Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.
In Reply: The strikingly different arguments
posed by Dr Reich, Dr Petty, and Dr Chirikos and colleagues exemplify the
debate occurring in lung cancer screening with helical CT.
Reich states that our model has an underlying bias favoring screening
and its cost-effectiveness. We did give screening the benefit of the doubt.
For example, in our simulation, the screened group experienced both absolute
and relative differences in stage distribution. The screened group had fewer
advanced-stage cancers with a corresponding increase in the numbers of localized-stage
cancers than the nonscreened group. We then incrementally increased the numbers
of localized-stage cancers by the degree of length and overdiagnosis biases,
which are most prominent in the first year of screening.
Mahadevia PJ, Powe NR. Cost-effectiveness of Screening for Lung Cancer. JAMA. 2003;289(18):2357. doi:10.1001/jama.289.18.2357-a