, leading to a conclusion of reduced mortality.

Of the 39 observed deaths they reported, 13 were from the Moffitt Cancer Center trial. Because of our involvement at the coordinating center of the International Early Lung Cancer Action Program (I-ELCAP) study, we are aware that some of the enrollees of the Moffitt Cancer Center were actually symptomatic and may have had lung cancer at baseline (data from US Department of Defense Grant [DAMD17-98-1-8659; principal investigator, M. Tockman] sent to the I-ELCAP Coordinating Center [IRB 0109005105; principal investigator, C. Henschke, 2002; http://www.IELCAP.org]). Also, . . . [Full Text of this Article]

Claudia I. Henschke, PhD, MD
chensch@med.cornell.edu

David Yankelevitz, MD
Department of Radiology
Weill Medical College of Cornell University
New York, New York

James P. Smith, MD
Division of Pulmonary and Critical Care Medicine
New York Presbyterian Weill Cornell Medical Center
New York

Olli S. Miettinen, MD, PhD
Department of Epidemiology, Biostatistics, and Occupational Health
Department of Medicine
Faculty of Medicine
McGill University
Montreal, Quebec

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