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December 20, 1985

Treatment of Breast Cancer-Reply

JAMA. 1985;254(23):3312. doi:10.1001/jama.1985.03360230042019

In Reply.—  The need for long-term, observed follow-up evaluation of a treatment regimen for primary breast cancer is brushed aside by Dr Wizenberg. Many studies indicate little difference in five-year follow-up when different procedures are applied to patients with similar extent of disease. However, inadequate local therapy that results in increased local recurrence is reflected in diminished ten-year survival.1-3The study quoted was based on actuarial five-year data, following an average follow-up of only 39 months, which is inadequate for proper evaluation of a therapeutic procedure for breast cancer. The complications of mastectomy Dr Wizenberg mentions—possible anesthetic death, persistent chest wall discomfort, edema of the arm, and limitation of motion of the arm—also accompany lumpectomy with axillary dissection, which is customarily performed before aggressive radiation therapy is directed to the remaining breast tissue.4Lymphangiosarcoma of the arm almost never appears, except when radiation therapy follows axillary dissection. Finally,