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September 18, 1996

Detection and Treatment of Ductal Carcinoma In Situ of the Breast-Reply

Author Affiliations

Vanderbilt University Medical Center Nashville, Tenn

JAMA. 1996;276(11):871. doi:10.1001/jama.1996.03540110025019

In Reply.  —We are not surprised at the diverse responses to the article by Dr Ernster and colleagues1 and our Editorial because we are all in a transition phase in the acceptance of and therapeutic responses to the heterogeneity of breast cancer, particularly DCIS. It was our opinion of the response of the popular press that most felt that too many women were getting mastectomies, while we thought that it was surprising that so many women were not undergoing mastectomy. Perhaps this is just a matter of perspective and bias of optimism vs pessimism. If our comments accepting this change toward conservative treatment of DCIS and looking forward to more certain evidence from multicenter trials constitutes speaking out of both sides of our mouths (as noted by Dr Vikram), then we so confess. It is not uncommon for surgical practice to change gradually over time as witnessed by the transition to