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Comment & Response
January 23, 2020

Lead-Time Bias in the Analyses of Overall Mortality of Breast Cancer in Men vs Women—Reply

Author Affiliations
  • 1Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
JAMA Oncol. 2020;6(3):442. doi:10.1001/jamaoncol.2019.6298

In Reply von Euler-Chelpin expressed a concern regarding lead-time bias in our recently published study1 comparing mortality after breast cancer diagnosis between men and women, owing to a high breast cancer screening rate in women. We agree that the lack of breast cancer screening in men could be one reason why men had higher mortality than women. This speculation is supported by our observation that men were more likely to have later-stage breast cancer compared with their female counterparts.2 The lead-time bias, if existent, would be more likely to present in patients diagnosed with earlier stages of breast cancer.3 However, in our study,1 the mortality disparity between male and female patients with breast cancer existed across all cancer stages. In fact, the mortality difference between men and women with stage I breast cancer was slightly smaller than the difference between men and women with stage II and III cancers. These results suggest that lead-time bias is not the sole explanation for the disparity that we observed between men and women.

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