IONIZING radiation is one of many mutagenic and carcinogenic agents encountered in the environment. The fact that radiotherapy and chemotherapy can both cause and cure cancer is a fascinating paradox of modern therapeutics and one that must be constantly considered when evaluating the risks and benefits of cancer therapy. Because absolute safety is rarely a reasonable goal, the physician's responsibility is to determine tolerable levels of risk.
Lumpectomy and radiotherapy are becoming an increasingly accepted alternative to the traditional modified radical mastectomy for the treatment of breast cancer. The results to date, both in terms of overall survival and cosmetic appearance, are encouraging.1 Radiation treatments are facilitated and normal tissue tolerance preserved by resection of gross tumor mass. Breast reconstruction permits the resection of lesions up to 4 cm in size without marked cosmetic deformity.
All therapeutic decisions involve risks and benefits. The clinical spectrum of the effects of