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THE letter from Frances Harcourt-Brown (VR, April 15, 2017, vol 180, pp 385-386), in response to my previous letter (VR, February 25, 2017, vol 180, p 204), in which she recommends that all female rabbits should be spayed is a classic example of ‘eminence-based medicine’. In her experience, uterine tumours are ‘common’ in older does, but she cannot say how common, and surgical and anaesthetic complications are ‘low’, but she cannot say how low. Obviously, spaying rabbits to prevent the tumours must be in their interest.
In human reproductive oncology, implementations of similarly intuitively right, but not evidence-based, policies have become controversial, having caused more harm than good in some people. Examples include prostate-specific antigen screening for prostate cancer, mammography screening of women under the age of 50, and radical mastectomy as a treatment for breast cancer (Andriole and others 2009, Barry 2009, Berry 2013, Godlee 2013, Broeders and Paci 2015, Ireland and O'Shaughnessy 2015, Prasad and Cifu 2015 …