It is important to appreciate the dependency of growth rates on tumor size. Diameter is a function of the number of tumor volume doublings (TVDs). Tumor diameter in centimeters, D = cell diameter(cube root of 2)number of TVDs; D =0.001(1.26)x; log form: x =ln1,000D/ln1.26.3 For example, a 1-cm tumor (IA) has undergone 30 TVDs; a 5-cm tumor (IB), 37. With a IA TVD-time of (230 days), 1,610 days (54 months) would be required for a 1-cm tumor to grow to 5 cm.3 Assuming unchanging TVD-time, the growth rate ratios of diameter and volume are, respectively, D and D2 (eg, fivefold and 25-fold for a 5-cm vs a 1-cm tumor).3 The additional 4.4 years of growth required to achieve a 5-cm (stage B) size increases the likelihood of overdiagnosis (greater in high-risk patients) because of a lengthier exposure to smoking-related, lethal comorbidities. Resectional surgery diminishes life expectancy presumably by accelerating the course of competing, smoking-related, cardiopulmonary morbidities (J. M. Reich, MD, FCCP; J. S. Kim, PhD; J. W. Asaph, MD, unpublished data, 2013).