We agree with Drs. Reich and Asaph that our study has limitations by nature of utilizing retrospective cancer registry data. Since it would be unethical to randomize stage I non-small cell lung cancer (NSCLC) patients to treatment or no treatment, population-based observational studies are the next-best data source to describe the natural history of stage I NSCLC. As mentioned in our article,1 the lack of information on staging methods likely results in underestimation of survival in patients with untreated stage I disease. For clarification, a lung cancer-specific 5-year survival of 22% and overall survival of 11% means that for a cohort of patients with stage I NSCLC with complete follow-up, 78% will have died of lung cancer, 11% will have died of other causes, and 11% will have survived for 5 years. Assuming that 5 years is sufficient time to estimate long-term survival from lung cancer, the percentage of patients with pseudodisease can be estimated by adding the 11% of survivors to a proportion of the 11% of patients who died of other diseases who would not have died of lung cancer had they survived. While Reich and Asaph argue that overall survival is not an adequate measure of efficacy for surgical resection in stage I NSCLC, it is hard to argue with data showing the excellent overall survival of patients with surgically resected stage I NSCLC, especially small tumors, compared with the survival of patients who refuse surgical resection. These survival estimates include perioperative deaths and deaths from comorbid conditions.