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September 12, 1986

Detection of Breast Cancer

Author Affiliations

University of New Mexico School of Medicine Albuquerque

JAMA. 1986;256(10):1292. doi:10.1001/jama.1986.03380100065011

To the Editor.—  In their recent JAMA article, Wertheimer et al1 point out that "now" the concept has been accepted that breast cancer at the time of diagnosis is a systemic disease. However, this concept has been pioneered for more than three decades and breast cancer has therefore been treated conservatively with lumpectomy and radiotherapy; survival rates for up to 25 years are not different when conservative and radical treatments for breast cancer are compared (Figure).Because no effective systemic treatment of breast cancer is available, emphasis must be placed on early diagnosis to increase the chance of survival. Mammography is now championed: "We must actively and aggressively screen asymptomatic women... radiation risk per se should no longer be a factor."1 These efforts are commendable and physicians already order mammograms liberally or excessively because of fears of overlooking carcinoma and facing possible litigation.Because the pathobiology of breast