Pinsky et al1 suggest in their article appearing in this issue of CHEST (see page 688) that chest radiographs (CXRs) performed as a screening test for lung cancer may also provide important prognostic information about premature death from respiratory and cardiovascular disease. These investigators took advantage of the huge database obtained as part of the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (> 70,000 subjects had CXRs performed annually for 3 years in this trial) to calculate the hazard ratios for all-cause mortality, respiratory mortality, and cardiovascular mortality based on CXR interpretations of abnormalities that were not suspicious for cancer. Approximately 35% of all CXRs were found to have findings that were abnormal but not suspicious for cancer, with granulomas, scarring/pulmonary fibrosis, and cardiac abnormalities being frequently described. Significantly increased hazard ratios for cardiovascular mortality were found for cardiac abnormalities and pleural fluid; COPD/emphysema and scarring/pulmonary fibrosis were associated with significant increases in respiratory mortality. The results are intriguing, but the reader should be cautious about using CXRs, or extrapolating these results to CT scans, for more ambitious screening for three reasons.