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A breast cancer surgeon and director of the Hispanic Breast Cancer Program at Smilow Cancer Hospital at Fairfield/Bridgeport, Dr. Monica Valero also sees patients at Smilow Cancer Hospital at New Haven and Trumbull. Before joining the Yale Cancer Center and Smilow, Dr. Valero was on faculty at Beth Israel Deaconess Medical Center. She completed general surgery at Brigham and Women's Hospital/ Dana-Farber Cancer Institute in Boston, followed by a breast surgical oncology fellowship at Memorial Sloan Kettering Cancer Center in NYC.

Dr. Valero recently joined the Yale Cancer Answers radio show with Tracy Battaglia, MD, MPH, filling in for host Eric P. Winer, MD, director, Yale Cancer Center and president and physician-in-chief of Smilow Cancer Hospital. They discussed changes in surgical care for individuals with breast cancer, the importance of open communication with patients, and what might be behind the rising rates in breast cancer diagnoses among young women

How is breast cancer surgical care evolving, and what future innovations are exciting?

In breast cancer care, surgery, medical oncology, and radiation oncology work closely together, with a shared focus on balancing effective treatment and quality of life. Surgical care, in particular, emphasizes achieving optimal outcomes while minimizing the physical and emotional burden on patients. Multidisciplinary teams — including specialists from all areas of breast cancer treatment and care — play a crucial role in this approach. Recent innovations include the de-escalation of surgical procedures to reduce patient burden, alongside advancements in follow-up therapies such as targeted treatments and immune-based therapies, all aiming to improve outcomes with less invasive strategies

Can you explain "de-escalation" of surgical approaches?

Advances in research have enabled a more personalized surgical approach based on tumor subtypes, minimizing interventions that do not influence treatment outcomes. For example, axillary staging (sentinel lymph node biopsy) is selectively omitted in cases where it does not affect systemic therapy decisions. This strategy reduces operative time, lowers the risk of complications, and supports improved postoperative recovery.

How has the role of treatment before surgery changed?

With advancements in systemic therapies and immune-based treatments, specific cancer subtypes can be targeted to shrink tumors before surgery. This approach allows for smaller surgical procedures, leading to improved outcomes and fewer side effects after surgery.

What is the current incidence of breast cancer, especially among younger populations?

Breast cancer incidence has been gradually rising over time, including among younger women. Although the increase in younger populations is more modest compared to older groups, it is still notable. Contributing factors include lifestyle changes such as delayed childbirth, reduced breastfeeding, obesity, and alcohol use, as well as environmental exposures. Improved detection methods and greater awareness have also played a role in identifying cases earlier.

What are the guidelines for breast cancer detection and the importance of understanding personal risk?

Detection guidelines recommend annual mammograms starting at age 40 for women at average risk. Those at higher risk, such as those with BRCA mutations determined by genetic tests, may need more frequent checks. Understanding personal risk helps determine the appropriate detection plan.

How does a hereditary genetic predisposition affect breast cancer detection?

Genetic mutations account for a small percentage of breast cancers. However, women with a significant family history of breast cancer or an early diagnosis of the disease may seek genetic testing to help determine how early and how often they should be screened and monitored.

What disparities exist in breast cancer care, and how is Yale Cancer Center addressing them?

How does having a medical navigator help a patient after she has an abnormal mammogram?

Patient navigation ensures timely diagnosis by guiding patients through the process, addressing challenges at work or home, and providing support from diagnosis through treatment. Navigators help ensure access to services and manage what can be a complex journey.

Why are clinical trials important in breast cancer care?

Clinical trials are essential for developing better treatment options. We encourage eligible patients to participate. Diverse representation in trials enhances the applicability of results across different populations. Our center offers numerous clinical trials, providing access to cutting-edge therapies.

What final messages are important regarding breast cancer care and prevention?

Empowering patients through understanding their breast cancer diagnosis and risks is crucial. Regular screenings and open communication with healthcare providers are key to better outcomes. Efforts are being made to improve awareness and access, particularly for underserved populations.