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October 19, 1994

Breast Cancer: Treatment Differences and Survival

JAMA. 1994;272(15):1166-1167. doi:10.1001/jama.1994.03520150031020

To the Editor.  —The recent review of breast cancer treatment and end results in Orange County by Dr Lee-Feldstein and colleagues1 may be shy on answers, but certainly raises provocative questions and broad new avenues for clinical investigation. We are heartened by evidence that shows superior survival in patients managed conservatively outside of the clinical trial environment.The implication that survival may relate to the type of treatment facility, while based on rather soft data, presents an opportunity for some interesting speculation. The radiation therapy component of conservative breast cancer management is in fact quite simple and straightforward with relatively little variation in practice around the country, and we doubt that it would be a significant factor.At least two other possible explanations exist. In our institution, as in many others, we are very quick to return the patient to the surgeon for reexcision at the primary site if