HJNO Jul/Aug 2026

58 JUL / AUG 2026 I  HEALTHCARE JOURNAL OF NEW ORLEANS ONCOLOGY DIAL GUE COLUMN ONCOLOGY WHETHER BREAST CANCER is identified through routine mammography, self-exam- ination, or a clinical breast examination, it is important to have the proper coordinated workup to optimize outcomes. Here I will share with you the approach I take with pa- tients when they are faced with a new breast cancer diagnosis. First Steps After an Abnormal Mammogram When facing an anxiety provoking radiol- ogy result such as a BI-RADS 4 suspicious finding on screening mammography and/or subsequent diagnostic mammography/ultra- sound, and a needle biopsy is recommended, take a deep breath. The results may end up being benign. Studies report that roughly 20% to 40% of BI-RADS 4 findings turn out to be malignant. A needle biopsy of the breast is a low-risk procedure performed in the outpatient setting under local anesthesia, so recommendations are made in order to minimize the chances of “missing” a cancer. If benign, an an excisional biopsy may be needed to sample more tissue for certain “atypical” lesions, but most of these turn out to be benign. It is important to proceed specifically with a needle biopsy if suspicious findings are noted. Do not start with an excisional biopsy. Make sure to have all the proper im- aging before proceeding with a needle biopsy. This is especially important in cases when a provider feels a mass on examination. The provider observes the size of the abnormal- ity before a needle biopsy to get an accurate assessment to determine if the patient needs surgery. If required, the appropriate amount of tissue is removed for the given diagno- sis. The provider should minimize operating roomprocedures because there is a potential, through proper planning, of more accurate oncologic and better cosmetic outcomes. Ask to be referred to or seek a second opinion with a fellowship-trained surgical oncologist or breast surgeon. Fellowship-trained cancer specialists have the expertise to coordinate care and help with navigating through the process to get the best outcomes. Understanding Diagnosis and Treatment Options If diagnosed with breast cancer, take an- other deep breath. Given current guidelines for breast cancer screening, most breast can- cers are diagnosed at an early stage as either stage 0 ductal carcinoma in situ (DCIS) or early-stage invasive cancers, which are high- ly curable. DCIS usually requires some form of surgical management with extremely high curability rates since it theoretically should not have spread beyond the confines of the breast tissue. If diagnosed with invasive or infiltrating cancer on biopsy, make sure to know the receptor status before moving for- ward with any treatment decision. Ask for and know the results of the estrogen and pro- gesterone (hormone) receptors, HER2/neu receptor, and the Ki-67 proliferative index. Fortunately, most breast cancers are hor- mone receptor positive, which are also the most favorable subtypes. These are usually managed by performing surgery first. Op- tions include breast conserving surgery (par- tial mastectomy or lumpectomy) where only Navigating Through Breast Cancer Diagnosis and Management: MY ADVICE TO PATIENTS