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We read with great interest the paper by Evans et al1 published online in your journal. The authors should be commended for having collected data from different sources to present a substantial series to try and draw some inferences. However, their inferences from these data are questionable and they have failed to recognise that their data suggest a change in stage distribution as a result of screening.
The authors suggest that annual screening “is ineffective in improving survival in BRCA carriers.” While this is possible, we cannot see how this inference is justified on the basis of the data presented. The analysis does not use any appropriate control group—that is, unscreened women. Although the authors presented some data from their historical controls at one centre, no statistical comparison was made. In addition, the group with which they have compared BRCA carrier survival includes high risk women, some of whom have not undergone genetic testing and therefore may also be carriers. Such a comparison is …
Competing interests: None.