Scrutiny-Dependent Cancer and Self-fulfilling Risk Factors
Authors: H. Gilbert Welch, Otis W. Brawley
Journal: Annals of Internal Medicine (2018)

Letters17 July 2018Scrutiny-Dependent Cancer and Self-fulfilling Risk FactorsH. Gilbert Welch, MD, MPH and Otis W. Brawley, MDH. Gilbert Welch, MD, MPHThe Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire (H.G.W.)Search for more papers by this author and Otis W. Brawley, MDAmerican Cancer Society, Atlanta, Georgia (O.W.B.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L18-0146 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:The existence of scrutiny-dependent cancer leads to confusion about not only the true incidence of clinically relevant disease but also cancer risk factors. We appreciate Zanetti and colleagues' mention of Richard Doll, who was correct about many things. He famously showed (with Bradford Hill) that cigarette smoking was the major cause of the lung cancer epidemic (1) and that it was by far the most important “avoidable” risk factor for cancer. He noted that important cancer risk factors must have large relative risks, arguing that the lower bound of the 95% CI for relative risk should be greater ...References1. Doll R, Hill AB. Lung cancer and other causes of death in relation to smoking; a second report on the mortality of British doctors. Br Med J. 1956;2:1071-81. [PMID: 13364389] CrossrefMedlineGoogle Scholar2. Taubes G. Epidemiology faces its limits. Science. 1995;269:164-9. [PMID: 7618077] CrossrefMedlineGoogle Scholar3. Doll R, Peto R. The causes of cancer: quantitative estimates of avoidable risks of cancer in the United States today. J Natl Cancer Inst. 1981;66:1191-308. [PMID: 7017215] CrossrefMedlineGoogle Scholar4. Landow SM, Gjelsvik A, Weinstock MA. Mortality burden and prognosis of thin melanomas overall and by subcategory of thickness, SEER registry data, 1992-2013. J Am Acad Dermatol. 2017;76:258-63. [PMID: 27887797] doi:10.1016/j.jaad.2016.10.018 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire (H.G.W.)American Cancer Society, Atlanta, Georgia (O.W.B.)Disclosures: The author has disclosed no conflicts of interest. The form can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-2792. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoScrutiny-Dependent Cancer and Self-fulfilling Risk Factors H. Gilbert Welch and Otis W. Brawley Scrutiny-Dependent Cancer and Self-fulfilling Risk Factors Roberto Zanetti , Lidia Sacchetto , and Stefano Rosso Metrics Cited byIncidence Trends of Melanoma and Nonmelanoma Skin Cancers in Jordan From 2000 to 2016Risk Factors Associated With First and Second Primary Melanomas in a High-Incidence PopulationCancer surveillance, obesity, and potential bias 17 July 2018Volume 169, Issue 2Page: 134-135KeywordsCancer risk factorsConflicts of interestDeath ratesDisclosureLesionsLung and intrathoracic tumorsMedical risk factorsMelanomaMortalityRelative risk ePublished: 17 July 2018 Issue Published: 17 July 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...