Facing breast cancer far from radiation therapy centres CMAJ 1997;157:253 Re: "Patterns of initial management of node-negative breast cancer in two Canadian provinces" (CMAJ 1997;156:25-35 [abstract / résumé]), by Dr. Vivek Goel and associates, and "A surgical subculture: the use of mastectomy to treat breast cancer" (CMAJ 1997;156:43-45 [abstract / résumé]), by Dr. Adalei Starreveld In response to: O.F. Bathe, D.T. Brosseuk Drs. Bathe and Brosseuk make some important points concerning initial surgery for early-stage breast cancer. We agree that access to radiation therapy can be an important factor in patients' selection of the type of breast surgery. As we noted in the introduction to our article, the current body of evidence shows that the 2 procedures are equivalent in outcome. Women need to be offered a choice and unbiased information about the 2 options in a way that allows them to make an informed decision that is appropriate for them. This is a complex issue and is obviously not value-free. Work to assist women in this area is progressing rapidly. A national cancer-information hotline is now available (tel. 888 939-3333). Health Canada has funded 5 regional Breast Cancer Information Exchange projects, which have produced and are distributing valuable resources.1 We have developed a decision aid for use at initial diagnosis, which explicitly presents the options and their consequences and includes pictures and graphic presentations of probabilities of different outcomes.2 A values-clarification exercise assists the decision-maker in incorporating her preferences into the decision. The challenge is not to eliminate variations in patterns of practice but to understand why they occur and to ensure that the physician­patient interaction is as fully informed as possible. Vivek Goel, MD, MSc Carol Sawka, MD University of Toronto Toronto, Ont. Ivo Olivotto, MD University of British Columbia Vancouver, BC References Olivotto I, Gelmon K, Kuusk U. The intelligent patient guide to breast cancer. Vancouver: Intelligent Patient Guide Ltd., 1995. Sawka CA, Goel V, Mahut C, Taylor G, O'Connor A, Ackerman I, et al. Pilot study of a decision aid for locoregional management for breast cancer. Breast Cancer Res Treat 1996;41:258. Send a letter to the editor responding to this article Envoyez une lettre à la rédaction au sujet de cet article | CMAJ August 1, 1997 (vol 157, no 3) / JAMC le 1er août 1997 (vol 157, no 3) |