To the Editor We read with interest the article by Chai et al,1 who performed a retrospective review of the National Cancer Data Base (NCDB) examining treatment for T1N0 squamous cell carcinoma of the anal canal and found that the overall survival was not different for those treated with local excision vs chemoradiotherapy. We congratulate the authors on their contribution to the trend in anorectal oncology questioning current treatment orthodoxy.