Treatment for occult breast cancer: A propensity score analysis of the National Cancer Database

Controversy exists regarding optimal treatment of occult breast cancer (OBC). Treatment options include mastectomy alone (MAST), radiation alone (XRT), or mastectomy with radiation (MXRT). We queried the National Cancer Database from 2004 to 2014 for patients with OBC who underwent MAST, XRT, or MXRT. We utilized propensity score matching to perform three head-to-head comparisons. Kaplan-Meier analysis was performed to compare overall survival (OS). A total of 190 patients received XRT, 237 received MAST, and 244 received MXRT. In the MXRT vs. XRT comparison, 5-year OS was 78.2% and 82.8%, respectively. In the MXRT vs. MAST comparison, 5-year OS was 81.5% and 86.7%, respectively. In the MAST vs. XRT comparison, 5-year OS was 83.2% and 82.5%, respectively. There was no difference in OS for all paired comparisons. There were no OS differences in patients undergoing MAST, XRT, or MXRT, suggesting that breast conservation can be considered in patients with OBC. •Occult breast cancer presents a clinical challenge for clinicians.•Treatment options include mastectomy alone, radiotherapy alone, or both.•Using propensity score matching, we compared these treatment options.•We found no difference in overall survival among the treatment groups.•These results suggest that radiotherapy alone may be sufficient. PRECISE: Occult breast cancer presents a clinical challenge for clinicians. Using propensity score matching, we found no difference in overall survival among mastectomy alone, radiation alone, or mastectomy and radiation.