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Reply to the siren's song of anonymous web‐based sampling

In their letter to the editor, Brasky et al highlight potential selection bias as an important limitation to online convenience sampling. As we acknowledge in our article, online survey study designs do carry inherent limitations. However, they carry key advantages as well and present a valid opportunity to contribute meaningful, complementary patientreported data to the literature on medical cannabis use among patients with breast cancer, as our study has. Research into medical cannabis use is greatly constrained for a variety of reasons, including the sensitive nature of patients’ disclosing the use of illegal substances. A key advantage of an anonymous online survey is the ability to elicit more truthful responses to sensitive topics such as cannabis use. Notably, only 39% of cannabis users in our study disclosed it to their physicians. Although Brasky et al note that our sampling scheme may overestimate cannabis use in the breast cancer population, the prevalence of use may be underreported in other studies, especially those including subjects who live in areas without legal medical cannabis. Rather than a siren’s song, our publication more simply serves as a siren for clinicians and hopefully will alert them to the alarming fact that a significant proportion of patients with breast cancer may be using cannabis during active treatment without medical guidance. Because of the widespread lack of awareness of the risks associated with unregulated cannabis products, potential drugdrug interactions, and misinformation about the use of cannabis as a treatment for breast cancer, it is crucial that physicians initiate informed conversations with their patients about this topic.