Comment & Response |

Differences in Breast Cancer Survival by Race—Reply

Jeffrey H. Silber, MD, PhD1; Paul R. Rosenbaum, PhD2; Kevin R. Fox, MD3
[+] Author Affiliations
1Center for Outcomes Research, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
2Department of Statistics, University of Pennsylvania, Philadelphia
3Leonard and Madlyn Abramson Cancer Center, University of Pennsylvania, Philadelphia
JAMA. 2013;310(22):2457. doi:10.1001/jama.2013.281075.
Text Size: A A A
Published online


In Reply Our study examined all 7375 black women older than 65 years diagnosed with breast cancer between 1991 and 2005 in the Surveillance, Epidemiology, and End Results database. Although Mr Harding and colleagues quote various numbers to illustrate the potential effect of overdiagnosis on racial disparities in breast cancer survival, these are hypothetical.

We matched patients for cancer stage and many other characteristics, in which stage was determined from the database based on chart review. That chart review included information from biopsy and postsurgical pathology. On this basis, patients with ductal carcinoma in situ (DCIS) were excluded from our data set. Although overdiagnosis may lead to unnecessary biopsies or unneeded treatment of patients with DCIS, neither of these possibilities are relevant to our study. Harding and colleagues cite an Editorial by Esserman et al1 that referred to the problematic diagnosis of DCIS when estimating cancer survival and suggest that premalignant conditions “(eg, ductal carcinoma in situ or high-grade prostatic intraepithelial neoplasia) should not be labeled as cancers or neoplasia, nor should the word ‘cancer’ be in the name.” Harding and colleagues suggest an additional analysis that takes account of breast cancer screening.


Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
First page PDF preview




December 11, 2013
Charles Ford Harding, AB; Francesco Pompei, PhD; Richard Wilson, DPhil
1Independent data scientist (self-employed), Seattle, Washington
2Department of Physics, Harvard University, Cambridge, Massachusetts
JAMA. 2013;310(22):2456-2457. doi:10.1001/jama.2013.281072.
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...