HJNO Jul/Aug 2026

HEALTHCARE JOURNAL OF NEW ORLEANS I  JUL / AUG 2026 59 Ralph L. Corsetti, MD Surgical Oncologist Mary Bird Perkins Cancer Center symptoms, making a diagnosis even more bewildering. Get a second opinion with a team of fellowship-trained specialists. A multidisciplinary team that includes a breast radiologist, surgical oncologist/breast sur- geon, medical oncologist, radiation oncol- ogist, plastic and reconstructive surgeon, and pathologist will provide you with a well- rounded picture of your case. Once the results are in and it’s time to proceed with treatment, consider consult- ing with physical and occupational thera- pists, nutritionists, and social services, be- cause early consultation can help support recovery, function, nutrition, psychosocial needs, and care coordination. Additionally, ask about working with a navigator. Naviga- tors provide guidance through each step of a difficult time of life in an organized, opti- mally effective, and supportive manner. n REFERENCES 1 Roberta M. Strigel, “Utility of BI-RADS Assessment Category 4 Subdivisions for Screening Breast MRI,” American Journal of Roentgenology 208, no. 6 (2017): 1392–9, https:// doi.org/10.2214/AJR.16.16730; K. Marthay et al., “A Five-Year Review of the Outcomes of Breast Imaging Reporting and Data System 4 Lesions in Hospital Universiti Sains Malaysia,” Cureus 14, no. 3 (March 1, 2022): e22757, https://doi. org/10.7759/cureus.22757. 2 Fadila Kouhen, “Omitting Radiotherapy in Elderly Breast Cancer Patients: Valid Strategy or Illusory Hope?” The Breast 72 (2023), https://doi. org/10.1016/j.breast.2023.103598; B. Fisher et al., “Twenty-Year Follow-Up of a Randomized Trial Comparing Total Mastectomy, Lumpectomy, and Lumpectomy Plus Irradiation for the Treatment of Invasive Breast Cancer,” New England Journal of Medicine 347, no. 16 (2002): 1233–41, https:// doi.org ./10.1056/NEJMoa022152. Ralph L. Corsetti, MD, is board-certified, fellowship- trained surgical oncologist at Mary Bird Perkins Can- cer Center in Covington,specializing in breast,endo- crine,andmelanoma surgery.He is recognized for his leadership in surgical oncology and his dedication to patient-centered, collaborative care. often counseled to strongly consider radia- tion therapy to help increase local (breast and chest wall) and regional (lymph nodes) control of the axilla. Need and extent for systemic whole body therapy (chemother- apy and endocrine therapy) is now often determined by molecular genomic testing. Patients with positive lymph nodes with low-risk molecular genomics may be able to defer chemotherapy while some node negative patients with high-risk molecular genomics may be offered chemotherapy. If the tumor is HER2/neu positive or a triple-negative breast cancer (TNBC) when hormone and HER2/neu receptors are all negative, pre-operative chemotherapy may be an option to consider. Terms used to de- scribe getting chemotherapy before surgery include up-front, neoadjuvant, induction, or primary chemotherapy. Chemotherapy before surgery may also be recommended if the tumor meets criteria by either size or lymph node positivity. Many patients with these receptors now respond completely with pre-operative therapy. Having chemotherapy before surgery al- lows the oncologists to assess the response to treatment and potentially change course with type and extent of therapy. It allows the team to potentially mitigate surgery, extent of lymph node removal, and radiotherapy. It also allows the provider to treat people more extensively if the cancer is not com- pletely responding before surgery, meaning only those who need extra therapy receive it. Multidisciplinary Care Matters Being diagnosed with breast cancer is scary and often confusing due to both the variety and sequencing of treatment strat- egies. Most breast cancers present without the tumor and a small rim of normal breast tissue are removed. This is most often fol- lowed by radiation therapy to the breast to keep the local recurrence rate in the breast itself under 5%. Recurrence rates in the breast are higher with lumpectomy alone without radiation, but, if certain favorable criteria are met, there are situations where radiation could be deferred with minimal impact on recurrence. It is important to discuss this with your team of oncologists, which should include a radiation oncologist. The other surgical option is a mastectomy, which includes traditional and nipple-spar- ing techniques, with or without reconstruc- tion. The mastectomy involves removal of the entire breast, in which case radiation is often not necessary. Local recurrence rates after mastectomy are generally low. Radia- tionmay be considered after mastectomy for larger tumors with skin, chest wall, or lymph node involvement. These factors should be discussed with the oncologic surgeon and plastic reconstructive surgeon to determine candidacy for skin-sparing versus nipple- sparing mastectomy, immediate versus de- layed reconstruction, tissue expander/im- plant versus your own autologous natural tissue reconstruction. Often, having a breast magnetic reso- nance imaging (MRI) is recommended be- fore making a final decision. Genetic testing may also be used to help make the difficult decision between lumpectomy and mastec- tomy. Additionally, a sentinel lymph node biopsy (SLNB) is likely to be recommend- ed. This is performed with lumpectomy or mastectomy to provide further prognos- tic information to help guide the extent of therapy. Patients with positive lymph node disease in their armpit, called the axilla, are