Breast Cancer Riddle: Best Ways to Screen and Treat

UCSF expert explains how to safely improve routine screening practices.

By Elizabeth Fernandez | | October 24, 2023

A young woman with cancer sits by her living room window and gazes out contemplatively. She is wearing a headscarf and drinking a cup of tea.

Despite decades of scientific progress, breast cancer remains the most common cancer among women in the United States. Experts are divided on many aspects, such as when and how often to do mammograms, how to rethink interventions for precancer lesions, and how to pinpoint risk and reduce the toxicity of treatments. During Breast Cancer Awareness Month, we asked Laura J. Esserman, MD, MBA, director of the UCSF Breast Care Center and co-leader of the Breast Oncology Program at the UCSF Helen Diller Family Comprehensive Cancer Center, about risk factors, progress in the field and the importance of tailoring treatment for women with low-risk cancer while also identifying women at high risk of invasive cancer.

I was just diagnosed with breast cancer, now what? What should I ask my doctor?

Cancer is not an emergency that needs to be tended to the moment it’s discovered. After receiving a cancer diagnosis, it’s entirely natural to feel scared and anxious, and the immediate impulse might be to rush into treatment. Give yourself and your health care team the time needed to understand the nature of the tumor. Partner with your health care team and make decisions together that consider your well-being every step of the way. You should also consider joining a clinical trial, which can provide more cutting-edge treatment options that are tailored to your tumor biology.

What has shifted in recent years in our understanding of breast cancer?

We now know much more about the biology of breast cancer and understand that breast cancer is not just one disease. We’ve made great strides in improving treatments by learning how to profile tumors and tailor therapy accordingly. We have also accelerated progress by switching the order of therapy by using systemic treatments before surgery. This has enabled us to learn quickly which treatments work well and which do not.

We also know that some breast cancers are slow-growing and some grow much faster. Treatments are not the same, and it stands to reason that screening should not be the same. For instance, some of the findings from screening, such as stage 0 cancer (or Ductal Carcinoma in Situ), may never develop into invasive cancer or cause harm, and safely reducing treatment is an important part of advancing breast cancer care.

We have also learned that women’s risk for developing breast cancer varies greatly based on her own individual risk factors. Thus, we can link treatment, screening and prevention by better understanding not only risk but risk for what type of cancer.