Lung cancer screening.

In the April 14 editorial, Matthew Stanbrook and Ken Flegel accused the Lung Cancer Alliance of having promoted screening with computed tomography (CT) for lung cancer. Our position is that people at high risk for lung cancer should speak with their physicians about the risks and benefits of CT scanning; we do not advocate population-based screening. We have advocated strongly for research funding to find a simple biomarker to further refine the optimal population subset for CT scanning. Stanbrook and Flegel stated that “targeting smoking avoidance and cessation, rather than detection and management of lung cancer, would seem a better investment” at present. Sadly, this statement ignores the fact that over 50% of lung cancer diagnoses are in people who quit smoking before their diagnosis; many had quit decades earlier. Another 15%–20% of patients with lung cancer have never smoked. Any analysis of investments concerning lung cancer is incomplete and suspect if it does not consider these patients.