ESR1 and breast cancer: Significant differences emerged after 5 years, suggesting tamoxifen as a potential option for elderly estrogen receptor-positive BC patients with a life expectancy of <5 years.45 The Italian GRETA trial showed increased local disease progression in the tamoxifen-alone arm compared with the tamoxifen plus surgery arm, without differences in OS or BC-specific survival.46 In our cohort, 31.9% of patients received HT alone, experiencing significantly higher global relapse and BC-related mortality rates than surgical patients (22.2% vs. 10.4%, and 25.0% vs. 1.33%, respectively).