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Hwang and colleagues have observed that women undergoing mastectomy have a poorer disease-specific survival rate compared with women undergoing lumpectomy.[1] One difference is that the women undergoing mastectomy have higher education/higher income (59% are in the upper socioeconomic quintiles for mastectomy compared with 50% for lumpectomy; 22% are in the lower quintiles for mastectomy compared with 29% for lumpectomy).[1]

This difference in income may partially explain the difference in the survival rate. Several studies[2, 3] have demonstrated that higher income women consume more alcohol than lower income women, and it has been well established that alcohol consumption increases the risk of breast cancer.[4] In addition, women with higher income are more likely to have received hormone-replacement therapy.[5]

  • Alan I. Glaser, MD

  • Newton-Wellesley Hospital, Newton, Massachusetts

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