BMJ 1996;312:1155 (4 May)

Letters

Large differences in survival are not explained

EDITOR,--As a specialist breast cancer surgeon it is in my enlightened self interest to accept the findings of Charles R Gillis and David J Hole1; at the same time, as a clinical scientist I cannot allow their conclusions to go unchallenged. From the world overview of trials we now know with statistical confidence that variations in local treatment cannot be associated with any of the differences in survival described in this article.2 Only the use of adjuvant systemic therapy could contribute to differences in survival outcome, and in absolute terms these differences are relatively modest and could not account for a 9% absolute difference in five year survival, nor for some of the quite extraordinary differences described in any of the subsets, such as the 19% difference in five year survival for patients with two positive nodes.

Let us just concentrate on the age group 50-64, in which an . . . [Full text of this article]


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Relevant Article

Survival outcome of care by specialist surgeons in breast cancer: a study of 3786 patients in the west of Scotland
Charles R Gillis and David J Hole
BMJ 1996 312: 145-148. [Abstract] [Full Text]

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