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October 3, 2012

Computed Tomographic Screening for Lung Cancer—Reply

Author Affiliations

Letters Section Editor: Jody W. Zylke, MD, Senior Editor.

Author Affiliation: Memorial Sloan-Kettering Cancer Center, New York, New York (bachp@mskcc.org).

JAMA. 2012;308(13):1320-1321. doi:10.1001/2012.jama.11898

In Reply: My colleagues and I believe that it is crucial to focus guidelines on what is known from the evidence. The review noted the characteristics of individuals for whom low-dose CT screening has been shown to reduce mortality. Dr Young and colleagues propose using a risk prediction model to select individuals for screening instead of using the characteristics of the individuals who have been studied.

While risk prediction is an intriguing area of research, Young and colleagues' approach may overlook important factors in the risk-benefit calculus.1 For instance, while identifying patients at increased risk of cancer is important (ie, these are the individuals who may benefit from screening), there are factors other than risk to consider when determining the magnitude of the expected benefits and risks.

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