Breast Cancer: Treatment Differences and Survival

To the Editor.  —In a recent Editorial, Dr Baue¹ supported other authors and advocated breast-conservation operations and radiation therapy, "if the patient wishes this to be done." Neither in his Editorial nor in the references cited was there any mention of long-term adverse effects, complications, and increased morbidity and mortality from radiation therapy to the breast.Breast cancer has a long natural history. One should not compare mortality of treatment based on the first 5 years following treatment. In trials employing radical mastectomy with or without irradiation, Cuzick et al² found a significant excess of deaths after 10 years among patients given radiotherapy. Friedman³ concluded from studying pathological tissues from 100 women who received radiation therapy that carcinoma of the breast cannot be considered a radiosensitive tumor. Yet radiation therapy must accompany breast-conservation operations.Modern radiotherapy for carcinoma of the breast irradiates a segment of the left