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—Our study included breast cancer patients diagnosed from 1984 through 1990. For HMO hospitals, estimated 5-year survival was 67.0% (SE, 5.3%) for localized disease and 49.5% (SE, 9.2%) for regional disease. Dr Amster and colleagues report figures for Kaiser Southern California breast cancer patients diagnosed from 1987 through 1992. Because this period varies from ours, patient groups treated at Kaiser hospitals would differ in our respective studies. Our article reports significantly worse survival for patients with localized disease treated at HMO hospitals (including Kaiser hospitals) compared with those treated at small community hospitals, particularly among patients treated before 1988. Amster et al present no data to refute this result. Since there is a time trend toward better survival in HMO hospitals in the later part of our study period (Table) and assuming that thistrend continues after 1990, one would expect better survival from 1987 through 1992 among Kaiser's
Lee-Feldstein A, Anton-Culver H, Feldstein PJ. Breast Cancer: Treatment Differences and Survival-Reply. JAMA. 1994;272(15):1166. doi:10.1001/jama.1994.03520150031019
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