BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7420.938 (Published 16 October 2003) Cite this as: BMJ 2003;327:938

One of the great fears of patients undergoing postoperative radiotherapy for their breast cancer is the possibility that the treatment will induce lung cancer. Sadly, 20 year follow up data confirm the worst. Extensive postmastectomy irradiation of the chest wall and regional lymphatic areas is associated with an increased incidence of subsequent primary lung tumours (on both sides). But it's not all doom and gloom: the data come from trials that used much higher doses of radiation and covered a greater volume of lung than does current treatment

As he approaches his 50th birthday, one emergency physician reflects on his personal evolution over 20 years of clinical practice Although he's not a religious person, he has learnt to recognise the value of spirituality as a personal process that includes the quest for meaning, purpose, connectedness, and values. When patients arrive in emergency departments in great pain, suffering, and fear, he's impressed with the unique ways they focus on what ultimately matters …

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