Needle biopsy is underused as the standard radiological procure of care for the diagnosis of breast cancer, while patients are receiving more invasive, surgical biopsy procedures. These are the conclusions of new research from the University of Texas MD Anderson Cancer Center, recently published in the Journal of Clinical Oncology.
According to the study, patients are encouraged by surgeons to undergo unnecessary surgical biopsies, when the alternative needle procedure is a reasonable standard care. Usually performed by a radiologist, the non-surgical procedure involves the extraction of sample tissue from the breast using a thin needle, which was approved as a quality measure by the American College of Surgeons (ACS) in 2006.
“Still too often in my practice, I see patients that come to MD Anderson for care after having an excisional biopsy performed for diagnosis, when they obviously could have had a needle biopsy,” says Benjamin Smith, MD, associate professor in MD Anderson’s departments of Radiation Oncology and Health Services Research and author of the study. The researcher believes that excisional biopsy negatively affects the treatment of breast cancer and is “simply a wasteful procedure.”
The aim of the study was to quantify the magnitude of the “wasteful procedure” nationwide, as well as identify its impacts on the well-being of patients. Therefore, the team of researchers reviewed Medicare claims from 89,712 patients diagnosed with breast cancer, between the years of 2003 and 2007, and who were treated with breast conserving surgery and radiation. According to the records, 68.4 percent of the patients underwent a needle biopsy, which amounts to 61,353 people. But the number of procedures rose from 60.8 percent in 2003 to 76.5 percent in 2007.
Some characteristics became prominent, according to the researchers, which included the facts that excisional biopsy were often associated with surgeons with a lack of board certification, training outside the U.S., medical school graduation before 1980, and lower case volume. The patients, on the other hand, tend to be older and African-American, to have Medicaid coverage and co-morbid illnesses, and to come from rural areas.
“The real question is the role of the surgeon and to understand that influence. With our study, we set up a statistical model that allowed us to compare the impact of patient-to-surgeon factors. While there are access issues that should be addressed, it’s clear that the surgeon’s role is very important for the patients’ care,” explains Smith.
The excessive use of excisional biopsies is negatively associated with multiple breast cancer surgeries, says Smith, on a scale of 69.6 percent, compared to 33.7 percent. The researcher believes patients still lack information and aren’t aware that needle biopsy is the standard procure for breast cancer diagnosis. “An open surgical biopsy actually makes lymph node biopsy less accurate — and lymph node status is the most important factor when making critical decisions about adjuvant therapy. So breast cancer patients should be fully educated that this is the standard of care and ask for it,” stressed Smith.
Smith believes the findings of the study may be a chance for physicians to become more conscious of the risks and harms of the surgical biopsy, as well as “an opportunity to educate and encourage them to do the right thing in the best interest of their patient.”
The study was funded by the Cancer Prevention and Research Institute of Texas, the Cancer Prevention Training Program at MD Anderson, the American Cancer Society, the Multidisciplinary Postdoctoral Awards from the Department of Defense and from the National Cancer Institute.
Last month, BioNews Texas also published the results of a study which revealed that expensive, invasive surgical breast biopsies remain the first diagnostic option for more than one-third of women in Texas. 35 percent of women who found an abnormality on a routine mammogram or a lump in one of their breasts, still underwent the traditional method for determining weather the mass is malignant or benign.