Dr. Tari King Shares Her Vision for Breast Cancer Care

It has been my privilege to practice breast surgical oncology for the last 23 years, helping to move the field forward through both clinical care and research. Today, I am more excited than ever about how far breast surgery has advanced and what the future promises to bring.

My team and I are in the midst of building a new breast surgery program from the ground up here at Emory Winship Cancer Institute, something I did previously with the Division of Breast Surgery at Brigham and Women's Hospital and Dana-Farber Cancer Institute in Boston; yet the Emory Healthcare system provides a much larger scope, and as Winship is the only NCI-designated Comprehensive Cancer Center in Georgia, our division is well positioned to truly transform breast surgical care across the region.

When I arrived at Emory Winship in 2025, our team of six breast surgeons was part of the Division of Surgical Oncology. Now, breast surgery has become its own independent division. My charge is to double the size of our surgical team over the next three to five years, creating an infrastructure that supports not only exceptional clinical care but also robust research and education, while fostering the career development of the next generation of surgical leaders in breast cancer care.

Breast cancer care today must be multidisciplinary. At Emory Winship, we are working closely with our colleagues in medical oncology, radiation oncology, breast imaging, pathology, genetics, plastic surgery and other specialties to create an ecosystem where every discipline has the resources needed to provide optimal care. This collaborative approach ensures our patients benefit from the full spectrum of expertise and innovation we offer. Beyond my role as division chief, I also serve as chief surgical officer for the cancer service line at Emory Winship Cancer Institute and Emory Healthcare. This allows me to apply the lessons I've learned from building robust multidisciplinary breast surgery programs to help optimize cancer care delivery across all surgical disciplines at Emory.

A career in breast surgical oncology is rewarding on many levels. There is the immediate reward of connecting with patients and helping them and their families through a very difficult time in their lives. It is a privilege to use my knowledge and skills on this very personal level.

As a clinical investigator, I also find it very rewarding to share important research results with the broader community. I have had the good fortune to share my knowledge to help other clinicians assimilate the growing body of literature and implement the latest science in the care of their own patients.

Helping younger clinicians in our field develop their careers is another passion of mine. It is so important to pay our experience forward, ensuring the next generation of thought leaders will continue to ask the right questions and improve the lives of patients diagnosed with cancer.

Over the last several decades, it has become clear that breast cancer is not one disease—it is a family of diseases. As a multidisciplinary breast oncology team, we make our treatment recommendations based on molecular subtyping, which helps determine whether we recommend surgery first or neoadjuvant chemotherapy. It also helps us gauge what the expected tumor response or treatment outcome might be.

We work collaboratively with our multidisciplinary colleagues to ensure a collective understanding of the specific needs of everyone under our care, considering patient factors including age and clinical presentation, along with biological and molecular features. Patient preference is always an important consideration in breast cancer care as well, and this informs our surgical recommendations at Emory Winship.

The most significant advance in breast cancer surgery over the last two to three decades has been our ability to de-escalate surgical management of the axillary lymph nodes.

In the 1980s, it was demonstrated that axillary lymph node surgery does not improve survival. However, we continued to perform it as a staging procedure as the presence of disease in the lymph nodes was used to determine which patients might need systemic therapy.

Over the last three decades, well-designed clinical trials have demonstrated that a "less is more" approach is safe and effective. Now, we use sentinel lymph node mapping and biopsy, removing just the first two or three lymph nodes, rather than all of them, to determine if the cancer has spread.

And in most situations, even if the sentinel nodes are positive, it is safe to avoid axillary lymph node dissection; either in favor of no further axillary treatment or axillary radiotherapy for local control.

We are now also identifying groups of women for whom axillary staging may be omitted altogether without impacting systemic treatment recommendations or long-term outcomes.

Minimizing axillary treatment is vitally important. The less we do, the lower the risk of lymphedema, which can be a lifelong consequence of surgical treatment. Responsible de-escalation of axillary surgery allows us to improve quality-of-life outcomes for our patients while still ensuring our medical oncology colleagues have the information they need to make sound clinical care decisions.

In addition to significant progress in treatment, we have also seen advances in the management of women at increased risk, particularly those with high-risk lesions such as lobular carcinoma in situ (LCIS). Work accomplished by teams I’ve led, as well as others, has better demonstrated the risk associated with these lesions. As a result, we shifted the paradigm away from bilateral prophylactic mastectomy toward enhanced surveillance and risk-reducing medications.

Medications used in the treatment of breast cancer for decades—tamoxifen and aromatase inhibitors—have also been used for prevention. We now understand that much lower doses likely provide equally effective prevention with far fewer side effects. The trend today is toward a minimally effective dose rather than a maximum tolerated dose, a very compelling concept in prevention.

When we counsel women with high-risk lesions, we aim to offer tolerable, acceptable options that empower them to reduce their breast cancer risk. Combining these options with lifestyle modifications and healthy behaviors further strengthens prevention efforts.

Many patients come to us with the belief that bigger surgery means better outcomes. Decades of clinical evidence prove that is not the case.

For example, we perform breast conservation—margin-negative lumpectomy followed by radiotherapy—with survival outcomes and local recurrence rates equal to mastectomy. We work hard to educate our patients that, in the realm of breast cancer surgery, bigger is not better.

Breast cancer outcomes are determined by a combination of disease burden, local and systemic therapies delivered, and disease biology. Having an aggressive breast cancer subtype does not mean a patient needs more surgery. It means they need multidisciplinary collaboration between their surgeon, medical oncologist, and radiation oncologist to ensure optimal treatment.

Every patient with breast cancer we see can expect to receive comprehensive, coordinated multidisciplinary care. We will thoroughly discuss their diagnosis, treatment options, and the risks and benefits of individualized approaches. There is no one-size-fits-all treatment.

We aim to provide sound clinical advice and engage in shared decision- making with patients, balancing the different management options for both the breast tumor and the axillary nodes. Determining, for example, if we need to escalate radiation therapy to optimize local control when surgery is deescalated, or if it is safe to deescalate both modalities.

We are also well-positioned to help referring providers navigate the nuances of real-world patients where clinical characteristics may not cleanly align with eligibility criteria for clinical trials. In terms of both matching the right patient to the right clinical trial and implementing the most recent trial data in clinical practice, we stand ready to help our referring providers.

It is important to recognize that we no longer live in an era where surgery is the only approach to cancer treatment. Everything we do in breast surgical oncology today is a team sport. Input from multidisciplinary colleagues is essential to care, and tumor biology is always king.

We have made extraordinary progress in improving outcomes for patients with breast cancer, but we still have a long way to go. It will take all of us working together to continue to advance the field forward to an even better future.