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The author summarizes reported findings that BCS is linked to a decreased suicide rate and improved self-esteem and quality of life, while offering constructive methodological refinements. Suggestions focus on using alternative statistical approaches beyond Cox regression, incorporating additional covariates (e.g., marital status, physical disease, emotional support, social attention), and conducting sensitivity analyses such as excluding patients with depressive syndromes to clarify the relationship between BCS, suicide risk, and depression-associated effects.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":40,"@type":76,"position":81},"https://docshare.wps.com/document/research-report/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/enhancing-the-understanding-of-association-between-breast-conserving-surgery-with-a-lower-incidence-of-suicide-among-females-with-breast-cancer-correspondence/332330/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/enhancing-the-understanding-of-association-between-breast-conserving-surgery-with-a-lower-incidence-of-suicide-among-females-with-breast-cancer-correspondence/332330.png","ImageObject",300,407,{"name":92,"@type":93},"Oliver","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-14","2026-09-21",true,{"@type":102,"interactionType":103,"userInteractionCount":34},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What is the main purpose of this correspondence?","Question",{"text":112,"@type":113},"To comment on and extend the interpretation of a retrospective cohort study examining the association between breast-conserving surgery and suicide incidence among females with breast cancer.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"Why does the author question the Cox regression model used in the study?",{"text":117,"@type":113},"The author suggests Cox regression may overestimate effects when hazards conflict and that traditional survival approaches may not fully account for how additional events influence the main outcome.",{"name":119,"@type":110,"acceptedAnswer":120},"What additional analyses and variables does the author recommend?",{"text":121,"@type":113},"The author recommends considering competing risk models or difference in restricted mean survival time tests, adding plausible covariates such as marital status and emotional/social support, and performing sensitivity analyses excluding patients with depressive syndromes, especially major depression.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},332330,1790746644,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":39,"category_name":40,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":34,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":14,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":24,"preview_page_count":4},8796095461610,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","’Correspondence  \nEnhancing the understanding of association between breast-conserving surgery with a lower incidence of suicide among females with breast cancer  \nZujun Wen, MSc  \nDear Editor,  \nI read with great interest the retrospective cohort study by Guo et al. [1] . Breast-conserving surgery (BCS) is associated with a lower incidence of suicide among females with breast cancer in the United States: a population-based retrospective cohort study. This study, which contained information from over a million US female breast cancer patients, discovered that BCS was associated with a suicide death risk. The authors have commendably showcased how BCS was linked to a significantly decreased suicide rate among female breast cancer patients, demonstrating its impressive methodology and insightful information. The primary findings, highlighting BCS presents a strong alternative for raising cancer patients’ self-esteem and quality of life while also offering a fresh viewpoint on cancer treatment, which are highly significant and timely. Although the study’s meticulous efforts and noteworthy achievements are greatly acknowledged, several valuable suggestions are offered for further development.  \nFirst, the choice of statistical model. Notwithstanding its widespread acceptance, the Cox regression model may overestimate in situations when there are conflicting hazards. It’s possible that traditional survival analysis techniques fail to completely take into consideration how additional events affect the main result. A competing risk model or the difference in restricted mean survival time (dRMST) test might offer a more thorough viewpoint[2,3] .  \nSecond, the potential covariates. It makes sense that the interplay between age, race, year of diagnosis, residential area, median household income, stage, follow-up time, surgical modality, and cause of death should be taken into account in the study. However, taking into account additional plausible variables including marital status [4], physical diseases (e.g.  \nDepartment of Pharmacy, Heyuan People’s Hospital, Heyuan, People ’s Republic of China  \nSponsorships or competing interests that maybe relevant to content are disclosed atthe end of this article.  \n*Corresponding author. Address: Department of Pharmacy, Heyuan People’s Hospital, No.733Wenxiang Road, Heyuan City, Guangdong Province 517000, People’s Republic of China. Tel.: +86 188 [184 290 25. E-mail: zujunwen@163.com](184 290 25. E-mail: zujunwen@163.com) (Z. Wen).  \nCopyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the Creative Commons Attribution-ShareAlike License 4.0, which allows others to remix, tweak, and build upon the work, even for commercial purposes, as long as the author is credited and the new creations are licensed under the identical terms.  \nInternational Journal of Surgery (2024) 110:5240–5241  \nReceived 10 April 2024; Accepted 14 April 2024  \nPublished online 3 May 2024  \n[http://dx.doi.org/10.1097/JS9.0000000000001530](http://dx.doi.org/10.1097/JS9.0000000000001530)  \ngastrointestinal disease [5], etc. ), emotional support, and social attention [6,7] could potentially strengthen the validity of the results.  \nThird, performing sensitivity analyses with the exclusion of certain populations, such as individuals with depressive syndromes, especially major depression, might help to better understand the relationship, as depression markedly increased the probability of suicide death in cancer patients[8] .  \nIn conclusion, the research conducted by Guo G et al. represents a noteworthy advancement in our comprehension of the variations in the suicide rate among breast cancer survivors between BCS and mastectomy. The current study’s findings offera fresh viewpoint on cancer care while highlighting the significance of raising the quality of life and self-esteem of female breast cancer patients. Improved treatment and preventative approaches may result f","cbCaivLB1njKtPGH","https://ap.wps.com/l/cbCaivLB1njKtPGH","pdf",197523,"English","# Correspondence\n## Overview of the original retrospective cohort study\n## Suggested methodological improvements\n## Suggested expansion of covariates\n## Proposed sensitivity analyses\n## Conclusion and author’s intent","[{\"question\":\"What is the main purpose of this correspondence?\",\"answer\":\"To comment on and extend the interpretation of a retrospective cohort study examining the association between breast-conserving surgery and suicide incidence among females with breast cancer.\"},{\"question\":\"Why does the author question the Cox regression model used in the study?\",\"answer\":\"The author suggests Cox regression may overestimate effects when hazards conflict and that traditional survival approaches may not fully account for how additional events influence the main outcome.\"},{\"question\":\"What additional analyses and variables does the author recommend?\",\"answer\":\"The author recommends considering competing risk models or difference in restricted mean survival time tests, adding plausible covariates such as marital status and emotional/social support, and performing sensitivity analyses excluding patients with depressive syndromes, especially major depression.\"}]","Enhancing the understanding of association between breast-conserving surgery with a lower incidence of suicide among females with breast cancer - Correspondence | PDF",1789997749]