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May 15, 1996

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

Author Affiliations

Covenant Cancer Treatment Center Waterloo, Iowa

JAMA. 1996;275(19):1478. doi:10.1001/jama.1996.03530430021023

To the Editor.  —Some comments regarding radiation therapy made in the recent Clinical Crossroads on DCIS1 could use clarification. The NSABP B-17 protocol was a trial designed to evaluate the difference between lumpectomy alone and lumpectomy with radiation therapy in women presenting with DCIS. The results, published in 1993,2 clearly show an advantage with radiation. Five-year event-free survival was better in women who received radiation therapy, and this improvement was attributable to a reduction in ipsilateral local recurrence. With surgery alone, 16% of women had ipsilateral recurrences, and the recurrences were evenly divided between invasive and noninvasive types. However, only 7% of women treated with surgery and radiation developed ipsilateral recurrence, and most of these (20 [71%] of 28) were noninvasive, ie, more DCIS. This resulted in a statistically significant reduction in invasive breast cancer recurrence.When discussing the risks of radiation-induced cancers, Dr Morrow comments on a