We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Letters |

Brachytherapy vs Whole-Breast Irradiation for Breast Cancer

Atif J. Khan, MD; Frank A. Vicini, MD; Doug Arthur, MD
JAMA. 2012;308(6):567-568. doi:10.1001/jama.2012.8486.
Text Size: A A A
Published online


To the Editor: Dr Smith and colleagues1 compared outcomes of whole breast irradiation (WBI) vs brachytherapy in older women with breast cancer. We are concerned that the findings from this claims-based study may result in unnecessary anxiety for women treated with brachytherapy. Claims-based studies using large databases are subject to the limitations of retrospective analyses and can be especially problematic if data on important and validated determinants of treatment success are not available. We are unsure if subsequent mastectomy is a valid surrogate for breast conservation as indicated by the authors. Laterality of breast surgery is typically not reported in Medicare claims. Thus a patient having a contralateral mastectomy for any reason would be scored as a treatment failure in the study. Also, we believe the 5-year difference in subsequent mastectomy rates after brachytherapy of 1.77% reported in the study should not be interpreted as inferior to WBI; a difference of this magnitude is of questionable clinical relevance.2


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?




August 8, 2012
Grace L. Smith, MD, PhD, MPH; Thomas A. Buchholz, MD; Benjamin D. Smith, MD
JAMA. 2012;308(6):567-568. doi:10.1001/jama.2012.8490.
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.