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ARTICLE |

When Is the Evidence for 'No Association' Sufficient? FREE

Barbara S. Hulka, MD, MPH
JAMA. 1984;252(1):81-82. doi:10.1001/jama.1984.03350010047022
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One of the provocative quirks about the scientific method is that we can never prove beyond doubt that there is no association between an exposure factor of interest and a particular disease. Even in the absence of any true association, the general theory of hypothesis testing practically guarantees that a small number of studies will show some "statistically significant" findings if enough studies are carried out. As a result, we can never be 100% sure that the null hypothesis of no association between exposure and disease is true. What is more, few are the scientists who would want to champion research that seeks to establish "no association." Journals are loath to publish negative results; funding agencies are apathetic; and for those who seek broader acclaim, the public press has little enthusiasm for negative studies. Why then is the article on estrogens and breast cancer in The Journal1 worthy of

REFERENCES

Kaufman DW, Miller DR, Rosenberg L, et al:  Noncontraceptive estrogen use and the risk of breast cancer . JAMA 1984;;252:63-67.
Silverberg E:  Cancer statistics, 1984 . CA 1984;;34:7-23.
Henderson BE, Powell D, Rosario I, et al:  An epidemiologic study of breast cancer . JNCI 1974;;53:609-614.
Brinton LA, Hoover RN, Szklo M, et al:  Menopausal estrogen use and risk of breast cancer . Cancer 1981;;47:2517-2522.
Hoover R, Glass A, Finkle WD, et al:  Conjugated estrogens and breast cancer risk in women . JNCI 1981;;67:815-820.
Ross RK, Paganini-Hill A, Gerkins VR, et al:  A case-control study of menopausal estrogen therapy and breast cancer . JAMA 1980;;243:1635-1639.
Hoover R, Gray LA, Cole P, et al:  Menopausal estrogens and breast cancer . N Engl J Med 1976;;295:401-405.
Hulka BS, Chambless LE, Deubner DC, et al:  Breast cancer and estrogen replacement therapy . Am J Obstet Gynecol 1982;;143:638-644.
Wingo PA, Layde PM, Webster LA, et al:  Risk of breast cancer in women using postmenopausal estrogens . Read before the American College of Obstetrics and Gynecology meeting, Atlanta, May 11, 1983 .
Sartwell PE, Arthes FG, Tonascia JA:  Exogenous hormones, reproductive history and breast cancer . JNCI 1977;;59:1589-1592.
Kelsey JL, Fischer DB, Holford TR. et al:  Exogenous estrogens and other factors in the epidemiology of breast cancer . JNCI 1981;;67:327-333.

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Kaufman DW, Miller DR, Rosenberg L, et al:  Noncontraceptive estrogen use and the risk of breast cancer . JAMA 1984;;252:63-67.
Silverberg E:  Cancer statistics, 1984 . CA 1984;;34:7-23.
Henderson BE, Powell D, Rosario I, et al:  An epidemiologic study of breast cancer . JNCI 1974;;53:609-614.
Brinton LA, Hoover RN, Szklo M, et al:  Menopausal estrogen use and risk of breast cancer . Cancer 1981;;47:2517-2522.
Hoover R, Glass A, Finkle WD, et al:  Conjugated estrogens and breast cancer risk in women . JNCI 1981;;67:815-820.
Ross RK, Paganini-Hill A, Gerkins VR, et al:  A case-control study of menopausal estrogen therapy and breast cancer . JAMA 1980;;243:1635-1639.
Hoover R, Gray LA, Cole P, et al:  Menopausal estrogens and breast cancer . N Engl J Med 1976;;295:401-405.
Hulka BS, Chambless LE, Deubner DC, et al:  Breast cancer and estrogen replacement therapy . Am J Obstet Gynecol 1982;;143:638-644.
Wingo PA, Layde PM, Webster LA, et al:  Risk of breast cancer in women using postmenopausal estrogens . Read before the American College of Obstetrics and Gynecology meeting, Atlanta, May 11, 1983 .
Sartwell PE, Arthes FG, Tonascia JA:  Exogenous hormones, reproductive history and breast cancer . JNCI 1977;;59:1589-1592.
Kelsey JL, Fischer DB, Holford TR. et al:  Exogenous estrogens and other factors in the epidemiology of breast cancer . JNCI 1981;;67:327-333.
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