February 3, 2009

Less Invasive Breast Biopsy Underused

When women have an abnormal mammogram and a biopsy is recommended, there are two basic options – a needle biopsy in which a sample is collected via a needle, or an open, surgical biopsy in which an incision is made and part or all of the tissue of interest is removed. Not surprisingly, surgical biopsies generally require a longer recovery time and can result in more complications, such as scar tissue that may interfere with future breast imaging.

In a study published in the January 2009 issue of the Journal of the American College of Surgeons, “Quality Assurance Initiative at One Institution for Minimally Invasive Breast Biopsy as the Initial Diagnostic Technique,” researchers looked at every patient undergoing a surgical biopsy for benign or malignant disease at a single teaching hospital during 7 months in 2007. While some of these biopsies were performed to treat malignancies, the study focused on diagnostic surgical biopsies, performed to determine whether or not the sample tissue was cancerous.

The authors note that their study took place after the American College of Surgeons Consensus Conference and the American Society of Breast Surgeons issued statements supporting diagnosis prior to (instead of through) surgery and encouraging minimally invasive biopsies – i.e. needle biopsies – whenever possible.

Despite these recommendations, the authors found that fully 36% of the surgical biopsies performed in the study were for initial diagnosis.

In a commentary in the same issue of the journal, surgeon Melvin J. Silverstein asks, “Where’s the outrage?” and reminds his colleagues that “the operating room is for treatment, not diagnosis.” Silverstein explains that “open diagnostic biopsies only add unnecessary costs to our already overburdened and compromised health care delivery system and much inconvenience, morbidity, and scarring for the individual patient.”

Maryann Napoli, of the Center for Medical Consumers, conducted an interview with Dr. Silverstein for the February issue of their HealthFacts newsletter. In it, Silverstein suggests that many surgeons may do invasive surgical biopsies because they simply don’t know how to do the less invasive needle biopsies, and offers other insight into the breast biopsy “market.” He also calls the nearly 40% surgical biopsy rate of the study “outrageous” and proclaims, “Once women all over America know about this, that number will drop precipitously.”

The Center for Medical Consumers also interviewed study co-author Susan K. Boolbol, who reinforced the idea that women need to be educated about this issue, and also “need to ask the question: Is there another way to do the biopsy?”


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