Breast cancer diagnosis and treatment can feel overwhelming, but understanding the process and the options available can help women approach it with confidence. In the latest episode of the Healthful Woman podcast, Dr. Christina Weltz, a breast surgeon, discusses the modern approach to diagnosing and treating breast cancer, including common myths and critical decisions women face.
How Breast Cancer is Diagnosed Today
Dr. Weltz explains that the vast majority of breast cancer diagnoses now begin with radiologists rather than surgeons. Thanks to the development of needle biopsies since the 1980s, women no longer need to undergo surgical procedures under general anesthesia just to confirm a diagnosis. Today, a core needle biopsy, which is performed in the radiologist’s office with local anesthesia, provides enough tissue for pathologists to determine whether a lesion is benign or malignant, and even to assess key characteristics such as hormone receptor status.
Radiologists now play a central role in patient care. They communicate directly with women about findings, guide next steps, and coordinate with primary care physicians or gynecologists. For benign results, follow-up may be minimal, but malignant findings involve referral to a breast surgeon, who works with the patient to determine the most appropriate treatment plan.
As Dr. Weltz emphasizes, “The radiologist becomes the key person in that regard…they are the ones who are getting women through this very difficult situation and making those phone calls saying, ‘This is what you’ve got.’”
The Importance of Consistency in Screening
Dr. Weltz also emphasizes that women benefit from seeing the same radiologist consistently. Familiarity with prior imaging allows for more accurate comparisons and can prevent unnecessary biopsies. For women with dense breast tissue, supplemental screening such as an ultrasound may be recommended. Expertise and volume matter: radiologists who focus primarily on mammograms and breast imaging provide the most reliable assessments.
Surgical Options: Lumpectomy vs. Mastectomy
A common question Dr. Weltz encounters is whether a woman should have a lumpectomy or a mastectomy. She clarifies that, with very few exceptions, surgery is necessary for most breast cancers. Lumpectomy, which includes removing only the tumor while preserving the rest of the breast, is equally effective as a mastectomy in most cases. Despite a common misconception that a larger surgery means a better cure, decades of research confirm that lumpectomy is safe and curative when appropriately indicated.
However, some women do require a mastectomy. Situations that may necessitate a full mastectomy include:
- Multiple tumors in different areas of the breast
- Extensive ductal carcinoma in situ (stage 0), which can be widespread even without symptoms
Dr. Weltz notes, “An early-stage breast cancer can require a mastectomy, whereas something far more invasive if isolated is very safely treated with a lumpectomy.” In these cases, removing all affected tissue is essential for a curative outcome. Modern mastectomy techniques often preserve most of the breast skin, allowing for natural-looking reconstruction while ensuring the cancer is completely removed.
Making the Right Treatment Decision
Dr. Weltz stresses the importance of patient education and communication. Women are often presented with options that may include a lumpectomy with additional treatments like radiation or chemotherapy, or a mastectomy to remove all tissue at once. By reviewing imaging, explaining research, and addressing myths, patients can make informed choices that align with their preferences and medical needs.
A Message of Hope and Support
Dr. Fox and Dr. Weltz highlight that while breast cancer is understandably frightening, advancements in screening, diagnostics, and treatment mean that most women do very well. Building relationships with specialized radiologists and breast surgeons ensures women receive expert care, both medically and emotionally. As therapies improve and screening becomes more advanced, the outlook for women today, and for future generations, continues to improve.
Dr. Weltz also emphasizes the human side of care: treating patients not just as a medical case but as individuals. This approach helps women navigate challenging decisions and supports them throughout their breast cancer journey.
Learn More
Understanding breast cancer, from screening to treatment options, empowers women to take control of their health and make informed decisions. For more insights, listen to the full podcast episode with Dr. Christina Weltz or schedule an appointment with a specialized breast surgeon. Our providers at Carnegie Women’s Health are here to support you on your cancer journey.
