Breast cancer remains one of the most common cancers among women, but there is also meaningful progress to recognize. Breast cancer death rates in the United States declined 44% between 1989 and 2023, a change that the American Cancer Society links to earlier detection, increased awareness, and advances in treatment.
As we move through Breast Cancer Awareness Month, we want to recognize how breast cancer treatment has changed and celebrate that today’s care can be tailored more closely to each patient.
Advances in research, surgery, tumor testing, and reconstruction are helping care teams recommend treatment based on the cancer’s features, the patient’s needs, and the goals that matter most to them.
Shaghayegh Aliabadi, MD, FACS, of The Oregon Clinic Center for Advanced Surgery, and Samuel V. Bartholomew, MD, FACS, of The Oregon Clinic Plastic Surgery, share how breast cancer care has evolved and why close collaboration can make a meaningful difference throughout treatment and recovery.
A More Limited Treatment Approach When It Is Safe
Dr. Aliabadi notes that breast cancer treatment has evolved markedly over the course of her 25-year career. Along with imaging advances that have increased early detection, large studies conducted over the past two decades have shown that appropriately selected patients with lower-risk cancer may be candidates for a more limited treatment approach without a significant adverse effect on overall survival. This could mean less extensive lymph node surgery, a shorter course of radiation or, in some cases, no radiation.
Some of the factors that help determine whether a patient is at lower risk include age, menopausal status, tumor size, and whether the tumor has receptors for estrogen, progesterone, or HER2.
The goal is not simply to do less. It is to choose the amount of treatment that offers effective cancer care based on each patient’s circumstances while avoiding procedures that may add side effects or recovery time without a meaningful benefit.
Treatment Guided by Tumor Biology
In the past, chemotherapy recommendations were based largely on the size of the cancer and whether it involved the lymph nodes. Today, genomic testing of cancer tissue can provide more information about tumor biology and the likelihood of recurrence. This helps care teams identify which patients are most likely to benefit from chemotherapy and which patients may be able to avoid it.
Coordinating Breast Surgery and Reconstruction
Breast surgeons and plastic surgeons can begin working together at diagnosis and continue collaborating through surgery, additional cancer treatment, and later stages of reconstruction.
When reconstruction takes place at the time of a mastectomy, the surgeons can discuss the technical details in advance and work side by side during the procedure. Reconstruction may also be completed in stages, with its timing coordinated around chemotherapy, radiation, or other needed treatments.
A strong working relationship between the breast and reconstructive surgeons is essential for coordinating the timing of care and planning for the best possible result for each patient.
Patients Have More Breast Reconstruction Options
Dr. Bartholomew notes that advances in implant-based and tissue-based flap reconstruction over the past two decades have given patients more options. Refined surgical techniques, improved implants, dermal matrix, and fat grafting can help improve overall breast contour. Pain-control approaches after surgery have also advanced, supporting a better recovery experience.
Among the newer reconstruction options that may be appropriate for some patients is a nipple-sparing mastectomy, which leaves less visible scars and provides a more natural-looking result. For some patients having a lumpectomy, oncoplastic reconstruction may also be an option. This approach moves nearby breast tissue to fill the area where the tumor was removed and is often combined with a breast lift.
Why a Multidisciplinary Team Matters
Breast cancer treatment can be complex at any stage or grade. It involves several specialties and requires a series of decisions over time. An experienced multidisciplinary team can help patients understand their options, coordinate the timing of care, and make choices that support both safety and quality of life.
Dr. Aliabadi and Dr. Bartholomew both emphasize the importance of working as a team alongside each patient to set treatment goals and identify opportunities for shared decision-making. The multidisciplinary team, including medical and radiation oncology when appropriate, considers what will support a good cancer outcome while avoiding interventions that may create additional complications without a meaningful benefit.
Finding the Right Plan for You
There is no single treatment or reconstruction plan that is right for everyone. The best approach depends on the type and stage of cancer, a patient’s overall health, personal priorities, and any additional therapies that may be needed. An experienced breast cancer team can explain the options, coordinate care, and help each patient make informed decisions throughout treatment and recovery.