Specialist surgeons and survival in breast cancer

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# Observational studies are essential {#article-title-2} EDITOR,—Several letters1 have criticised the methods used and the conclusions drawn in Charles R Gillis and David J Hole's study, which showed substantial improvements in survival from breast cancer among women referred to specialist surgeons.2 The study used observational data from the West of Scotland Cancer Registry. It is argued that such data can never be appropriately controlled for differences in case mix and that only data from randomised controlled trials can be used to provide reliable evidence. We believe that this objection …