The role of adjuvant radiotherapy (RT) following breast-conserving surgery in early-stage breast cancer has been well established based on several landmark clinical trials in the 1970s.1,2 Subsequent studies3,4 have suggested that in a subgroup of patients, particularly older women with smaller estrogen receptor (ER)–positive tumors receiving antihormonal therapy, irradiation may not provide as compelling a clinically meaningful benefit. More recently, significant technical5 and practical6,7 advances in breast RT have been made, and an emphasis on individual patient-centric care has become the norm. Taken together, these factors beg the question: Is it time to reevaluate the practice of omitting RT in patients 65 years or older with favorable early-stage breast cancer?