pET vs surgery in older women with ER-positive breast cancer: no clear survival gap

A systematic review and meta-analysis published 6 November 2026 in JAMA Network Open pooled evidence on more than 22,000 patients with estrogen receptor–positive (ER-positive) breast cancer comparing primary endocrine therapy (pET) with upfront surgery in older women.

Main findings

According to the journal’s media release, there was no statistically significant survival difference between pET and upfront surgery. Durable disease control under pET appeared concentrated in patients with favorable tumor biology. The authors frame the results as supporting decisions that weigh tumor biology and frailty, not age alone, when considering pET candidacy. Corresponding author: Neil Carleton, Brigham and Women’s Hospital / Harvard Medical School.

Limits — talk to clinicians

The evidence base is a meta-analysis of heterogeneous studies; many pET comparisons rely on observational or non-randomized data. Hazard ratios and confidence intervals beyond the media-release summary were not independently verified here for every outcome. This is not individualized medical advice — treatment choices belong with patients and their clinicians.