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Evaluation of Treatment Options for Ductal Carcinoma In Situ of the Breast

Arch Surg. 1991;126(12):1541. doi:10.1001/archsurg.1991.01410360119019.
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To the Editor. —The paper that appeared in the April 1991 issue of the Archives by Silverstein et al1 is a well researched study that sheds light on the natural behavior of intraductal carcinoma. Based on the 7% local recurrence rate, the authors cast a doubt on the effectiveness of lumpectomy and radiation therapy for ductal carcinoma in situ (DCIS). This is unfortunate! The risk of ipsilateral failure is much lower than the risk of a new tumor in the contralateral breast. It is heartening that none of the patients in the series had, and the authors do not recommend, bilateral mastectomy for DCIS.

The 7% incidence of local recurrence in patients treated with lumpectomy and radiation therapy is significantly lower than the reported incidence of local recurrence in infiltrating ductal carcinoma treated in a similar manner. Hence, there is no basis for the authors' comment that "Intraductal carcinomas


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