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September 18, 1996

Detection and Treatment of Ductal Carcinoma In Situ of the Breast

Author Affiliations

Albert Einstein College of Medicine of Yeshiva University Bronx, NY

JAMA. 1996;276(11):870. doi:10.1001/jama.1996.03540110024017

To the Editor.  —In their Editorial, Drs Page and Jensen1 appear to be talking out of both sides of their mouths. On the one hand they underscore "the urgent need for studies of prognosis and treatment for women with DCIS," but on the other hand they castigate2 the only large-scale prospective randomized study on the subject to date (the NSABP B-17 trial).3,4 One suspects that this was because the results of that study failed to support their opinion that a subgroup of women with DCIS can be identified for whom partial-breast treatment is adequate.The NSABP B-17 trial randomly assigned women with DCIS (median lesion size of 8 mm) to whole-breast treatment vs partial-breast treatment groups and found that partial-breast treatment was inadequate and led to a significantly greater incidence of recurrences, particularly invasive recurrences.3 Further multivariate analysis identified 2 independently significant prognostic features, involved surgical margins and comedo