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David L. Wishart, MD
Yakima Valley Memorial Hospital Yakima, Wash

JAMA. 1994;272(15):1165-1166.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.

—Determining the appropriateness of breast-conserving surgery (BCS) is a more complex problem than indicated in the report by Dr Lee-Feldstein and colleagues,¹ though Dr Baue² hints at the most important issue in his related Editorial. His closing phrase encompasses an element that is often overlooked: "if the patient wishes this to be done."

In our community, where the medical staff of the two hospitals is conjoined and their combined occupancy rate would qualify as a "large community hospital" by the criteria of Lee-Feldstein et al, multidisciplinary breast cancer treatment has been pursued for the past 14 years. Thus, persons who are candidates for BCS virtually always have the opportunity to discuss the alternatives with a surgeon and the radiation oncologist before making a decision. The outcome is about a 30% or 40% rate of BCS among those who meet the National Institutes of Health consensus . . . [Full Text PDF of this Article]

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