If you are told you need a surgical breast biopsy, ask why

March 14, 2011

If you are told you need a surgical breast biopsy, ask why
If you are told you need a surgical breast biopsy, ask why

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.”  

The mission of the American Society for Aesthetic Plastic Surgery (ASAPS) includes medical education, public education and patient advocacy. Plastic Surgery News Briefs are summaries of current stories found through various news and magazine outlets that relate to or mention plastic surgery and cosmetic procedures. The views expressed in these news articles do not necessarily reflect the opinions of ASAPS, but are merely published as an educational service to our members and the general public. For additional information on these subjects and other plastic surgery related topics, please go to www.surgery.org

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The American Society for Aesthetic Plastic Surgery (ASAPS), is recognized as the world's leading organization devoted entirely to aesthetic plastic surgery and cosmetic medicine of the face and body. ASAPS is comprised of over 2,600 Plastic Surgeons; Active Members are certified by the American Board of Plastic Surgery (USA) or by the Royal College of Physicians and Surgeons of Canada and have extensive training in the complete spectrum of surgical and nonsurgical aesthetic procedures. International Active Members are certified by equivalent boards of their respective countries. All members worldwide adhere to a strict Code of Ethics and must meet stringent membership requirements.


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