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Theodore J. Williamson, MD; Margaret J. Thompson, MD; Kirby L. Allen, MD; Amelia C. Hennig, MD; Nancy S. Boutin, MD
Salem Hospital Radiation Oncology Salem, Ore

JAMA. 1994;272(15):1166-1167.

	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.

—The recent review of breast cancer treatment and end results in Orange County by Dr Lee-Feldstein and colleagues¹ may be shy on answers, but certainly raises provocative questions and broad new avenues for clinical investigation. We are heartened by evidence that shows superior survival in patients managed conservatively outside of the clinical trial environment.

The implication that survival may relate to the type of treatment facility, while based on rather soft data, presents an opportunity for some interesting speculation. The radiation therapy component of conservative breast cancer management is in fact quite simple and straightforward with relatively little variation in practice around the country, and we doubt that it would be a significant factor.

At least two other possible explanations exist. In our institution, as in many others, we are very quick to return the patient to the surgeon for reexcision at the primary site if . . . [Full Text PDF of this Article]

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