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Breast cancer, one of the most prevalent cancers affecting women worldwide, has witnessed remarkable advancements in diagnosis and treatment over the past few decades. These advancements have undoubtedly improved survival rates and offered patients more treatment options. However, this progress has also given rise to concerns about the potential for over surgery in breast cancer management [1]. Over surgery, in this context, refers to the excessive use of surgical procedures that may not always translate into clear clinical benefits but instead expose patients to unnecessary risks and complications.

The management of breast cancer has evolved significantly, moving away from radical approaches toward more conservative and patient-centered strategies. Yet, the challenge of striking the right balance between aggressive intervention and the preservation of patients' physical and emotional well-being remains [2]. This article delves into the concept of over surgery in breast cancer, shedding light on the various dimensions of this issue and emphasizing the need for informed decision-making, shared discussions between healthcare providers and patients, and a holistic approach to breast cancer care.

The overarching goal of this article is to promote a comprehensive understanding of over surgery in breast cancer and encourage a patientcentric approach to treatment decisions [3]. By doing so, healthcare providers can contribute to ensuring that breast cancer management not only maximizes the potential for survival but also respects the diverse needs and values of each patient, ultimately leading to more favorable outcomes and enhanced quality of life for individuals facing this challenging diagnosis.

Defining over surgery

Over surgery in breast cancer refers to the excessive use of surgical procedures that may not provide clear clinical benefits but instead expose patients to unnecessary risks and complications. It encompasses a range of issues, including the overuse of mastectomy over breastconserving surgery, extensive lymph node dissections, and the removal of healthy breast tissue in contralateral prophylactic mastectomies (CPM) [4].

Mastectomy vs. Breast-conserving surgery

Mastectomy, the complete removal of the breast, has historically been a standard treatment for breast cancer. However, studies have shown that breast-conserving surgery (lumpectomy) followed by radiation therapy is equally effective in treating early-stage breast cancer [5]. Yet, some patients continue to undergo mastectomy, often driven by fear or misconceptions about the risks associated with breastconserving surgery.

Extensive lymph node dissections

The extent of lymph node dissection is another area where over surgery can occur. While it is essential to determine the spread of cancer, the removal of an excessive number of lymph nodes can lead to complications like lymphedema and decreased quality of life. Sentinel lymph node biopsy, a less invasive technique, can often provide sufficient information without the need for extensive dissections [6].

Contralateral prophylactic mastectomies (CPM)

The rise in CPM rates is a concerning trend in breast cancer treatment. CPM involves removing the healthy breast in addition to the affected breast. While it may reduce the risk of contralateral breast cancer, its impact on overall survival is minimal. Patients should be educated about the limited benefits of CPM and the potential physical and psychological consequences [7].

Balancing aggressive treatment and well-being

Striking the right balance between aggressive treatment and preserving patients' well-being is crucial. Several steps can help achieve this balance:

1. Informed decision-making: Encourage patients to actively participate in treatment decisions. Provide them with clear, evidencebased information about the benefits and risks of different surgical options.

2. Shared decision-making: Collaborate with patients to align treatment choices with their values and preferences. Recognize that some patients may prioritize breast preservation and quality of life over aggressive treatments [8].

3. Psychological support: Offer psychological support and counseling to address the emotional and mental health aspects of cancer diagnosis and treatment. Help patients cope with anxiety and body image concerns [9].

4. Minimally invasive techniques: Whenever possible, use minimally invasive surgical techniques and sentinel lymph node biopsies to reduce the extent of surgery and associated complications.

5. Multidisciplinary care: Emphasize the importance of a multidisciplinary approach involving surgeons, oncologists, radiologists, and psychologists to provide comprehensive care.

Conclusion

Over surgery in breast cancer is a complex issue that requires a delicate balance between aggressive treatment and patient well-being.

It is essential to educate patients about their treatment options, involve them in decision-making, and provide psychological support to address the emotional toll of breast cancer. By doing so, healthcare providers can help ensure that breast cancer treatment is not only effective but also respectful of patients' physical and emotional needs. Ultimately, the goal is to provide personalized care that maximizes both survival and quality of life for breast cancer patients.

Acknowledgement

None

Conflict of Interest

None

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