Reconditis: A Malignant Variety of Obscurantism Associated with Pathological Deficit of Common Sense

RECONDITIS: A MALIGNANT VARIETY OF OBSCURANTISM ASSOCIATED WITH PATHOLOGICAL DEFICIT OF COMMON SENSE WILLIAM M. LANDAU* Like trolling for bottom-feeding muskellunge, seduction of opponents into scientific controversy is an inexact art. Evidently the subtitle "Unsolicited Reportage from a Board Certified Non-epidemiologist" of my Perspectives paper "Humbug Breast Cancer Follies: Odds Ratios for the Relative Risk of Truth" was great bait [I]. I hooked a real epidemiologist of an aggressive species (Mikel Aickinensis) , afflicted with a fatal sense of humor [2] . In order to complete this fishing metaphor, I now have to gaff, clean, and fillet the catch, or cut bait. The readers of Perspectives may decide whether my angle is accurate. Aickin and I do share a disdain for subtlety. Having reluctantly given me some credit for defining my numbers, derivations, and calculations, he brands me with his diagnosis of "reckonitis" for having stated, "This fraction (1/8) thus represents the lifelong prospective risk for a woman who is born tomorrow and survives all competitive death risks to reach her centennial ." He states that this "sentence ... is utterly, pathologically wrong." I believe that he is mistaken. He neither cites nor gives evidence of having read the source of my data, ' 'The Lifetime Risk of Developing Breast Cancer " by EJ. Feuer, et al. [3]. These authors explain that, "The life table for invasive breast cancer (Table 1) [reproduced here] summarizes results for all races using incidence and mortality data from SEER areas in 19871988 . The total number of individuals alive and cancer-free at the beginning of each interval decreases in each interval starting with a cohort of ten million live births." It is essential to define the presumptions of the original data collection *Department of Neurology and Neurological Surgery, Washington University School of Medicine, 660 South Euclid, St. Louis, MO 63310.© 1999 by The University of Chicago. All rights reserved. 0031-5982/99/4202-1091101.00 220 William M. Landau ¦ Reconduis: A Malignant Variety of Obscurantism TABLE 1 Probability of Developing Invasive Breast Cancer in SEER Areas, Women, All Races, 1987-1988 Age Total No. alive and cancer-free at beginning of interval No. that developed cancer this interval No. that died of other causes this interval* Cumulative probability of developing cancer from birth1 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90-94 95 + 10,000,000 9,892,431 9,883,294 9,873,810 9,849,466 9,824,049 9,791,935 9,743,686 9,665,529 9,534,710 9,334,333 9,055,523 8,667,048 8,102,343 7,370,954 6,407,722 5,173,747 3,649,753 2,166,509 807,240 59 0 0 0 450 3,449 12,116 29,912 61,967 91,069 103,830 120,721 151,118 160,288 154,016 150,217 110,820 60,041 35,570 11,287 107,510 9,137 9,484 24,344 24,967 28,665 36,133 48,245 68,852 109,308 174,980 267,754 413,587 571,101 809,216 1,083,758 1,413,174 1,423,203 1,323,699 795,953 .000006 .000006 .000006 .000006 .000051 .000396 .001607 .004599 .010795 .019902 .030285 .042357 .057469 .073498 .088900 .103921 .115003 .121008 .124565 .125693 * Among cancer-free population at beginning of the interval who did not develop cancer during the interval, t Until the end of the interval. from which future risks are estimated. The National Cancer Institute's Surveillance , Epidemiology and End Results (SEER) data are derived from nine standard SEER areas. It is presumed that the breast cancer diagnosis is accurately and consistently determined for all of the afflicted women in these areas. The original data are digital: one patient, one diagnosis, one year of age. For counting there are three entry qualifications: (1) being female; (2) being alive; (3) never having been previously diagnosed with breast cancer. The generally accepted idea is that over the term of, say, 10 to 20 years, the nature of the surveyed population...