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Abraham Morgentaler, MD; William C. DeWolf, MD
Beth Israel Hospital Boston, Mass

JAMA. 1993;270(6):705-706.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.

—In a recent issue of JAMA, Giovannucci et al^1,2 report in two studies an association between vasectomy and prostate cancer, concluding in both that their work supports a causal relationship. However, a major study flaw invalidates any possible conclusion regarding causality. Namely, Giovannucci et al failed to obtain reliable information on the incidence of prostate cancer in their study population in a systematic manner and have therefore identified only a fraction of the clinically detectable cases of prostate cancers in their study population. Index cases were identified entirely on the basis of self-reports or spousal reports, a particularly insensitive assay for the presence of a disease such as prostate cancer, which may be asymptomatic even at advanced stages. As an illustration, Labrie and coworkers³ identified 57 cases of prostate cancer among 1002 men selected from electoral rolls, for a detection rate of 5.7%, whereas Giovannucci . . . [Full Text PDF of this Article]

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