REVIEW article
Front. Oncol.
Sec. Surgical Oncology
De-escalating Breast and Axillary Surgery in Breast Cancer: Evidence, Controversies, and Future Directions
Provisionally accepted
Baha Sharaf1*
Ala' Seif1
Fadi Alawneh1
Hira Bani Hani1
Marwa Sh Abrahim1Sharif Jehad1Mohamed Abdallah1Suleiman Mahafdah2- 1King Hussein Cancer Center, Amman, Jordan
- 2Jordanian Royal Medical Services, Amman, Jordan
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The surgical management of breast cancer has achieved considerable improvement, shifting from radical resections toward increasingly conservative approaches driven by the advances in systemic therapy, precision imaging, and tumor biology. De-escalation strategies reducing the extent of surgery in the breast and axilla, aiming to minimize treatment-related morbidity (e.g., lymphedema, chronic pain, impaired mobility), while maintaining oncologic safety. This review synthesizes evidence from over 20 landmark trials, critically examines current clinical guidelines, and explores emerging technologies (e.g., artificial intelligence, liquid biopsy) that may further refine patient selection. We also highlight global disparities in adopting de-escalation strategies and discuss unanswered questions, such as applicability in high-risk subtypes and long-term recurrence risks.
Keywords: Axillary management, breast cancer, deescalation, Mastectomy, Oncology surgery
Received: 01 Oct 2025; Accepted: 02 Feb 2026.
Copyright: © 2026 Sharaf, Seif, Alawneh, Bani Hani, Sh Abrahim, Jehad, Abdallah and Mahafdah. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Baha Sharaf
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