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Reason to screen for prostate cancer based on selective referencing

      To the Editor:
      In their article, Ransohoff et al. describe why prostate cancer screening is so common, even though the evidence supporting screening is uncertain (
      • Ransohoff D.F.
      • McNaughton Collins M.
      • Fowler Jr, F.J.
      Why is prostate cancer screening so common when the evidence is so uncertain? A system without negative feedback.
      ). We agree completely with the points made and with their conclusions. The authors overlook one important factor, however, and involuntarily demonstrate this omission in their article: the selective use of references.
      They refer to the landmark study by Holmberg et al. (
      • Holmberg L.
      • Bill-Axelson A.
      • Helgesen F.
      • et al.
      A randomized trial comparing radical prostatectomy with watchful waiting in early prostate cancer.
      ), mentioning that “for persons with cancers discovered by means other than screening, surgical therapy may reduce prostate cancer mortality compared with watchful waiting” (
      • Ransohoff D.F.
      • McNaughton Collins M.
      • Fowler Jr, F.J.
      Why is prostate cancer screening so common when the evidence is so uncertain? A system without negative feedback.
      ). In doing so, they omit the important remarks by Holmberg et al. regarding the probable lower effect of radical treatment in prostate cancers detected by screening owing to the lower baseline risk of death from prostate cancer (
      • Holmberg L.
      • Bill-Axelson A.
      • Helgesen F.
      • et al.
      A randomized trial comparing radical prostatectomy with watchful waiting in early prostate cancer.
      ). Moreover, they do not cite the most important conclusion—in our view—of the Holmberg study, which was “surgical therapy does not reduce overall mortality compared with watchful waiting” (
      • Holmberg L.
      • Bill-Axelson A.
      • Helgesen F.
      • et al.
      A randomized trial comparing radical prostatectomy with watchful waiting in early prostate cancer.
      ).
      Although Ransohoff et al.’s citation of Holmberg et al. is correct word for word, an optimistic interpretation of their data is given, thus formulating a view on treatment of localized prostate cancer that is too optimistic. For clinicians, this might be another positive reason to screen their patients for prostate cancer. We believe that this is not sufficiently founded.
      Readers may easily overlook the major nuances of a referenced article. Therefore, we think that it is important for authors and editors to guarantee the accuracy of objective information from cited articles.

      References

        • Ransohoff D.F.
        • McNaughton Collins M.
        • Fowler Jr, F.J.
        Why is prostate cancer screening so common when the evidence is so uncertain? A system without negative feedback.
        Am J Med. 2002; 113: 663-667
        • Holmberg L.
        • Bill-Axelson A.
        • Helgesen F.
        • et al.
        A randomized trial comparing radical prostatectomy with watchful waiting in early prostate cancer.
        N Engl J Med. 2002; 347: 781-789