In Reply. —We thank Dr Lawrence for his supportive and thoughtful comments on our article. We would like, however, to take issue with a few points, most importantly, the local failure rate for radiation therapy.
Dr Lawrence states that our local recurrence rate is 7%. He uses this to justify radiation therapy as the treatment of choice for DCIS. He states that we failed "to emphasize the positive aspects" of our study and that we "cast a doubt on the effectiveness" of radiation therapy.
In our published series of 103 patients treated with radiation therapy, seven failed locally, an absolute recurrence rate of 7%. However, during the past few years, we have been accruing patients with DCIS at a rapid rate. This rapid accrual of new patients with DCIS dilutes the study population with freshly diagnosed patients who have not had time to develop recurrence, keeping the absolute recurrence rate