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Mr Dalrymple-Hay and Dr Drury (January 2001 JRSM, pp. 2-5) rightly highlight the deficiencies which have been associated with lung cancer screening programmes and the fact that thus far none of the `tools' have measured up to expectations. One should hardly be surprised that this is the case when many of the investigators have been looking for a single test which has `high sensitivity, specificity and positive predictive value'. Is this not the search for Nirvana?
Regarding the low-dose helical computed tomography (CT) being evaluated by the Early Lung Cancer Action Group, it should be noted that some 50% of lung cancer cases develop within the bronchial tree. It is unlikely such a tumour would be identified by low-dose CT at an early stage; some other methods would be needed to diagnose such tumours. I was therefore surprised that no reference is made in the article to fluorescence bronchoscopy which, when combined with proper sampling and the use of histological and molecular methods, has been shown to have great potential in the screening of high-risk individuals1, particularly when combined with sputum cytology. Whilst this method does not fulfil the criteria for an ideal screening test, it does offer a way forward. Several pilot studies are already in progress throughout the world, including one at the Yorkshire Laser Centre.