After reading the article by Frisch and colleagues [1], I found myself asking what medical researchers mean when they advise the primary care physician, such as myself, to "keep something in mind."

The article indicates the presence of a certain statistical relation between the diagnosis of basal-cell carcinoma and increased risk for testicular cancer, breast cancer, and non-Hodgkin lymphoma. The authors concede that no change in the otherwise recommended screening measures for breast or testicular cancer is justified, and there are no screening recommendations for lymphoma to be modified. The authors suggest that breast and scrotal symptoms "be taken particularly seriously in younger patients who have previously had basal-cell carcinoma." I would suggest that breast and scrotal symptoms in young patients should always prompt particularly serious concern, and I cannot imagine undertaking a different diagnostic approach on the basis of the statistics offered in Frisch and colleagues' article. Similarly, lymph node enlargement in a young patient would, no doubt, prompt serious evaluation.

I am not suggesting that articles of academic interest only should not find their way into Annals of Internal Medicine. I would respectfully caution the authors, however, to take care not to overstate their case in terms of the immediate change in practice patterns justified by their data. Need I point out that as a primary care physician I certainly face no lack of information to "keep in mind"?