 |
 |

Exclusion Bias and the False Relationship of Reserpine and Breast Cancer
Ralph I. Horwitz, MD;
Alvan R. Feinstein, MD
Arch Intern Med. 1985;145(10):1873-1875.
Abstract
 |  |
Although reserpine has an important role in treating patients with hypertension, its appeal was sharply reduced a decade ago when an alleged relationship to breast cancer was reported in case-control studies. Since the relationship was not confirmed in subsequent research and analyses, the original association is now regarded as erroneous. Since patients with cardiovascular disease were rejected as possible controls in the original reserpine—breast cancer case-control study, we suspected that the false association may have been produced by a phenomenon called exclusion bias. This bias can arise in case-control studies if patients with a particularly high (or low) rate of prior exposure to the alleged etiologic agent are excluded from the selection of either cases or controls, but not from both. To test that suspicion, we recapitulated the original study, in another medical setting. The cases were 257 women with breast cancer; and the controls were 257 hospitalized women matched according to date of admission, age, and race. The overall data showed no association between reserpine and breast cancer (odds ratio [OR]=1.1, but when we excluded 101 women with cardiovascular disease from the control group, the OR rose to 2.5. The results suggest that exclusion bias played an important role in creating the false association between reserpine and breast cancer.
(Arch Intern Med 1985;145:1873-1875)
Author Affiliations
From the Departments of Medicine and Epidemiology and the Robert Wood Johnson Clinical Scholars Program, Yale University School of Medicine, New Haven, Conn. Dr Horwitz is a Henry J. Kaiser Family Foundation Faculty Scholar in General Internal Medicine.
Footnotes
Accepted for publication Feb 27, 1985.
Reprint requests to Clinical Scholars Program, Yale University School of Medicine, 333 Cedar St, PO Box 3333, New Haven, CT 06510 (Dr Horwitz).
CiteULike Connotea Del.icio.us Digg Reddit Technorati
What's this?
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Challenges and Opportunities for Pharmacoepidemiology in Drug-Therapy Decision Making
Etminan et al.
J Clin Pharmacol 2006;46:6-9.
ABSTRACT
| FULL TEXT
Cancer risk in people with epilepsy: the role of antiepileptic drugs
Singh et al.
Brain 2005;128:7-17.
ABSTRACT
| FULL TEXT
Bias
Delgado-Rodriguez and Llorca
J. Epidemiol. Community Health 2004;58:635-641.
ABSTRACT
| FULL TEXT
Perspectives on Isolated Systolic Hypertension in Elderly Patients
Vardan and Mookherjee
Arch Fam Med 2000;9:319-323.
ABSTRACT
| FULL TEXT
Postmarketing Surveillance and Adverse Drug Reactions: Current Perspectives and Future Needs
Brewer and Colditz
JAMA 1999;281:824-829.
ABSTRACT
| FULL TEXT
Evidence Against the Association Between Alcohol Use and Ischemic Stroke Risk
Henrich and Horwitz
Arch Intern Med 1989;149:1413-1416.
ABSTRACT
Scientific standards in epidemiologic studies of the menace of daily life
Feinstein
Science 1988;242:1257-1263.
ABSTRACT
|