Experts Share Updates on Breast Cancer Screening and Treatment

Advances in breast cancer screening and treatment are helping doctors detect the disease earlier, tailor therapies to individual patients and, in some cases, spare women from unnecessary chemotherapy, radiation and surgery.

To mark Breast Cancer Awareness Month, Cedars-Sinai breast surgical oncologists Ronald Hurst, MD, and Carey Cullinane, MD, spoke with the Cedars-Sinai Newsroom about these advances-and what women should know about their individual breast cancer risk.

Hurst and Cullinane treat patients at Cedars-Sinai Marina Hospital and The Angeles Clinic and Research Institute, an affiliate of Cedars-Sinai Cancer.

Why is it more important than ever to catch breast cancer early?

Ronald Hurst, MD: When breast cancer is detected early, survival rates increase and treatment is often less intense. Outcomes also improve exponentially.

The five-year overall survival rate for women with breast cancer treated at the earliest stage is over 99%. When detected at a later stage where the cancer has spread to the lymph nodes, survival drops to 87%. That drops to 33% if the disease is metastatic, meaning it has spread to a distant site such as the brain.

At what age should women begin breast cancer screening?

Carey Cullinane, MD: For most women at average risk, major guidelines now recommend starting mammograms at age 40. But if you are in your 20s or 30s, it's worth talking with your doctor about your own risk, because the right screening plan for someone at higher risk looks different.

That conversation should cover your family history of breast and other cancers, whether genetic testing makes sense for you, any past breast biopsies or chest radiation, how dense your breast tissue is, and even the age at which you got your first period. Ask questions, and look for a doctor who asks you questions, too. Your risk can change over time, so this isn't a one-time conversation. Starting this conversation in your late 20s and 30s is important for those who would benefit from starting screening earlier.

How has screening changed in recent years?

Hurst: We've come a long way in cancer detection. We now use 3D mammography, which gives a three-dimensional view of what is happening inside the breast, and AI algorithms to give us even more detail from the same image.

If the mammogram shows something that might be concerning, we can perform a breast ultrasound, breast MRI or even a contrast-enhanced breast MRI to help us get as much information as possible without doing a biopsy. That is our goal, and that is where technology is taking us.

Is there a downside to these new tools?

Cullinane: The more sensitive a test is, the more often it finds things that turn out not to be cancer. Getting a call asking you to come back for a second look is stressful, and I never take that lightly. The good news is that most callbacks turn out to be nothing serious. But it's one more reason we match screening to each woman's risk: Screening more than you need can mean more callbacks and more worry, without more benefit. For those who are at higher risk, additional screening can help to detect early-stage breast cancer, when outcomes are the best.

How has treatment changed in recent years?

Cullinane: Treatment today is far more personalized. We can test a tumor's genetic makeup to see which treatments are likely to help and which may not. That means some women can now safely avoid chemotherapy or radiation that, not long ago, nearly everyone with their diagnosis would have received. It's not about doing less for its own sake; it's about giving each woman effective personalized treatment.

Hurst: Molecular tumor evaluation even helps us de-escalate lymph node surgery. We used to remove many lymph nodes, which are small structures that are part of the immune system and an avenue for cancer to spread. Now we biopsy a single lymph node with a much smaller incision to help determine the extent of treatment a woman might need.

And thanks to new immunotherapies that harness the power of the immune system to help fight cancer, even women who have metastatic cancer are living longer. They're living with breast cancer and living a normal life because these treatments are keeping the cancer at bay.

What advice do you have for women who are newly diagnosed?

Hurst: Breast cancer treatment is complex and is different for each patient. There can be an overwhelming amount of advice your community may share. While I understand that patients might want to share their journey with many people, when they are making decisions, I encourage patients to trust their providers and their family and a few key individuals who can support them through that journey.

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