The overtreatment dilemma in early breast cancer detection may have less to do with medical evidence and more with how patients process fear, how doctors navigate liability concerns, and whether healthcare systems can operationalize watchful waiting protocols. This reality emerges from the first comprehensive analysis of stakeholder perspectives on active surveillance for low-grade ductal carcinoma in situ, a non-invasive breast lesion increasingly caught by screening mammograms. The systematic review of 14 studies reveals that patient acceptance of surveillance over immediate surgery fluctuates dramatically based on terminology used, individual anxiety levels, perceived cancer risk, and trust in their medical team. Meanwhile, clinicians express reservations about progression uncertainty, variability in pathology interpretation, and medicolegal exposure from deviating from standard surgical protocols. Healthcare institutions face implementation gaps including inadequate surveillance pathways and insufficient risk-stratification tools. These findings illuminate why evidence-based alternatives to surgery often struggle with real-world adoption. The psychological dimension appears particularly critical, as patient decision-making around DCIS surveillance involves processing abstract statistical risks while managing cancer-related anxiety. For longevity-focused adults, this research underscores how medical decision-making extends far beyond clinical data to encompass communication strategies, institutional readiness, and individual psychological factors. The challenge of reducing overtreatment in healthcare may require addressing these human and organizational elements as systematically as we approach the underlying medical science.