This Article Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Patz, E. F. Articles by Herndon, J. E. Search for Related Content PubMed Articles by Patz, E. F., Jr Articles by Herndon, J. E., II Related Articles Related Correspondence Social Bookmarking                            What's this?

In Reply:

Duke University Medical Center, Durham, NC

Stephen J. Swensen

Mayo Clinic, Department of Radiology, Rochester, MN

James E. Herndon, II

Duke University Medical Center, Durham, NC

After carefully considering all of the issues involved in computed tomography screening for lung cancer, we believe we constructed an accurate and conservative model. We did not estimate the 5-year survival as stated by Dr Grannis, but used published survival data to estimate mortality. Dr Grannis's suggestion that we use previously published stage IA survival statistics for the current study clearly reflects his misunderstanding of the model, and the importance of using stage-specific survival rates. The previous manuscript by two of the authors (E.F.P. and J.E.H.)¹ addressed a very different issue, correlating tumor size to survival in patients with stage IA disease only. No other stages were evaluated. Thus, it would have been impossible to use these limited data for the current study. It is completely inappropriate to uniformly apply stage IA survival data to all other stages, which has resulted in Dr Grannis's incorrect estimate of the overall mortality.

In fact, if he had changed the survival probability for the stage IA patients only using data from that previous study, there would be a negligible effect on lung cancer mortality, because most of the deaths in these trials will be of patients with advanced stage disease. As stated in this and other manuscripts,² to see a meaningful reduction in mortality, a stage shift must be demonstrated. The principle of stage shift not only requires an increased number of patients with early-stage disease but also obligates a concomitant decrease in advanced-stage disease. Although all trials have reported an increased percentage of early-stage lung cancer, more importantly, none have shown a reduction in advanced stages, and without this decrease there will be no significant improvement in mortality.

As we declared when submitting this manuscript, none of the authors have a real or potential conflict of interest. None of these authors have testified in any class action suit nor served as an expert witness for the tobacco industry. Dr Patz never received any funding from the tobacco industry, and while Duke University (Durham, NC) may have received research dollars from The Tobacco Institute in 1986, that donation was received well before any of the authors were even employed by Duke University Medical Center, and none of the authors have ever received any support from said research funds. Further investigation of the Tobacco Institute Web site (http://www.tobaccoinstitute.com) demonstrates that the Industry Support of Biomedical Research, 1986 document referred to in Dr Grannis's letter³ reports funding many universities and hospitals in the United States. Given the comments in his letter, it is astonishing to us that Dr Grannis failed to acknowledge that even his own institution, the City of Hope Hospital (Duarte, CA), was listed as one of the recipients of these Tobacco Institute research funds.⁴ We confirm no conflict of interest.

Authors' Disclosures of Potential Conflicts of Interest

The authors indicated no potential conflicts of interest.

REFERENCES

1. Patz EF Jr, Rossi S, Harpole Jr DH, et al: Correlation of tumor size and survival in patients with stage IA non–small-cell lung cancer. Chest 117:1568-1571, 2000[Abstract/Free Full Text]

2. Patz EF Jr, Goodman PC, Bepler G: Screening for lung cancer. N Engl J Med 343:1627-1633, 2000[Free Full Text]

3. The Tobacco Institute: The Tobacco Institute, Industry Support of Biomedical Research 1986. http://legacy.library.ucsf.edu/cgi/getdoc?tid=ueq91f00&fmt=pdf&ref=results

4. The Tobacco Institute: The Tobacco Institute, Industry Support of Biomedical Research 1986. http://www.tobaccoinstitute.com/getimg.asp?if=avtidx&DOCID=TITX0027186/7192&PGNO=TITX0810.36&docnum=2&START=0&BOOL=industry+support+of+biomedical+research

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

Related Correspondence

• Overestimation of Lung Cancer Mortality in a Computed Tomography–Screened Population
  Frederic W. Grannis
  JCO 2005 23: 2439-2440 [Full Text]
• Overestimation of Lung Cancer Mortality in a Computed Tomography–Screened Population
  Frederic W. Grannis
  JCO 2005 23: 2439-2440 [Full Text]

This Article Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Patz, E. F. Articles by Herndon, J. E. Search for Related Content PubMed Articles by Patz, E. F., Jr Articles by Herndon, J. E., II Related Articles Related Correspondence Social Bookmarking                            What's this?