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October 19, 1994

Breast Cancer: Treatment Differences and Survival

JAMA. 1994;272(15):1167. doi:10.1001/jama.1994.03520150031021

To the Editor.  —In a recent Editorial, Dr Baue1 supported other authors and advocated breast-conservation operations and radiation therapy, "if the patient wishes this to be done." Neither in his Editorial nor in the references cited was there any mention of long-term adverse effects, complications, and increased morbidity and mortality from radiation therapy to the breast.Breast cancer has a long natural history. One should not compare mortality of treatment based on the first 5 years following treatment. In trials employing radical mastectomy with or without irradiation, Cuzick et al2 found a significant excess of deaths after 10 years among patients given radiotherapy. Friedman3 concluded from studying pathological tissues from 100 women who received radiation therapy that carcinoma of the breast cannot be considered a radiosensitive tumor. Yet radiation therapy must accompany breast-conservation operations.Modern radiotherapy for carcinoma of the breast irradiates a segment of the left