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Dr Feiner and Dr Mahmood's point about the frequency of relapse being related to the vigor with which one searches for it is well taken. The patients reported had periodic chest and bone x-rays but not bone scans, as this series was from 1961 through 1970. The minimum follow-up, however, was five years, and it is probable that asymptomatic metastases detected by bone scan would have appeared by that time. Furthermore, our data were compared with those of the National Surgical Adjuvant Breast Project, whose cases were followed in approximately the same way since this was generally the era before bone scans became popular.
Prosnitz LR. Relapses of Breast Cancer-Reply. JAMA. 1978;239(1):25. doi:10.1001/jama.1978.03280280025011
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