An article published in The New York Times, “Study of Breast Biopsies Finds Surgery Used Too Extensively,” by Denise Grady, discussed a study that found that too many women with abnormal mammograms or other breast problems are undergoing surgical biopsies when they should be having needle biopsies, which are safer, less invasive and cheaper, according to the article.
The article is based on a study in Florida that found 30 percent of the breast biopsies from 2003 to 2008 were surgical, when according to medical guidelines, the rate should be 10 percent or less.
Researchers say the figures in the rest of the country are likely to be similar to Florida’s, which would translate to more than 300,000 women a year having unnecessary surgery, at a cost of hundreds of millions of dollars.
The author of the Florida study, Dr. Stephen R. Grobmyer, and his colleagues, said they kept seeing patients referred from other hospitals who had undergone surgical biopsies (also called open biopsies) when a needle should have been used.
A surgical biopsy requires an inch long incision, stitches and sometimes sedation or general anesthesia. It leaves a scar. A needle biopsy requires only numbing with a local anesthetic, uses a tiny incision and no stitches and carries less risk of infection and scarring.
Many of these women do not even have cancer: about 80 percent of breast biopsies are benign. For women who do have cancer, a surgical biopsy means two operations instead of one, and may make the cancer surgery more difficult than it would have been if a needle biopsy had been done.
Some researchers suggest the problem was that not all doctors keep up with medical advances and guidelines. Others suggest surgeons keep doing open biopsies because needle biopsies are usually performed by radiologists. The surgeon would have to refer the patient to a radiologist, and lose the biopsy fee.
“I see it all the time,” said the surgeon, Dr. Elisa R. Port, the chief of breast surgery at Mount Sinai Medical Center in Manhattan. “People are causing harm and should be held accountable.”
Dr. Melvin J. Silverstein, a breast cancer surgeon at Hoag Memorial Hospital Presbyterian in Newport Beach, California, and a clinical professor of surgery at the University of Southern California, said it was “outrageous” that 30 percent of breast biopsies were done by surgery.
Doctors interviewed in the article urged not only educating surgeons, but the patients. Any woman who is told that she needs a surgical biopsy should ask why, and consider a second opinion.
Dr. Silverstein suggested, “Maybe we have to get patients to say, ‘This guy took a big chunk out of me and I didn’t even have cancer, and now I’m deformed. ”
Grady, Denise. “Surgical Breast Biopsies Study of Breast Biopsies Finds Surgery Used Too Extensively.” The New York Times 18 Feb 2011.