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May 15, 1996

A 47-Year-Old Woman With Ductal Carcinoma In Situ of the Breast

Author Affiliations

University of Pennsylvania Medical Center Philadelphia

JAMA. 1996;275(19):1477-1478. doi:10.1001/jama.1996.03530430021021

To the Editor.  —Dr Morrow's1 otherwise excellent review of treatment options for a 47-year-old patient with DCIS is marred by the statement that mastectomy is "clearly the safest choice." It is our contention that this statement is based on outdated literature and no longer reflects the standard of care. That lumpectomy followed by radiation therapy is an equivalent choice in terms of overall cure rate—and a superior choice in terms of cosmetic and functional outcome— for many if not most women with DCIS is supported by a substantial and growing body of literature. Indeed, the National Cancer Institute's PDQ "up-to-date" online database2 on cancer treatment lists standard treatment for DCIS as total mastectomy or lumpectomy with radiotherapy.Morrow reasons that women undergoing lumpectomy followed by radiation will retain an intact breast that retains a 10% to 15% chance for developing recurrent breast cancer, that about half of patients