To the Editor.
—Determining the appropriateness of breast-conserving surgery (BCS) is a more complex problem than indicated in the report by Dr Lee-Feldstein and colleagues,1 though Dr Baue2 hints at the most important issue in his related Editorial. His closing phrase encompasses an element that is often overlooked: "if the patient wishes this to be done."In our community, where the medical staff of the two hospitals is conjoined and their combined occupancy rate would qualify as a "large community hospital" by the criteria of Lee-Feldstein et al, multidisciplinary breast cancer treatment has been pursued for the past 14 years. Thus, persons who are candidates for BCS virtually always have the opportunity to discuss the alternatives with a surgeon and the radiation oncologist before making a decision. The outcome is about a 30% or 40% rate of BCS among those who meet the National Institutes of Health consensus
Wishart DL. Breast Cancer: Treatment Differences and Survival. JAMA. 1994;272(15):1165-1166. doi:10.1001/jama.1994.03520150031018