Breast cancer care should be as unique as the patients it serves

This content was originally featured in the October edition of the Indianapolis Business Journal.

By Dr. Rina Yadav

There is a phrase we hear often in medicine: “Treat the patient, not just the disease.”

In breast cancer care, that principle is becoming more important than ever. But I would take it a step further: We should know the patient before we treat the disease.

Breast cancer is not one disease, and the patients who develop it are not interchangeable. Yet our approach to breast cancer prevention and treatment has sometimes been built around broad categories—age, family history, tumor type or stage—when the reality is far more nuanced.

In 2026, an estimated 321,910 women and 2,670 men in the United States will be diagnosed with invasive breast cancer. At the same time, breast cancer mortality has fallen substantially over the past several decades, demonstrating what is possible when earlier detection, research, and treatment advances come together.

The next step is making sure those advances are personalized to the person sitting in front of us.

Personalization should begin before cancer does

When people hear “personalized breast cancer care,” they may think about genomic testing after a cancer diagnosis. That is an important part of modern oncology. We can examine characteristics of a tumor—including hormone receptors, HER2 and other biomarkers—to better understand how an individual cancer behaves and which treatments are most likely to help.

But personalization should not start with a biopsy.

It should start with understanding a patient's individual risk.

Two individuals of similar demographics can have very different breast cancer risks. One may have a strong family history or an inherited genetic mutation. Another may have dense breast tissue or a history of a prior breast biopsy. Another may have none of these obvious risk factors and still develop breast cancer.

That is why prevention cannot simply mean telling every patient to follow the same screening schedule.

It means asking better questions.

What is your family history? Have you or a relative ever undergone genetic testing? What is your breast density identified on mammogram? Have you had a prior biopsy? What other factors might affect your risk?

A personalized approach does not necessarily mean more screening or more testing. Sometimes it means additional surveillance. Sometimes it means genetic counseling or risk-reducing medication. And sometimes it means reassuring a patient that their current screening plan is appropriate.

The goal is not to do everything for everyone.

The goal is to do the right things for the right person.

The tumor has a story, too

Personalization becomes even more important after a diagnosis.

We now understand that two patients can be diagnosed with breast cancer at the same stage and still have cancers that behave very differently. Molecular and biomarker testing can help physicians understand those differences and determine which therapies are most likely to benefit an individual patient.

That distinction matters.

For generations, the instinct in cancer treatment was often to fight harder: more chemotherapy, more treatment, more intervention.

Today, precision medicine allows us to ask a different question: Does this particular patient actually need this particular treatment?

It can mean identifying a patient who is likely to benefit from chemotherapy while sparing another patient when the expected benefit is small. It can mean matching a targeted therapy to a specific characteristic of a tumor.

In other words, personalization is not simply about finding a more powerful treatment.

Sometimes it is about knowing when less treatment is better.

Technology should make care more personal — not less human

We are also entering an era in which artificial intelligence, advanced imaging and increasingly sophisticated genomic tools are changing how we detect and understand breast cancer.

These technologies are exciting, but we should be thoughtful about how we use them.

An algorithm can identify a pattern in an image. A genomic test can identify a mutation. A computer can analyze enormous amounts of information in seconds.

But none of those things knows what it means for a particular patient to hear the words, “You have breast cancer.”

Technology should help us see more clearly, ask better questions and make more informed decisions. It should not replace the conversation between a patient and their care team.

We should be asking, does this patient want to preserve fertility? Are they caring for young children? Is avoiding a particular treatment especially important to them? Can they take time away from work for appointments? Do they understand what each of their options mean?

Those are not side questions.

They are a critical part of the treatment plan and cancer journey.

Personalization also means improving access and outcomes

There is another reason personalized breast cancer care matters: not every patient has benefited equally from the progress we have made.

Despite a lower incidence of breast cancer, Black individuals face a disproportionately higher risk of dying from the disease. Variations in early detection, stage at diagnosis and access to timely care underscore the need for more equitable approaches to prevention and treatment.

We cannot call breast cancer care personalized if the quality of that care depends on someone’s ZIP code, income, insurance status, ability to take time off work or access to a specialist.

Personalization must include access.

That means making risk assessment easier to obtain. It means connecting patients with appropriate genetic counseling and testing when indicated. It means ensuring that abnormal screening results lead to timely follow-up. And it means designing care around the realities of patients’ lives rather than expecting patients to navigate a complicated health care system on their own.

The goal is to prevent more cancers — not simply treat them better

As a physician focused on breast cancer prevention, I believe our ultimate goal should be bigger than improving how we treat cancer.

It should be preventing more cancers from occurring in the first place and finding those that do occur as early as possible.

We cannot prevent every breast cancer, but we can identify individuals whose risk may be higher than average. We can use that information to make smarter decisions about screening and prevention. We can recognize inherited risk. We can encourage healthy behaviors that are within a person’s control, such as decreased smoking, limited alcohol intake and increased exercise—all of which have shown to decrease one's individual risk of developing breast cancer.

Most importantly, we can move away from the idea that breast cancer prevention is simply a once-a-year mammogram.

Prevention is a conversation.

It is a risk assessment.

It is understanding your family history and knowing what is normal for you. It is asking whether your screening plan is appropriate for your risk—not simply your age.

Breast cancer care has already changed dramatically. Now we have an opportunity to make the next chapter even more personal.

The future of breast cancer care should not be about finding one treatment that works for the greatest number of people.

It should be about understanding the individual sitting in front of us well enough to know what they truly need— and what they simply do not.

Personalized medicine is not solely about technology, genetics, or algorithms.

It is about recognizing that behind every risk assessment, mammogram, biopsy and treatment plan is a person whose cancer—and whose life—is uniquely their own.