Based on these results, guidelines recommend BCT for patients with breast cancer with BRCA1 or BRCA2 pathogenic variants as moderate-level evidence.25 In the most recent study conducted on patients with BRCA1 variants, although it was a univariate analysis, patients who underwent BCT demonstrated superior BCSS compared with those who underwent mastectomy.37 Our results provide stronger evidence for the eligibility for BCT in these patients with regard to DR and OS, based on a large-scale, long-term follow-up cohort utilizing advanced statistical methods such as PSM. This evidence concerns the gene BRCA1 and breast carcinoma.