If you are told you need a surgical breast biopsy, ask why
March 14, 2011
Dr. Stephen R. Grobmyer, director of the breast cancer program at the University of Florida in Gainesville, was surprised when he kept seeing patients referred from other hospitals who had undergone surgical biopsies when a needle should have been used instead. He told the New York Times, February 18, 2011, “After a while you keep seeing this, you say something’s going on here.”
Grobmyer initiated a study that found that 30 percent of Florida breast biopsies from 2003 to 2008 were surgical when the rate should be 10 percent or less, according to medical guidelines.
Women with abnormal mammograms or other breast problems should undergo needle biopsies, which are safer, less invasive and cheaper. A surgical biopsy leaves an inch long scar and may require sedation or general anesthesia; a needle biopsy, which requires only numbing with a local anesthetic, uses a tiny incision, no stitches and carries less risk of infection and scarring.
There are 2 different explanations for the overuse of surgical biopsies; the first is innocuous and the second, an indictment. Surgical breast biopsies may occur simply because not all doctors keep up with medical advances and guidelines.
But there is also keen speculation that surgical biopsies may be unnecessarily performed so that the surgeon does not have to refer the patient to a radiologist and lose the biopsy fee. When a breast abnormality is too small to be felt and has been detected by mammogram or other imaging, the needle biopsy must also be guided by imaging, which takes a radiologist. If, however, a lump can be felt, imaging is not needed to guide the needle and a surgeon can perform the needle biopsy.
Researchers predict that figures in the rest of the country are probably similar to Florida’s, which means that more than 300,000 women a year are having unnecessary surgery at a cost of hundreds of millions of dollars.
Dr. Melvin J. Silverstein, breast cancer surgeon at Hoag Memorial Hospital Presbyterian in Newport Beach, Calif., and clinical professor of surgery at the University of Southern California said it was “outrageous” that 30 percent of breast biopsies were done by surgery. He thinks hospitals should ban surgical biopsies unless they are truly necessary.
He wants to take this message straight to patients, “Any woman who is told that she needs a surgical biopsy should ask why, and consider a second opinion.”
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