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May 16, 2012

Breast Cancer Mortality and Age at Diagnosis—Reply

Author Affiliations

Author Affiliations: Department of Surgical Oncology, Leiden University Medical Center, Leiden, the Netherlands (c.j.h.van_de_velde@lumc.nl).

JAMA. 2012;307(19):2023-2024. doi:10.1001/jama.2012.3645

In Reply: Drs Biau and Porcher comment on the accurateness of the end point of disease-specific mortality in our study of 9766 postmenopausal patients diagnosed with breast cancer included in the TEAM (Tamoxifen Exemestane Adjuvant Multinational) randomized controlled trial. Disease-specific mortality was defined as death due to breast cancer as indicated on the case report form. Patients with distant metastases at the time of death were considered to have died due to breast cancer. Biau and Porcher argue that attributing death to breast cancer when evidence of disease is present may be misleading. We agree that ascertainment of cause of death is not always easy, regardless of age. Unfortunately, postmortem examinations are usually not available and physicians must rely on history and clinical course to assign a cause of death.