New Era In Breast Cancer Care: Breakthroughs Or Hype?

Every October, pink ribbons appear on lapels and social media feeds fill with survivor stories. Yet, despite enough awareness, many Indian women fear that the test may hurt or that the diagnosis and treatment may change their lives.

Breast cancer is India’s most commonly diagnosed cancer among women, and delayed diagnosis remains a significant challenge. A 2024 review published in the International Journal of Breast Cancer highlighted the country’s uneven access to screening, socioeconomic barriers and the need for locally appropriate detection strategies.

The encouraging news is that breast cancer care is evolving. Artificial intelligence (AI) is helping radiologists interpret mammograms, less extensive surgical procedures can preserve healthy tissue, and targeted medicines are improving outcomes for selected patients.

Screenings Sans Mammograms

Mammography remains the established screening test for many women. It uses low-dose X-rays and briefly compresses the breast between plates, a process that can be uncomfortable or painful, particularly for women with tender breasts. For women who find this daunting, alternatives and complementary technologies are gaining attention.

Gynaecologist Dr Husna K Mohammad says, ‘Breast ultrasounds are a painless or minimally uncomfortable examination that use sound waves rather than radiation. They have been useful for evaluating a lump and distinguishing fluid-filled cysts from solid masses. This comes without the ionising radiation or breast compression of a mammogram, and is also relatively affordable and widely available. However, it cannot be considered as accurate. It may miss certain cancers. Results depend on the operator's expertise, and additional investigations will have to follow an abnormal finding. So although it is a valuable diagnostic tool and as supplemental screening, it is not a universal replacement for mammography.’

Yet another option is a digital breast Tomosynthesis (3D mammography). Instead of producing only conventional two-dimensional images, this technique captures images from multiple angles to create thin breast slices. It can help radiologists distinguish overlapping tissue and identify suspicious areas. This offers better lesion visibility in many women, particularly those with dense breasts, and potentially fewer false alarms. However, breast compression is still required. It can cost more, and radiation exposure varies by technique and protocol.

Dr Husna adds, ‘A Breast MRI is what I would recommend over an ultrasound. It uses magnetic fields rather than X-rays and can be particularly sensitive in women at high inherited risk. Abbreviated MRI uses a shorter imaging protocol, potentially reducing scanning time and cost. It is especially useful for some women with dense breasts. However, it may require an intravenous contrast agent, can be expensive, and in some cases may identify benign abnormalities that lead to unnecessary biopsies. So, while it is an important option for high-risk screening and selected diagnostic situations, it is not routinely necessary for every woman.’

The American College of Radiology's 2024 updated recommendations, published in 2025, support tailoring supplemental screening to breast density and individual risk rather than applying the same approach to everyone. One of the most exciting developments is the use of artificial intelligence to assist radiologists in identifying suspicious changes on breast images.

In September 2026, reports from India described an AI-based mammography interpretation tool developed by researchers at All India Institute of Medical Sciences (AIIMS), New Delhi, moving towards wider deployment through technology transfer. Its intended role is to help flag possible abnormalities for clinical review, but not to replace the radiologist. AI can produce false positives and false negatives. Performance may vary across equipment, age groups and populations; independent validation and regulatory oversight are essential.

International research supports the potential of AI as a second reader in mammography. However, this is not yet automatically a proven population-screening programme. A lot still depends on real-world evidence on accuracy and patient outcomes.

Alternatives To Tissue Biopsies

The idea sounds almost futuristic, of detecting cancer-related DNA or other tumour signals in a blood sample, potentially avoiding an invasive procedure. Liquid biopsies can detect circulating tumour DNA and are already useful in specific cancer-management settings, including selecting certain targeted therapies and monitoring some advanced cancers. A simple blood draw is generally less uncomfortable than a tissue biopsy. It can provide information about tumour mutations and, in selected settings, changes over time. However, small or early-stage tumours may release very little detectable DNA and so a negative result does not rule out cancer. Similarly, a positive result may not establish where a tumour originated.

Dr Husna adds, ‘Liquid biopsy has established applications in selected treatment decisions, particularly in advanced disease. However, it is not currently a validated stand-alone substitute for mammography or tissue diagnosis in routine breast cancer screening and must definitely not be treated as such.’

When imaging identifies a suspicious lump, a biopsy is often necessary to determine whether cancer is present and, if so, what type it is. A core needle biopsy typically uses local anaesthesia and a hollow needle to collect small tissue samples. Compared with open surgical biopsy, it usually requires no major incision and involves less recovery time.

Vacuum-assisted biopsy uses suction to collect multiple tissue samples through a small skin opening and can sometimes remove selected benign lesions.

Precision Treatment

The next revolution is not only about detecting cancer earlier. It is also about treating it more selectively. For suitable patients in selected early-stage breast cancer, a lumpectomy removes the tumour while preserving most of the breast. It is commonly followed by radiotherapy. This preserves breast shape and much of the natural tissue and generally less extensive than mastectomy. Note that additional surgery may be needed if margins are involved, and radiotherapy is often required, so it is not suitable for every tumour or clinical situation.

Another option is sentinel lymph node biopsy. Instead of routinely removing many lymph nodes from the armpit, surgeons examine the first draining lymph nodes to assess whether cancer has spread. This means less extensive surgery and a lower risk of arm swelling, numbness and restricted movement than full axillary lymph node dissection. It still involves an operation, and further treatment may be needed if nodal involvement is found.

Modern radiotherapy can deliver treatment in fewer sessions for many patients. Hypofractionated schedules use larger doses per session over a shorter overall period. Randomised trials and long-term follow-up support the effectiveness of appropriately selected shorter-course regimens. Partial-breast irradiation is another option for certain patients, but it is not appropriate for everyone.

Drugs directed at specific tumour characteristics (including HER2-targeted treatments and certain hormone-pathway medicines) can improve outcomes for eligible patients. Immunotherapy is beneficial in particular breast cancer settings, including some triple-negative cancers. Treatment can be matched more closely to tumour biology, sometimes improving disease control while avoiding ineffective therapies.

However, benefits depend on the tumour subtype, stage, biomarkers and individual clinical circumstances. Molecular testing is therefore central to choosing the right treatment. The broader shift is from treating every breast cancer alike to understanding what makes each tumour different.

What Indian Women Need To Know

Technology alone cannot close India's breast cancer gap. Access, affordability, awareness and timely referral matter just as much. Women should seek medical assessment for a new breast or underarm lump, nipple inversion, spontaneous nipple discharge, skin dimpling or a persistent change in breast shape. Many breast changes are benign, but a painless lump should not be ignored. Breast self-awareness can help women recognise changes. It is not a substitute for recommended screening. Screening decisions should take age, family history, inherited risk, breast density, local guidance and personal circumstances into account. Women with a strong family history may also benefit from genetic counselling.

Most importantly, no woman should feel compelled to choose an unproven test simply because it is advertised as painless or advanced. Breast cancer awareness should equip women to make informed decisions without shame or fear.