Taking a Nuanced Approach to Breast Cancer Screening, Treatment, and Awareness With Matthew Kurian, MD, and Jasmin Hundal, MD, MS, MPH

The Core Message of Breast Cancer Awareness Month

When asked what message most resonates with him during Breast Cancer Awareness Month, Dr. Kurian was stated: “The first thing to have in mind is screening.” Early detection through regular screening continues to save lives. He also cautioned clinicians and patients against the pitfalls of “pinkwashing”—marketing campaigns that may not actually support cancer research or patient care. “It’s fantastic to raise awareness,” he said, “but we want those things to go to societies that are adequately set up to handle those things.”

Dense Breast Tissue and Screening Nuances

With recent regulations requiring mammogram reports to include breast density, Dr. Kurian highlighted how density complicates detection. “When breasts are more dense, that obscures the ability to see cancers on regular screening mammography,” he stated, adding that clinicians must tailor screening plans to individual risk profiles. Options include supplemental ultrasound, breast magnetic resonance imaging (MRI), and newer approaches like contrast-enhanced mammography. Importantly, he noted that up to 40% of cancers can be missed in dense breast tissue if alternative imaging is not considered: “The conversation becomes very nuanced, and it requires a very detailed discussion of each person’s risk.”

Male Breast Cancer: Rare but Overlooked

Though accounting for just 1% of cases, male breast cancer demands greater awareness. “BRCA2 increases the lifetime risk of a male by six to eight times,” Dr. Kurian explained. He added that diagnosis is frequently delayed because symptoms—such as gynecomastia, subareolar masses, or axillary fullness—may be dismissed or misinterpreted. Dr. Kurian emphasized the role of thorough family history assessments, noting that cases are often stumbled upon after a discussion of family history.

Treatment Challenges in Men

Clinical management in men can be complex, especially with drug interactions with newer agents. “There can be some interactions between tamoxifen and ribociclib,” he explained, which requires careful sequencing and adaptations in endocrine therapy. As precision medicine evolves, clinicians must weigh CDK4/6 inhibitors, PARP inhibitors, and hormonal strategies, balancing efficacy with safety.

The Future of Breast Cancer Care

Looking forward, Dr. Kurian expressed optimism. “We’re very much in the golden age of breast cancer treatment,” he said. Antibody-drug conjugates, preventative vaccines, and advancements in circulating tumor DNA for surveillance are reshaping clinical practice. He pointed to the pipeline of therapies moving from metastatic into earlier-stage disease as particularly promising: “The options for patients are just exploding.”

Key Takeaways for Clinicians

• Screening remains central: Early detection improves outcomes, and Breast Cancer Awareness Month is a timely opportunity to reinforce screening diligence.
• Breast density must be addressed: Dense breasts obscure cancers—clinicians should individualize supplemental screening based on risk.
• Male breast cancer warrants more awareness: Family history is key; misdiagnosis or delays are common without vigilance.
• Treatment is becoming more nuanced: Drug interactions and genetic-targeted therapy require highly personalized approaches, especially in men.
• The pipeline is robust: Antibody-drug conjugates, targeted agents, vaccines, and ctDNA-based surveillance herald a transformative era in breast oncology.

About the Speakers

Matthew Kurian, MD, is a Medical Oncologist at St. Elizabeth Healthcare and an Assistant Professor of Medicine at the University of Kentucky College of Medicine. He specializes in the treatment of lung and breast cancer, and he is passionate about bringing academic-level care into the community setting by enrolling patients in clinical trials and by improving access, equity, and education for both patients and medical trainees.

Jasmin Hundal, MD, MS, MPH, is a second-year Hematology/Oncology Fellow at the Cleveland Clinic in Cleveland, Ohio. Previously, she completed her Internal Medicine Residency at the University of Connecticut. Dr. Hundal’s main area of interest is the overlap between cardiometabolic health and cancer, particularly for breast cancer patients and survivors. Outside of work, she enjoys traveling, cooking, and hiking.