Earlier Diagnosis Not Self-Evidently Beneficial: Natural History of Subcentimeter Lung Cancers.

We estimated the natural history of subcentimeter stage I non-small cell lung cancers detected on screening CT using a computed mean 230-day tumor volume doubling time and exponential growth. We found that the majority of patients with subcentimeter, non-small cell lung cancers would survive for more than 5 years without treatment. The benefit of cancer interdiction would be offset to some extent by the combined effects of surgical mortality and materially diminished longer-term disease-free survival among the more than 40% of patients who would be overdiagnosed.

Current Controversies in Cardiothoracic Imaging: Low-dose Computerized Tomographic Overdiagnosis of Lung Cancer is Substantial; Its Consequences are Underappreciated-Point.

Lung cancer seems an ideal screening candidate because of its frequency and lethality, its well-known risk factors, and because it can often be identified at a curable stage with noninvasive procedures. The lethality of clinically diagnosed lung cancers rendered the possibility of material overdiagnosis (OD) (by means of screening) implausible in the judgment of experienced clinicians. Increased experience with lung cancer screening trials, which showed an excess of cases in screened versus control cohorts, led to broader acceptance of its existence.

Erratum to inequivalence of non-aggressiveness in clinically diagnosed lung cancers and overdiagnosis in lung cancer screening trials.

[This corrects the article DOI: 10.21037/jtd.2018.

In Defense of Lady Windermere Syndrome.

Defense of Lady Windermere Syndrome (LWS) provides a critical analysis of its proposed pathogenesis, evidence supporting a causal role of volitional cough suppression, pathogenesis of M. avium complex (MAC) superimposition, a defense of the eponym, and cites a possible contribution of LWS to the bronchiectasis population.

Five reasons for caution in advocating low-dose computerized tomographic lung cancer screening.

The 53.5K-person, low-dose computerized tomographic (LDCT), National Lung Cancer Screening Trial (NLST) achieved a 20% reduction in lung cancer mortality and a 6.7% reduction in all-cause mortality at 6.

Diminished Susceptibility of African-Americans to Non-tuberculous Mycobacterial Disease.

The incidence of three granulomatous response diseases-sarcoidosis, tuberculosis, and non-tuberculous mycobacterial pulmonary disease-differ markedly in African-Americans versus Caucasians. In reviewing a large compendium of non-cystic-fibrosis bronchiectasis, we noted that complicating infection with non-tuberculous mycobacteria was relatively infrequent among individuals of African-American descent, confirming previous observations of their inherent resistance. Disease-specific variance among African-Americans in the efficacy of their granulomatous response suggests a nexus, a mediating, immunological mechanism.

Anomalies in the dominant sarcoidosis paradigm justify its displacement.

The prevailing paradigm defines sarcoidosis as a disease of unknown etiology characterized by a systemic noncaseating epithelioid granulomatous response (SGR). This formulation fails to account for the elusiveness of the etiological agent, the nature of the Kveim response, the paradox of cutaneous delayed type hypersensitivity anergy in a setting of intense immune response and the appearance of SGR, indistinguishable from sarcoidosis, in persons with lymphohematogenous and solid neoplasms and a variety of cellular immune deficiencies. Displacing this formulation with an evidence-based alternative in which the SGR is viewed as an etiologically diverse, primitive immunological fallback due to inefficient cellular immune processing eliminates these shortcomings, providing a unifying accounting for the puzzles and violations of expectations associated with the prevailing paradigm.

The National Lung Screening Trial Premise of Null and Chest Radiography Equivalence Is Open to Question.

Objective: Lung cancer screening guidelines are based on the National Lung Screening Trial (NLST) that used chest radiographic control subjects on the premise of the reported mortality equivalence in chest radiography versus unscreened persons in the NLST-eligible subgroup of the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial. The purpose of this article is to discuss concerns regarding the validity of the NLST premise of chest radiography and null screening equivalence.

Conclusion: Anomalous findings combined with the failure of CT trials using unscreened control subjects to replicate the benefits of the NLST open to question the validity of this premise.

Diminished Disease-Free Survival After Lobectomy: Screening Implications.

Background: The aim of this study was to estimate the effect of lobectomy on life expectancy in healthy smokers and consider the implications for lung cancer screening.

Materials And Methods: In a retrospective cohort study that provided a minimum of 15 years of follow-up, we analyzed lung cancer survival, all-cause survival, and fatality (1-survival) of 261 persons with stage I non-small-cell lung cancer who underwent lobectomy at Portland Providence Medical Center between 1978 and 1994. We: (1) compared 5-year disease-free fatality (non-lung-cancer fatality) with lung cancer fatality; and (2) based on actuarial data that demonstrated life expectancy equivalence of the healthiest smokers (whom we assumed would be comparable with subjects judged eligible for lobectomy) in the US population, we compared their long-term, disease-free survival (our primary end point) with actuarial expectations by computing the Kaplan-Meier survival function of the differences between lifetimes since surgery in disease-free persons versus matched, expected remaining lifetimes in the US population.