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October 7, 1974

Management of Breast Cancer: Radical Mastectomy: In Rebuttal to Dr. Crile

Author Affiliations

From the New England Baptist and New England Deaconess Hospitals, Boston.

JAMA. 1974;230(1):108-109. doi:10.1001/jama.1974.03240010074042

THE rejection of Dr. Crile's policies by most informed surgeons is not a consequence of uncertainty as to his precise meaning about local excision or "partial mastectomy." It is rather a consequence of wide recognition of the extensive and easily demonstrable bias introduced by favorable case selection for the simple procedures that characterize his reports. This has been amply demonstrated in our article. There are, however, some points in Crile's article that merit further discussion and rebuttal.

  1. Crile asks, "Is there increased risk in partial mastectomy?" He answers the question by citing a retrospective, randomized, matched-pair study that as originally reported consisted of two groups of 53 patients: one group was treated by partial mastectomy and the other by total mastectomy. The ten-year survival rate for the partial mastectomy patients was a meager 34.4%. The data for the total mastectomy patients are not given, but it is stated that