disease? >> there are two reasons. first of all, woman who chos that may be sicker. secondly the surgery may have more complications. sometimes less is more. if you do a bigger surgery, there is more risk of bleeding, more risk of side-effects, more risks of anesthesia, all these risks if you have underlying disease can increase your risk of dying. the question is what works the best. it is proven lumpectomy plus radiation is not only alternative to mastectomy but should be used in most cases. this is great reminder. it is observational study. it is not proof but reassuring to woman considering the more conservative option. patti ann: as you say the authors pointed out, this is a linkage but not necessarily a cause and effect. but you believe women should consider this study when choosing a treatment course? >> they should consider the study. they already should have considered data clearly shows lumpectomy is the way to go in most cases. i think fear is the issue here. this helps cut through the fear. you don't have to have the breast removed in order to