HJAR Mar/Apr 2021

52 MAR / APR 2021 I  HEALTHCARE JOURNAL OF ARKANSAS DIALOGUE COLUMN ONCOLOGY WHILE EACHOF THESE have revolutionized our field, and we are better surgeons because of them, the most important “innovation” is actually something that often removes sur- geons from the equation altogether, at least for a bit. For many patients and physicians alike, a breast cancer diagnosis often warrants an immediate reaction to “cut it out.” Common thought is that by removing the suspicious mass, you optimize the patient’s chances of recovery and reduce the rate of recurrence. And while there are cases when surgery is the most appropriate initial treatment, the modern standard of care actually calls us to pause before making any surgical or treat- ment decisions. During this pause, the surgeon should rec- ommend patients undergo a biopsy, which will obtain a histologic diagnosis of the lesion and tell us if it is cancerous or noncancer- ous. While around 5% to 10% of biopsies may need to be completed throughmore invasive surgical means, most can be done through a minimally invasive, image-guided biopsy. This can be performed by the diagnostic radi- ologist who likely discovered the suspicious mass or by the surgeon if they are able to do image-guided biopsies. The bottom line is that we need a diagnosis before performing surgery. If the mass is can- cerous, the preoperative workup will explain the cancer’s receptor status, which will tell us the type of cancer, specifically the estrogen BREAST CANCER SURGERY DOESN’T START WITH SURGERY Marian Miller, MD Surgical Oncologist CARTI, Inc. Over the nearly 140-year history of breast cancer surgery, there have been countless innovations in techniques and technologies that not only increase precision and efficiency, but also result in better outcomes for our patients.