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August 19, 1992

Breast-Conserving Surgery and Radiation Therapy: Are They Underused?

Author Affiliations

Mayo Foundation Rochester, Minn

JAMA. 1992;268(7):869. doi:10.1001/jama.1992.03490070047023

To the Editor.  —We have three objections to the article by Lazovich and colleagues.1 Our first concern is the title that suggests that general surgeons "underutilize" conservative breast surgery and "mistreat" many women. The implication is that general surgeons should advise the use of breast-preserving surgery as opposed to mastectomy for the majority of patients with breast cancer. No mention is made of the inconvenience of 5 to 6 weeks of irradiation for a woman who lives a long distance from a qualified treatment center. Breast irradiation is time-consuming and expensive (as suggested in the article); many women have fears of recurrence in the preserved breast. These factors are downplayed, minimized, or ignored in the design, data acquisition, and discussion of the article by Lazovich et al.Many of our patients choose not to pursue adjuvant radiotherapy. Many view mastectomy as dealing with the problem immediately and completely, without