To the Editor We read with great interest the results from the study by de Boniface et al,1 which indicated a significantly higher comorbidity burden in patients using mastectomy irrespective of postoperative radiotherapy, compared with those treated with breast-conserving surgery with radiotherapy in patients with early-stage breast cancer. Moreover, after stepwise adjustment for all covariates, overall survival and breast cancer–specific survival were significantly worse after mastectomy without radiotherapy and mastectomy with radiotherapy than after breast-conserving surgery plus radiotherapy. Based on these results, the authors stated that mastectomy should not be regarded as equal to breast conservation.