LETTERS AND COMMENTS Perspectives on Lung Cancer TO THE EDITOR: I trust the title "Lung Cancer: Perspec- tives and Prospects " (ANNALS, 73:1003-1024, 1970)

was chosen tongue-in-cheek. An excellent article but one that should either have appeared in The Journal of Negative Results or perhaps even Mad Comics. Piddling survival increases are considered "significant" because the P values are> 0.05. It surely must be noted that this "significance " is with regard to scientific valid-ity, but the techniques contribute almost nothing to the control of this increasingly prevalent killer. As an example, take the statement "surprisingly, the 5-year survival of all diagnosed and registered patients almost tripled from 3 % to 8%, for patients diagnosed between 1940 and 1960. " Hosannah! By 1980 perhaps they will triple again—to the breathtaking heights of, shall we say, 25 % ? Crude calculations based on projec-tions of death rates and survival rates (assuming changes for 1960 to 1980 proportional to those that occurred be-tween 1940 and 1960) predict that in 1980 about 68,600 more Americans will die of lung cancer than died in 1960! The cause and method of control of this malig-nant epidemic were dismissed in two sentences of the article. "In summary, the ultimate goal for eventual con-trol of lung cancer is prevention. Such effective prophy-lactic control of the total environmental factors involved, however, is far in the future." Far in the future indeed, if an institution as prestigious as our National Cancer Institute puts out a 22-page arti-cle on "perspectives and prospects " with regard to lung cancer in which cigarette smoking is not once mentioned! (My apologies—I exaggerate. The words appear in 2 of the 161 references.) The Inter Society Commission for Heart Disease Re-sources has called for a phasing-out of the cigarette in-dustry as one step in controlling epidemic atherosclerotic disease, the etiology of which is a good deal more com-plex than that of lung cancer. Dare those of us more specifically concerned with lung cancer suggest less? The disease is most difficult to diagnose and treat, as your article and others document. It can, however, be (ugh) snuffed out