Early detection has long been described as the most powerful tool in the fight against breast cancer. But what specifically does early detection mean today -- and what do women often overlook about their own risk and possible treatment options?
Dr. Hadeel Assad, medical oncologist and leader of the Breast Cancer Multidisciplinary Team at the Barbara Ann Karmanos Cancer Institute whose work spans breast cancer treatment, survivorship, decision-making and clinical trials, explained that modern screening and care involve far more personalization than most women realize.
Many women don’t know they’re high risk -- until their first mammogram
One of the realities Dr. Assad shared is that a portion of women classified as high risk for breast cancer don’t know it until they get their first screening.
At Karmanos, every patient’s first visit includes a unique step.
“Every woman who gets a mammogram at Karmanos will take the high-risk breast assessment that allows us to calculate a patient’s individual risk for developing breast cancer.”
This assessment also has broader benefits, as it can calculate a patient’s risk for colon and lung cancer.
This level of risk evaluation is not standard at many imaging facilities.
Younger women can be at risk, too
While women who are at average risk of breast cancer should begin screenings at 40, those who are high risk might need to begin earlier.
“Some even 10 years earlier than when their mother was diagnosed with breast cancer or even at age 25, depending on their individualized lifetime risk of breast cancer,” Dr. Assad said.
She emphasized that even women younger than 40 need awareness and self-advocacy.
Signs that are worth bringing to a doctor’s attention include:
- Lumps or thickening in/near the breast or underarm area.
- Changes in breast shape or size.
- Skin dimpling or puckering.
- Nipple discharge, especially if it is bloody.
- Scaly, red or swollen skin on the breast, nipple or areola.
Women should also consider their family history of breast cancer and discuss their risks with their doctor.
Dr. Assad’s advice is consistent and clear: “If something feels off, talk to your doctor.”
Dense breasts? You might need more than a mammogram
While mammograms are the cornerstone of breast cancer detection, Dr. Assad noted that screening sometimes must go further.
Women with dense breasts may need adjunct imaging, such as a breast ultrasound or MRI, to ensure cancers aren’t missed.
“Screening methods vary for many women, but everyone will get a mammogram. From there, those who have dense breasts may receive an adjunct screening, such as a breast ultrasound or a breast MRI.”
These decisions are based on a person’s individual risk -- as opposed to simply their age -- something many women don’t realize.
A clinic designed specifically for high-risk women and survivors
Karmanos offers a High-Risk Breast Cancer Program within the Women’s Wellness Clinic. It monitors women who have elevated risk, as well as breast cancer survivors, long after treatment ends.
Dr. Assad said the clinic ensures women get the proper screenings at the right frequency -- a crucial factor in catching disease or recurrence early.
The clinic’s nurse practitioners also provide long-term follow-up care, including support for menopausal and post-treatment health issues -- a depth of survivorship care that is not typical at many cancer centers.
Breakthrough treatments and research -- often available before FDA approval
Dr. Assad plays an active role in the Phase I Clinical Trials Multidisciplinary Team at Karmanos, where emerging cancer therapies are tested -- sometimes years before they become widely available.
The most important benefit of participating in a clinical trial is that patients get early access to potentially new and successful treatments or screenings before the general public.
“We have studies for all types of cancers, anywhere from stage I to IV, for patients who have had multiple lines of therapy and for those who are looking for options for their first line of therapy,” Dr. Assad explained.
She said many people have misconceptions about clinical trials.
“Clinical trials are safe,” Dr. Assad said. “We test these treatments extensively in labs in preclinical settings, and the studies must be carefully reviewed by the FDA and ethics boards before patients can enroll in them.”
[Learn more: Clinical trials at Karmanos]
She said many people think the trials can be expensive, but it’s quite the opposite.
“Many trials cover treatment cost; some provide financial assistance for transportation and other expenses to make participation easier.”
[RELATED: Karmanos leader explains benefits of clinical trials for cancer patients | 6 myths you may have heard about clinical trials]
Perhaps the most reassuring point she made is that patients are always in control.
“Clinical trials are voluntary. Patients can withdraw at any time without penalty. Additionally, if the therapy is not working as intended, we can adjust the regimen or remove you from the clinical trial to try an alternative treatment.”
With one of the nation’s most robust clinical trials programs, Karmanos frequently offers therapies that aren’t available elsewhere, giving patients options that can be lifechanging.
“We offer clinical trials and new therapies that may not be available elsewhere, so coming to Karmanos allows you to learn about those and consider those treatment options,” Dr. Assad said.
[Learn more about clinical trials in cancer care in 10 minutes.]
A three-oncologist first visit: A rare model of care
Karmanos’ Breast Cancer MDT Clinic at the Weisberg Cancer Center in Farmington Hills offers something few other centers do: the ability to meet with the medical, surgical and radiation oncologists all in one visit.
“The patient gets the opportunity to spend time with each of these oncologists who will be part of their care team, ask questions and learn more about the options they have for treatment.”
This approach means patients understand their comprehensive treatment plan immediately, rather than meeting each specialist only when it’s time to begin that portion of care.
Second opinions: Why they matter in the cancer journey
One of the most important things doctors at Karmanos stress is how important it is to seek a second opinion.
“Second opinions are best practice,” Dr. Assad said. “Patients need to know that it’s not about doubting their doctor but about having confidence in the care they will receive.”
Many patients feel overwhelmed, uncertain about insurance or pressured to start treatment quickly. But Dr. Assad explained that a second opinion can change everything.
“A second opinion can confirm a diagnosis, present new treatment options or even reveal a different path. Cancer is complex, and having more than one expert review your case can make a big difference.”
A second opinion can also validate a patient’s initial diagnosis and treatment plan, giving them more confidence and reassurance in how to navigate the journey ahead.
“Patients can ask further questions, understand different treatment approaches and actively participate in the decision-making regarding their treatment,” Dr. Assad said. “Sometimes, patients want the latest innovative therapies and clinical trials, and they have access to these treatments at Karmanos.”
Karmanos makes second opinions fast -- within seven days
To remove barriers, Karmanos has built a streamlined process that manages the heavy lifting for patients.
“We’ve developed a patient-centered process to facilitate rapid second opinions by eliminating the barriers,” Dr. Assad said.
Karmanos patient navigators are dedicated to gathering patient records and insurance authorizations so patients don’t have to.
“An oncology nurse will call the patient days before their appointment to review details and make sure they are prepared for the visit. Within seven days of requesting the appointment, the patient meets with a cancer expert familiar with their case and type of cancer, ready to provide guidance and therapy options.”
This model ensures patients don’t lose time -- or peace of mind.
Breast cancer care today is more personalized, data-driven and collaborative than ever before. And Dr. Assad’s perspective underscores a central theme: women deserve knowledge, options and confidence throughout their care.
“We are dedicated to finding more effective and safer cancer-fighting drugs,” Dr. Assad said.
For screenings, appointments or a second opinion, click or tap here, or you can call 800-527-6266.