To the Editor: In the systematic review by Dr Bach and colleagues,1 the American Cancer Society, the American College of Chest Physicians, the American Society of Clinical Oncology, and the National Comprehensive Cancer Network recommended that computed tomography (CT) for lung cancer screening be offered to those meeting National Lung Screening Trial (NLST) criteria. While evidence-based, these criteria limit screening to current or former smokers aged 55 to 74 years with a 30 pack-year or longer history. However, age and pack-years alone are not the best predictors of lung cancer risk.2- 4 Patient selection for CT screening using these 2 criteria results in only a 1% annual detection rate for lung cancer,1 and less than 50% of all those who will develop lung cancer would be eligible for screening.3
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