Frandsen et al. respond to “A note on variable adjustments”

Abstract

In response to M. Naylor’s valuable critique of our study “Polycystic Ovary Syndrome and Endometrial Cancer Risk: Results from a Nationwide Cohort Study,” we recognize the merit in the suggested areas. We recognize that including information on hormone therapy may have added to the understanding of the relationship between polycystic ovary syndrome (PCOS) and endometrial cancer risk. We further acknowledge the importance of the frequency of gynecological visits, which we have treated as a mediator rather than a confounder, given its role in reflecting PCOS severity and management. This approach, however, may introduce surveillance bias by influencing early cancer detection rates. Although the Danish health care system is fully subsidized, our exclusive use of hospital records may miss some PCOS cases managed in primary or specialized care settings outside the hospital, potentially leading to underestimation of the true association. Incorporating these variables in future studies could enhance analytical scope, though it would involve complex methodologies. We appreciate the comprehensive feedback, which underscores the necessity for further studies to elucidate the links between PCOS and endometrial cancer. These insights will inform future research and advance understanding in this area.