From Tony Waldron Your article on breast cancer surgery (23 June, p 42) exemplifies the gulf between epidemiologists and doctors in their thinking about disease. To the epidemiologist it seems absurd to operate on a woman with a non-invasive ductal carcinoma in situ (DCIS) -a tumour in a milk duct that is unlikely to spread. As "few" as 4 per cent will go on to develop an invasive carcinoma. These odds are far from negligible. What is the surgeon to say to a woman with DCIS? "Don't worry, you only have a roughly 1 in 25 chance of going on to develop a disease that may kill you." How about when the patient asks if the surgeon can guarantee she will be one of those who does not get invasive carcinoma?
展开▼
