678 Fig. 1 Overall and age-speciﬁc percentages of the patients who did not receive breast surgery, by country Fig. 2 Overall and age-speciﬁc percentage of patients that received breast conserving surgery (of all patients that received surgery), by country *Less than 50 patients in the selection % *Less than 50 patients in the selection Breast Cancer Res Treat (2012) 132:675–682 relatively few patients did not undergo breast surgery. However, in Ireland and the Netherlands more than half of patients aged 90 years and older had no breast surgery. Figure 2 shows the proportion of the patients that received BCS (of all operated patients) in the countries by age. In most countries more than half of the included patients underwent BCS, except for the Netherlands, Ire- land, and Portugal. The use of breast conserving procedures was highest in Switzerland (70%). In all countries, except for the US and Ireland, the proportion of BCS decreased with age. In the US the proportion of BCS was relatively stable with age and in Ireland the use of BCS increased with age. Radiotherapy after breast conserving surgery Figure 3 shows the proportion of patients treated with BCS who received adjuvant RT. This proportion decreased substantially with age in all countries (P \ 0.001), and also varied markedly between countries (P = 0.0005). The largest overall proportion of BCS followed by RT was observed in Belgium (85%) and the lowest in Portugal (59%) although the sample size was small for the latter. 123 Axillary surgery Figure 4 shows proportions of all included patients who did not receive axillary surgery. The national cancer registry of Belgium could not provide this information and in the US, data on axillary staging were missing for 9.8% of patients. In all countries, the percentage of patients who did not undergo axillary surgery increased with age. However, there was major variation among countries (P \ 0.001), from 1.4% (MCR Germany) to 22.6% (Ireland) overall. Survival Figure 5 shows the 5-year survival after diagnosis by age and stage. For all ages combined, there were no major differences in survival between countries, with the highest relative survival for Ireland (99%). Among stage I patients, survival was similar between countries in all age categories. For stage II, patients aged 65–74 years had a similar survival in all countries, but there were differences for patients aged 75–84 and patients aged C85, where survival was higher for patients in Germany (MCR) and Ireland.