Before You Get a Biopsy, Read This!

All too often, when a woman finds a lump in her breast she hits the panic button and then immediately goes out to find a general surgeon who is more than happy to take her to surgery and remove the lump. This is, frankly, a bad idea—bad for several reasons.

No, I'm not trying to give you added anxiety by saying to leave that lump in there. And no, I'm not even going to say you should ignore it until your next menstrual period to see if it goes away. What I am saying is don't support a common but harmful trend these days—that of allowing a general surgeon, who doesn’t specialize in breast-cancer surgery, to perform a full-blown surgical biopsy, complete with general anesthesia.

I rcently read a commentary by Dr. Mel Silverstein, a celebrated breast surgical oncologist, in which he expressed his outrage at the fact that almost 40 percent of the breast-lump biopsies done in the U.S. are currently performed by general surgeons who, instead of carrying out what should be a routine—and minimally invasive—biopsy, typically choose to do one of these much more intricate and dangerous open biopsies.

Fewer than 5 percent of breast biopsies today really need to be accomplished by means of this full-blown surgery. But even the insurance companies, once they see the words “possibly cancer,” don’t usually challenge the wide use of this dangerous and costly operation. Another way of saying this is that, of the 1.6 million breast biopsies performed each year, approximately 38 percent of them are not being done correctly, using the standard, minimally invasive procedure, but are instead being done using the more dangerous surgery. These nearly 580,000 unnecessary surgeries per year could just about be considered a bona fide atrocity.

Besides the fact that the vast majority of these open, surgical biopsies of the breast are unnecessary, what other problems attend this major surgical procedure?

  • In the first place, someone other than a general surgeon needs to be the one who determines whether a biopsy is even needed. Lesions that are considered “suspicious” must certainly be biopsied, but many general surgeons can’t tell the difference between a suspicious lesion and a benign, fluid-filled cyst (needless removals make up a substantial portion of these wasted surgical procedures each year).
  • Any time the breast is sliced into, scar tissue forms. And scar tissue changes over time, so that it can look different from year to year on a mammogram. Then, on future mammograms, that subtly changing scar tissue might result in a doctor ordering yet another biopsy there.
  • Open, excisional biopsies usually require general anesthesia, which, although reasonably safe today, is not totally without risks.
  • Since this is surgery we're talking about, the tissue samples will have to be sent to the Surgical Pathology Department, which can take as long as a week to process tissue and release a report; with a core biopsy, results are generally known in 24 hours.
  • Surgery carries a higher risk of infection than does biopsy.
  • Recovery time from surgery takes longer.
  • And last—here's a biggie—if the abnormality does turn out to be cancer, then performing an open excisional biopsy is a big mistake. The correct technique used to remove a known cancerous tumor from the breast is strikingly different from an excisional biopsy. Excising a real tumor, for example, requires that the surgeon leave clear margins. And if an invasive tumor is indeed present, the surgeon must perform a sentinel-node biopsy at the same time.

There you have it: Seven good reasons to think twice before running off to a general surgeon and having an open, surgical biopsy of an unidentified breast lump.

So, which types of masses or abnormalities should be investigated with an open, excisional biopsy? Here, let me list them: Clustered microcalcifications that lie so close to the chest wall that getting at them with a stereotactic core biopsy would be too dangerous. Believe it or not, that’s it. This is the one and only situation where an open, surgical biopsy is warranted.

Don't be among the 576,000 women a year who undergo this surgical approach without a good medical precondition behind it.

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