We thank Retsky et al. for their comments regarding our study.1 We regret that they misinterpreted our study as indicating a condescending attitude toward medically underserved populations. Our intent was exactly the opposite—to provide information that would ultimately reduce socioeconomic disparities in cancer outcomes and help all patients make healthcare choices that optimize the length and quality of their lives.

In our discussion of concerns regarding surgery promoting the spread of cancer, we alluded to some clinical situations in which that might occur, such as an incisional biopsy of a testicular germ cell tumor or rupturing an ovarian cystadenocarcinoma. We are aware of the exciting work by Retsky et al. regarding the effect of primary tumor resection on angiogenesis and on the growth of metastases, but considered this topic beyond the scope of our article. Awareness of this recent research is likely to be extremely low among the general public, and therefore not expected to be a significant factor influencing either the prevalence of beliefs concerning cancer surgery or the associations between these beliefs and sociodemographic characteristics.

Although we speculated as to why some people might be concerned about surgery promoting the spread of cancer, their reasons for this belief are not as important as the fact that current clinical evidence indicates that resection of primary lesions offers substantial benefit for most patients with malignant solid tumors and that some patients either do not know or do not believe this information. In addition, these patients tend to be poorer, less educated, older, and more likely to be a member of a medically underserved racial minority group than people who accept this information as true.

In the vast majority of cases, it would be unwise to forego treatment performed by an experienced surgical oncologist as recommended by evidence-based guidelines. We believe that clinicians should try to ensure that this and other potentially life-saving information is understood by all patients regardless of age, race, ethnicity, education, or income.


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Ted Gansler M.D., M.B.A.*, Kevin Stein Ph.D.†, S. Jane Henley M.S.P.H.‡, * Department of Health Promotion, American Cancer Society, Atlanta, Georgia, † Behavioral Research Center, American Cancer Society, Atlanta, Georgia, ‡ Department of Epidemiology and Surveillance Research, American Cancer Society, Atlanta, Georgia.