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Chemotherapy in Women with Breast Cancer
- The Editors
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
IN RESPONSE:
We appreciate that Dr. Liebmann and associates took the trouble to write to us about our Editors' Notes for the article by Du and colleagues. We said that “many unnecessary deaths could probably be prevented by following the National Institutes of Health guidelines.” Liebmann and associates' citation of our statement omitted the word “probably,” a word that we chose with care to be sure that readers understood that we were making a conjecture rather than a conclusion based on established fact. Our conjecture would have been more informed if we had estimated the number of women who might have benefited from adjuvant therapy, as we have tried to do for this response.
The NIH guidelines in force in 1991 to 1997, the dates of Du and colleagues' study, recommended chemotherapy for women with node-positive tumors or node-negative tumors with poor prognostic features. For our estimate, we confined ourselves to node-positive tumors, since Du and colleagues' study lacked information about the latter group. In the New Mexico study, 1660 women 50 to 69 years of age received a diagnosis of stage I, stage II, or stage IIIA breast cancer between 1991 and 1997 and did not receive adjuvant chemotherapy. The article did not provide the number of node-positive women who did not receive chemotherapy. To provide an upper bound on this number, we assumed that 34% of women who did not receive chemotherapy had node-positive disease, the same proportion as in all women in the New Mexico study (in fact, <34% of women who did not receive chemotherapy had node-positive disease, as seen in Du and colleagues' Table 2). According to this assumption, 564 of the 1660 women who did not receive chemotherapy would have had node-positive disease. According to data from the Early Breast Cancer Trialists' Collaborative Group (1), the absolute gain in 10-year survival was 3% for 50- to 69-year-old women with node-positive disease (46% to 49%). Therefore, the potential gain in 10-year survival from receiving recommended chemotherapy was no more than 17 women. This number is smaller than we supposed when we wrote the Editors' Notes, and we would frame our comment more judiciously now.
–The Editors
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
