WOMEN'S HEALTH
March 2, 2011

Too Many Breast Biopsies

Doctors are ordering surgical breast biopsies when needle biopsies would suffice. What's the cost, emotionally, financially?

A new study finds that when doctors have reason to suspect a woman may have breast cancer, they too-often tend to order a surgical biopsy, an expensive and extreme way of checking to see if cancer cells are present. A better first step would be to use a needle biopsy. This would save the country millions of dollars per year, not to mention be much easier on and safer for the patient.

Surgical biopsies put a woman at higher risk for a number of complications, including scarring, infection, and additional surgeries. Needle biopsy is an excellent alternative in many cases and prevents many of the issues that accompany surgical biopsy.

Needle biopsies are extremely accurate; although there are some situations in which surgical biopsy is warranted, these instances only account for about 5%-10% of all cases.

In the study, over 170,000 biopsies in a 5-year period were analyzed from a Florida database. The researchers found that the rate of surgical biopsies was 30%, which they say is much higher than it needs to be. The standard recommendation is 5%-10%, which is a more reasonable number, according to the authors. Needle biopsies are extremely accurate; although there are some situations in which surgical biopsy is warranted, these instances only account for about 5%-10% of all cases.

If doctors stuck to doing surgical biopsy only 10% of the time, the authors calculate that the financial cost nationwide would be reduced by hundreds of millions of dollars per year.

It’s unclear why doctors so often favor surgical biopsy, given the complications that can come along with it, and the relative accuracy of needle biopsy. It’s possible that some doctors are simply not educated on the benefits of needle biopsy — the authors did find that non-academic medical centers were much more likely to perform surgical biopsy than academic institutions. Financial considerations may also be at play. Needle biopsies are performed by radiologists, so sending patients on to another specialist would cause the referring doctor to lose "business". This is a disturbing thought, but one that may explain the strange findings of the study.

More research clearly needs to be done to determine exactly why doctors are not sticking to the recommendations that would most benefit their patients. If you are in the position of requiring a biopsy, please talk to your doctor about the pros and cons of each method, and make sure the decision is one that you are both 100% behind.

The study was carried out by researchers at the University of Florida and published in the February 3, 2011 online issue of The American Journal of Surgery.

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