To the Editor.
—The recent article by Dr Kattlove and colleagues1 regarding development of a basic benefit package for the treatment of early breast cancer failed to address fully the issues surrounding local treatment. It is important to understand that the ultimate local treatment outcome from conservative surgery and radiation therapy is far superior, particularly on a cosmetic and functional basis, than that from complete mastectomy alone. To quantitate the cost of one treatment vs another, one must include the costs, both monetary and physical, of reconstruction after complete mastectomy.If one does compare similar local care outcomes, those being either a preserved breast or a fully reconstructed breast, conservative surgery and radiation therapy become attractive, particularly from the cost standpoint. It has been shown that the treatment of early breast carcinoma with conservative surgery and radiation therapy is more cost-effective than modified radical mastectomy followed by reconstruction.2
Cotter GW. The Efficacy of Mammography and Screening for Breast Cancer. JAMA. 1995;274(5):380. doi:10.1001/jama.1995.03530050028016