While Reich is correct in insisting that there are important pitfalls in screening, it is important to put LC screening into a 21st century perspective. The lessons learned from prior screening trials in other organs have been carefully incorporated into the planning of the prospective single-arm I-ELCAP6 trial that is now in progress at 20 medical centers in the United States and a number of other nations. The I-ELCAP protocol carefully minimizes radiation dosage, maximizes quality control, fosters smoking cessation in study subjects, and incorporates a strict protocol emphasizing demonstrable growth in order to minimize the number of invasive tests and operations. The original ELCAP trial was very successful in all of these areas, and refinements in the protocol make I-ELCAP even better. The research plan of I-ELCAP will provide a definitive answer to the question of whether low-dose, noncontrast, spiral CT scanning will effect a stage shift toward early diagnosis. The overwhelming body of evidence available from hundreds of published surgical series suggests that surgical treatment in very small stage IA non-small cell lung cancer will result in high survival rates and should reduce LC population mortality. Paradoxically, the large scope of this multi-institutional trial also will offer a better opportunity to answer the question of ODB, since it is inevitable that there will be study subjects who are reasonably young and physiologically fit who will opt for no therapy. Careful follow-up in these individuals will provide a definitive answer as to the existence and frequency of pseudodisease LC and nonaggressive LC.