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May 15, 1996

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

Author Affiliations

Northwestern University Medical School Chicago, Ill

JAMA. 1996;275(19):1478-1479. doi:10.1001/jama.1996.03530430021024

In Reply.  —Dr Kaufmann raises important concerns regarding the follow-up of mammographic abnormalities with a low suspicion of malignancy. When strict morphological criteria are applied by experienced radiologists, the diagnosis of carcinoma will be delayed in fewer than 2% of cases.1 To confirm that diagnostic criteria are being appropriately used in individual practices, careful audits of biopsy yields and missed cancer rates must be carried out. A review of the audit data by the primary care physician will help to confirm that a recommendation for follow-up is valid. The concept of interval follow-up is based on the observation that a 6-month delay in diagnosis does not appear to result in an upstaging of mammographically detected lesions, and this is particularly true for patients with DCIS.Dr Blank asserts that lumpectomy followed by irradiation and mastectomy is an equally effective treatment for DCIS. No prospective randomized trials have tested this