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In Reply: The comments of Drs Gopal and Budoff concern the use of cardiac CT for lung cancer screening, an indication that we did not examine. We acknowledge the important additional strengths of the National Lung Screening Trial design highlighted by Drs Berg and Aberle.

Dr Spaggiari and colleagues misstate our findings: we did not observe a reduction in lung cancer mortality in association with CT screening. The theory that there exists "indolent" lung cancer is an explanation for our findings, not one on which our analysis is based. Changing patterns of competing risks affect projections of the length of time an individual will be "at risk,"^1-2 but in our analysis, the length of time each individual was at risk was known. Our mortality model was validated in women after we raised a concern about this issue.^2-3 Further refinements to our predictions of stage-specific or surgical outcomes, or to our . . . [Full Text of this Article]

Peter B. Bach, MD, MAPP
Department of Epidemiology and Biostatistics
Memorial Sloan-Kettering Cancer Center
New York, New York

James R. Jett, MD
Division of Pulmonary Medicine and Oncology
Mayo Clinic
Rochester, Minnesota

Ugo Pastorino, MD
Division of Thoracic Surgery
Istituto Tumori
Milan, Italy

Melvyn S. Tockman, MD, PhD
Department of Cancer Prevention and Control
Moffitt Cancer Center
Tampa, Florida

Stephen J. Swensen, MD, MMM
Department of Radiology
Mayo Clinic

Colin B. Begg, PhD
Department of Epidemiology and Biostatistics
Memorial Sloan-Kettering Cancer Center

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