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July 22, 1974

Local Excision Plus Irradiation for Breast Cancer

Author Affiliations

University of Maryland Hospital Baltimore

JAMA. 1974;229(4):392-393. doi:10.1001/jama.1974.03230420014009

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To the Editor.—  The MEDICAL NEWS item, " 'Simulated Partial Mastectomy' Leaves Tumor Cells in Most Breasts" (228:1081, 1974), contributes only irrelevant material to the present controversy in regard to conservative surgery for the treatment of breast cancer. The argument is not whether radical surgery is better than local excision, but whether radical excision is better than local excision plus irradiation. If we were all convinced that local excision could, indeed, remove the entire tumor, postsurgical irradiation would be unnecessary. Proponents of the combined technique have long recognized the inadequacy of the simple surgical procedure alone, and are, therefore, not surprised to find residual disease. Nor should we be surprised in the second half of the 20th century to learn that radiation therapy can, in fact, eradicate carcinoma.Is not the time past when we should have recognized that what we are treating is a patient rather than a disease? If