To the Editor It is with my great surprise that the study by Sparano et al1 was published in JAMA Oncology. In this high-risk group of participants with breast cancer with a recurrence score of 26 to 100, the treatment was not randomized. The statistical methods for projection of clinical outcomes were also estimated. The authors used National Surgical Adjuvant Breast and Bowel Project (NSABP) B20 data, but the trial’s prospective period was from October 1988 to March 1993, which predates the Oncotype DX recurrence score assay (Genomic Health, first available in 2003).