Authors' response

摘要

We thank Dr Willis for his comments on our paper. We agree that our findings should be seen as a first step in developing a decision tool for women with breast symptoms in terms of prioritising and enhancing the appropriateness of referral to breast care clinics. We have submitted a large collaborative proposal, led by colleagues at the University of Southampton via the NIHR School of Primary Care Research, so that the issues that Dr Willis raises of prior prevalence, possible spectrum bias, and precision of clinical predictors can be assessed. This proposal, the CANcer DIagnosis Decision rules (CANDID) project, will also encompass patients presenting with symptoms suggestive of colorectal cancer and will provide a working template for similar large-scale studies in cancer in the primary care setting.