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August 19, 1992

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

Author Affiliations

University of Washington Seattle

JAMA. 1992;268(7):869-870. doi:10.1001/jama.1992.03490070047024

In Reply.  —We welcome the opportunity to continue the discussion about the underutilization of breast-conserving surgery and radiation therapy for early invasive breast cancer. The title of our article1 expresses our interpretation of the study's findings, and we are pleased that it has raised concern among clinicians about the appropriate use of breast-conserving surgery.As stated in the article, we recognize that the analysis was limited by our inability to measure tumor characteristics or patient preference that would determine type of surgery. But we doubt that the majority of the 5364 women with mastectomy (66%) in our study were either unsuitable candidates for conservative surgery or chose that treatment after appropriate counseling. Despite growing scientific evidence in support of the efficacy of breast-conserving surgery and radiation therapy, the time trends indicate essentially no change in breast-conserving surgery for women with stage I disease and a possible decline for women