Letters Section Editor: Jody W. Zylke, MD, Senior Editor.
Author Affiliations: Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (Drs Mets and de Jong) (firstname.lastname@example.org); and Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (Dr Prokop).
In Reply: The comments by Dr Huesch and colleagues and Dr Wittig address important concerns about screening in smokers and the technical limitations of CT. Screening in current and former smokers is challenging because smoking cessation is the most effective tool for risk reduction, be it cancer risk, cardiovascular risk, or progression of COPD. This potentially makes a negative outcome of screening counterproductive because it might be viewed as an incentive to continue smoking. However, smoking cessation remains difficult in any setting. Adherence is low and the outcome of screening has little long-term influence on smoking behavior.1
Mets OM, de Jong PA, Prokop M. Evaluating Other Diseases With Computed Tomographic Screening for Lung Cancer—Reply. JAMA. 2013;309(7):655-656. doi:10.1001/jama.2012.157211