October is Breast Cancer Awareness Month, and breast cancer (BC) remains one of the most pressing challenges in modern oncology. As doctors, we often focus on statistics and the latest clinical guidelines, overlooking one simple fact: behind every diagnosis is a person whose life is fundamentally changed by the disease. That is why it is important to talk not only about treatment options, but also about what each of us can do to help detect the disease early.

During pre-flight safety demonstrations, passengers are repeatedly reminded that if the cabin loses pressure, they should put on their own oxygen mask before helping others. Unfortunately, women do not always follow this principle when it comes to their own health. They postpone preventive check-ups for months, sometimes even years, while still finding time to care for their parents, children, and partners. The reasons vary: lack of time, fear of a possible diagnosis, or the belief that “nothing is bothering me, so why should I see a doctor?”

Meanwhile, the global burden of breast cancer continues to grow. According to researchers’ estimates, approximately 2.3 million new cases of breast cancer and around 670,000 deaths were recorded worldwide in 2022. If current trends continue, these figures could rise to 3.2 million new cases and 1.1 million deaths annually by 2050 [1]. Particularly significant increases are expected in countries with low Human Development Index (HDI) scores, where opportunities for early diagnosis and access to treatment are often limited.

These figures prompt us to reflect not only on the development of cancer care, but also on the organization of screening programmes and the role every doctor can play in the early detection of breast cancer.

Why is early detection important?

The stage of breast cancer at diagnosis has a significant impact on prognosis and treatment options. According to data from the US Surveillance, Epidemiology, and End Results (SEER) programme for 2016–2022, the five-year relative survival rate for women with localized breast cancer was 100%, compared with just 33.8% for those with distant metastases [2]. These figures reflect outcomes in the United States and cannot be directly extrapolated to the Ukrainian population. However, they illustrate how prognosis differs depending on the stage and extent of the disease.

Unfortunately, early detection does not guarantee a favourable outcome in every case. Prognosis is also influenced by the tumour’s biological characteristics, its molecular subtype, and the availability of appropriate treatment. Nevertheless, diagnosing breast cancer at an early stage often provides more treatment options and may allow for less extensive surgery.

Screening is not just the responsibility of breast specialists

When people talk about the early detection of breast cancer, they usually think of oncologists and surgical oncologists. However, a woman who regularly visits her family doctor, gynaecologist, or endocrinologist may go years without consulting an oncologist. That is why every appointment with a female patient is an opportunity to remind her of the importance of undergoing recommended preventive screening.

As a doctor, you do not need to spend much time on this. A few brief but important questions can make a difference: When did the patient last undergo the recommended screening? Has anyone in her family had breast, ovarian, pancreatic, or prostate cancer? Has she noticed any recent changes in her breasts?

It is important to distinguish between screening and diagnostic examinations. Screening is intended for people who have no symptoms, whereas a breast lump, abnormal nipple discharge, skin or nipple retraction (including the “peau d’orange” appearance), or other suspicious changes require further diagnostic assessment. In such cases, patients should not wait for their next routine screening appointment.

In Ukraine, population-based breast cancer screening includes mammography every two years for women aged 50–69. Women aged 40–49 with risk factors are also eligible for mammographic screening every two years [3].

Breast ultrasound remains an important diagnostic tool, particularly for further evaluating detected abnormalities. However, it is not a universal substitute for screening mammography. The appropriate approach depends on the clinical situation, the patient’s age, and the results of previous examinations.

The role of doctors across all specialties is not to replace oncologists, but to recognize situations that require further assessment in a timely manner and explain to patients why the appropriate examination is necessary.

Breast cancer does not automatically mean mastectomy

Another issue worth addressing is the fear of treatment. For some women, the possibility of a breast cancer diagnosis is directly associated with having a mastectomy. Sometimes this fear itself becomes a reason to postpone examination.

However, modern treatment does not always require the removal of the entire breast. For many patients with early-stage disease, breast-conserving surgery—removing the tumour while preserving the rest of the breast, followed by radiotherapy—is an option. When patients are appropriately selected and clinical indications are met, this approach is an oncologically sound alternative to mastectomy [4].

At the same time, breast-conserving surgery is not suitable for everyone. The decision depends on the extent of the tumour, its size, whether clear surgical margins can be achieved, the tumour’s biological characteristics, the indications for and contraindications to radiotherapy, and, of course, the patient’s preferences. If mastectomy is the most appropriate treatment option, breast reconstruction using implants or the patient’s own tissue may be possible in many cases.

Treatment also involves more than surgery. Depending on the stage and biological subtype of the disease, it may include chemotherapy, endocrine therapy, targeted therapy, immunotherapy, and radiotherapy. The treatment plan must be individualized, based on clinical findings and multidisciplinary discussion.

It is important for patients to understand that a breast cancer diagnosis does not mean everyone will receive the same treatment. The available options depend on the individual clinical situation, and seeking medical advice promptly helps ensure that time is not lost in assessing all suitable options.

What can doctors do today?

Early breast cancer detection cannot be the sole responsibility of specialized oncology centres. It also depends on the accessibility of primary healthcare, whether patients know about recommended examinations, and whether they are referred for the necessary investigations in a timely manner.

This is particularly important in Ukraine. In 2025, the Ministry of Health of Ukraine approved the medical care standard Breast Cancer, which defines approaches to diagnosing and treating the disease [5]. Doctors in any specialty can contribute by asking about preventive examinations, recognizing symptoms, assessing risk factors, and explaining where patients should seek further care. This does not mean turning every appointment into an oncology consultation. Sometimes, it is enough to ask a question that might otherwise be overlooked while focusing on the patient’s primary concern.

Pink October is an opportunity to raise awareness about breast cancer, but this conversation should not be limited to one month of the year. For doctors, it is also an opportunity to reflect on everyday practice and consider whether we are doing enough to ensure that patients do not keep putting their own health off until later.

Sometimes, timely care begins not with a complex intervention, but with a simple question about an examination that should have been done long ago. And that question can be asked by any doctor, not just an oncologist.

This article was prepared by Anna Veskera, a third-year medical resident at the Lviv Oncology Regional Treatment and Diagnostic Centre.

References and further reading

1. Kim J, Harper A, McCormack V, et al. Global patterns and trends in breast cancer incidence and mortality across 185 countries. Nature Medicine. 2025;31:1154–1162. doi:10.1038/s41591-025-03502-3.
2. National Cancer Institute. Cancer Stat Facts: Female Breast Cancer. Surveillance, Epidemiology, and End Results (SEER) Program. Data for 2016–2022. Available at: https://seer.cancer.gov/statfacts/html/breast.html
3. Ministry of Health of Ukraine. On the provision of screening and early diagnosis of selected types of cancer and monitoring the health of patients in risk groups. Order No. 1368 of 5 August 2024, as amended. Available at: https://zakon.rada.gov.ua/laws/show/uk-sv/z1273-24
4. Rajan KK, Fairhurst K, Birkbeck B, et al. Overall survival after mastectomy versus breast-conserving surgery with adjuvant radiotherapy for early-stage breast cancer: meta-analysis. BJS Open. 2024;8(3). doi:10.1093/bjsopen/zrae040.
5. Ministry of Health of Ukraine. On the approval of the Medical Care Standard “Breast Cancer”. Order No. 195 of 3 February 2025. Available at: https://www.dec.gov.ua/mtd/rak-molochnoyi-zalozy/

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