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To the Editor.—
In "Distribution Pattern of Metastatic Bone Disease" (237:2504-2506, 1977), there is a misleading item in the results that demands mention: not one case of femoral metastasis in breast carcinoma. Tell that to the unfortunate women who have experienced the dreaded complication of femoral fracture.There must be a lesson to be learned, perhaps that the femur is not scintigraphically involved early in the course of bone metastasis, where in this study there was a mean of only 3.8 lesions per patient.To test this hypothesis, we analyzed 68 consecutive cases of breast cancer with positive bone scintigrams. Fourteen (21%) of these women had a total of 16 femoral lesions, which was 3.8% of all the lesions found. The women without femoral involvement had a mean of 4.2 lesions per patient. The women with femoral involvement had a mean of 13.6 lesions per patient. Clearly femoral involvement is
Helman N, Helman AJ. Metastatic Bone Disease. JAMA. 1977;238(14):1503. doi:10.1001/jama.1977.03280150073031