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August 7, 1981

Detection of Lung Cancer

Author Affiliations

Stanford University School of Engineering Stanford, Calif

JAMA. 1981;246(6):621. doi:10.1001/jama.1981.03320060025008

To the Editor.—  In their recent editorial, Fontana and Sanderson (1980; 244:592) questioned the American Cancer Society's (ACS) recent recommendation concerning the use of annual chest x-ray films to screen asymptomatic smokers for lung cancer. While the rationale for the Society's recommendation is described in detail elsewhere,1 Fontana and Sanderson raise several points that deserve specific responses.First, they state that "the chest roentgenogram is much more likely to disclose the presence of curable lung cancer than are symptoms or a physical examination." The ACS is aware that x-ray films can detect cancers in asymptomatic persons and that the cancers often appear to be detected in early stages. The Society is also aware, however, of the many biases that can cause an interpretation of staging information and case-survival rates to overestimate the effectiveness of a screening program. These include the lead-time bias, the length bias, patient-selection bias, and the possibility