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Lung Cancer Chemoprevention with Inhaled Corticosteroids?

We appreciate the comments on our article (1) by Drs. Kahn and Agarwal. As described in our Methods, we assessed the reliability of our outcome measure based on a similar group of patients and found a high degree of reliability between our assessment of outcome and histological confirmation of lung cancer and/or enlarging chest mass consistent with lung cancer (1). In addition, as detailed in the article, because of concern of misclassification relating to cohort identification, we performed a series of sensitivity analyses and found that our estimates were robust to changes in cohort definition. Also, as described in the article, the decision was made to divide the cohort so that roughly equal proportions of subjects would be in each stratum. This decision was made a priori and corresponded to an exposure level of 1,200 µg/day of triamcinolone equivalents. Finally, the interpretation of the confidence intervals simply reflects that there is a 95% probability that the true effect is within a given range and has little to do with the clinical relevance of the finding.

David H. Au

VA Puget Sound Health Care System
and
University of Washington
Seattle, Washington

Jason W. Chien

University of Washington
and
Fred Hutchinson Cancer Research Center
Seattle, Washington

Christopher L. Bryson

VA Puget Sound Health Care System
and
University of Washington
Seattle, Washington

FOOTNOTES

Conflict of Interest Statement: None of the authors has a financial relationship with a commercial entity that has an interest in the subject of this manuscript.

REFERENCES

1. Parimon T, Chien JW, Bryson CL, McDonell MB, Udris EM, Au DH. Inhaled corticosteroids and risk of lung cancer among patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2007;175:712–719.[Abstract/Free Full Text]

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