Breast Cancer Today: What Women Need to Know
with Dr. Rache Simmons
Breast cancer is the most common cancer in women, making up 30% of all new cancer diagnoses. One in eight women will be diagnosed with invasive breast cancer in her lifetime. And while survival rates have dramatically improved, what’s changing now is how we approach detection and treatment—especially as diagnoses are appearing more often in younger women.
To walk us through what women need to know right now, I spoke with Dr. Rache Simmons, one of the nation’s most respected voices in breast cancer surgery and women’s health leadership. She is a Professor of Surgery at Weill Cornell Medicine, the Weiskopf Endowed Professor of Surgical Oncology, and former Chief of Breast Surgery at New York-Presbyterian/Weill Cornell. A pioneer in minimally invasive breast surgery and a leader in women’s equity in academic medicine, Dr. Simmons has authored more than 100 peer-reviewed studies and helped shape national standards through her work with the American Society of Breast Surgeons, where she served as President. She also serves as Associate Dean of Diversity and Inclusion and Director of the Office of Women at Weill Cornell. Simply put: she knows this field inside and out—and she’s shaped how it works.
Early detection is everything. Breast cancer caught early is usually treatable and curable. To increase your probability of catching it early you should do three things:
Get annual physicals with clinical breast exams
Know your body—monthly self-exams matter
Start mammograms at 40—earlier only if you’re high risk
Mammograms1 remain the gold standard. A full 25% of diagnoses are in women ages 40 to 50. Earlier screening is generally not recommended for average-risk women under 40 because breast density can obscure mammogram results—and younger women typically have denser breasts.
What about ultrasounds? These can see through dense tissue and are often used alongside mammograms, especially for women under 50 or with dense breasts. But they’re not routine for everyone.
MRIs are not used for average screening. They’re more sensitive and can find things that mammograms miss—but they also yield more false positives. MRIs are usually reserved for high-risk cases, like BRCA mutation carriers.
If cancer is detected, treatment depends on the tumor’s type, size, and spread. Options include:
Lumpectomy2 plus radiation3 – preferred when the tumor is small and caught early
Mastectomy4 without radiation – used in certain cases, especially larger tumors or multifocal disease
Lymph node evaluation – determines whether the cancer has spread and guides further treatment
In some cases, medical treatment happens first—chemotherapy5 or endocrine therapy6—to shrink the tumor before surgery. This is often done when preserving the breast is possible but not guaranteed.
Dr. Simmons noted a trend toward less chemotherapy, guided by tools like the Oncotype DX test, which evaluates how likely the cancer is to return and whether chemo will help. Not everyone benefits from chemo, and today’s approach aims to treat smart—not just hard.
Radiation protocols have changed too. Depending on the case, radiation may now last one, two, or three weeks—less time, fewer side effects. Prone radiation, delivered while lying on your stomach, helps protect the heart and lungs by letting the breast fall away from the body.
There’s often confusion around outcomes for mastectomy versus lumpectomy. Here’s the reality:
Lumpectomy has a 5–10% recurrence risk in the same breast
Mastectomy reduces that risk to <1%
But there’s a 0.5% yearly risk of developing cancer in the opposite breast, regardless of treatment
For those choosing mastectomy, nipple-sparing and skin-preserving surgeries are increasingly common. A plastic surgeon can place implants or use your own tissue—often from the abdomen—to reconstruct the breast. This “tummy tuck” approach (called DIEP flap surgery) uses belly fat to create a natural shape.
Reconstruction is fully covered by insurance when it’s part of cancer treatment.
One of the most exciting developments is cryoablation—a minimally invasive technique where a probe is inserted into the tumor, freezing it from the inside out. For the right type of tumor, in the right hands, it works as well as surgery. But: it’s not for everyone. Tumor size and type matter, and it’s not yet covered by insurance.
When exploring options like cryoablation, it’s critical to work with a specialized care team—ideally at a NAPBC-accredited center (National Accreditation Program for Breast Centers), which ensures the highest standards for treatment and support. Dr. Simmons helped establish these standards.
A nurse navigator can make all the difference—guiding you through appointments, tests, and decisions with consistency and clarity.
Looking ahead, liquid biopsies like the Grail blood test7 are being studied. These tests aim to detect cancer through a blood sample—before symptoms even appear. The hope is earlier diagnosis, and more targeted treatment from the start.
Dr. Simmons closed with this:
Screening is key – it saves lives
Choose an accredited team – where expertise and coordination are built in
Do your treatments – early detection and modern therapies only work if you follow through
Breast cancer today is not what it used to be. With smarter screening, more personalized treatments, and better outcomes, women have more options—and more hope—than ever before.
You can watch or listen to the episode TODAY on Youtube, Apple Podcasts, and Spotify or at Inside the Wellspace.
Here’s to choosing knowledge and power over fear,
Cathy
A low-dose X-ray of the breast used to screen for and detect breast cancer, often before symptoms develop.
A type of breast cancer surgery that removes the tumor and a small margin of surrounding tissue, while preserving most of the breast.
Radiation therapy uses high-energy rays (like X-rays) to kill cancer cells or stop them from growing.
A surgical procedure that removes the entire breast, usually to treat or prevent breast cancer. Depending on the case, it may involve one (unilateral) or both breasts (bilateral).
A cancer treatment that uses drugs to kill fast-growing cancer cells throughout the body.
Used to treat hormone receptor-positive breast cancers by blocking the body’s ability to produce estrogen or by interfering with its effects on breast cancer cells, helping to prevent growth and recurrence.
An experimental liquid biopsy designed to detect multiple types of cancer early by analyzing fragments of tumor DNA circulating in the blood, potentially identifying cancers before symptoms appear.