Survival and cause of death was investigated for Primary Surgical Therapy (PST) and Primary Endocrine Therapy (PET). Of women aged ≥75 years 113 patients received PET, 233 patients underwent PST. PST gave better survival, although this group was younger (p < 0.001). During follow-up the percentage of deaths due to breast cancer was similar and stable in both groups. Increased age was associated with a higher risk on death due to other causes (HR 1.11; CI 1.07-1.14), not on death due to breast cancer (HR 0.94; CI 0.87-1.01). The association of type of treatment and death due to breast cancer was not different between both groups in univariate analyses (HR 0.78; CI 0.44-1.39). In the multivariate model this non-significance remained after correcting for tumor size and age (HR 0.68; CI 0.33-1.42). Treatment should not be based merely on surgical treatment. PET may be an acceptable alternative.
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