A surgical subculture. The use of mastectomy to treat breast cancer.

The results of the study by Dr. Vivek Goel and associates (see page 25 of this issue) are similar to those of studies conducted in the United States that have found that the use of breast-conserving surgery to treat breast cancer is inconsistent. The current understanding of the biological basis of the treatment of breast cancer stresses the limited role of extensive surgery and the value of radiation therapy and other forms of adjuvant treatment in reducing the rates of local recurrence. During the Montreal Forum on Breast Cancer, held in November 1992, participants expressed a wish for consistency in medical practice in this area. However, the goal of consistency may not be served by guidelines that present only a summary of scientific findings. Guidelines must present clear recommendations, and the diffusion of these recommendations into general medical practice must involve regional medical groups and their opinion leaders.