Increase in the Use of Breast-Conserving Surgery—Reply

In Reply: Although the primary goal of our study was a comparison of diagnosis and treatment patterns between the health maintenance organization and fee-for-service sectors of Medicare, we reported that rates of BCS and adjuvant radiation therapy were substantially higher than we had found in earlier years.¹ Based on analyses of SEER data, Dr Du raises the additional point that the rapid increase in the use of BCS has been accompanied by a slower increase in the use of adjuvant radiation therapy, thereby increasing the number of women receiving nondefinitive therapy for early-stage breast cancer. It is possible, though, that the observed difference in rates of increase between BCS and radiation therapy may be partially attributable to underreporting of radiation therapy in SEER, which may be increasing over time with the proliferation of radiation facilities not affiliated with hospitals.