Researchers in Florida report that surgeons are performing many more invasive breast biopsies than needed. Another recent study finds similar rates of unnecessary biopsies in New York, New Jersey and Pennsylvania.
But, at the same time, that study offers good news: Nationwide, doctors in most states are adhering to guidelines and performing surgery for only 10-15 percent of biopsies for breast cancer. And the national average for so-called "open surgical biopsies" has declined dramatically in recent years.
That's in line with recommendations from the American College of Surgeons which call for the less invasive, less costly and less complicated "needle biopsy" for the vast majority — nearly 90 percent — of patients.
"We've come a long way," says radiologist Carol Lee with the American College of Radiology and Memorial Sloan Kettering Cancer Center in New York.
Lee notes that the needle biopsy doesn't require general anesthesia or stitches. And it doesn't cause scarring or risk complications associated with all surgery, including infection and bleeding.
Pointing to significant research in recent years, Lee calls the needle biopsy "as effective as surgical biopsy," adding that it's simply a different process of taking tissue.
"It spares 85 to 90 percent of women from having to have surgery," she says.
The Move Toward Needle Biopsies
Breast surgeon Stephen Grobmyer recently completed a study looking at the rates of surgical biopsy compared to the rates of needle biopsy in Florida.
"We found that still, approximately 30 percent of biopsies are being done using an open surgical technique," says Grobmyer, the director of the breast cancer program at the University of Florida in Gainesville. "This is approximately three to five times higher than current recommendations."
Grobmyer's study didn't analyze why this might be occurring but suggested it could be a lack of education about the latest techniques, both among doctors and patients.
In a related study, David P. Winchester with the American College of Surgeons and North Shore University Health System in Chicago found that, looking at the national "average," surgical biopsy rates are on the decline.
Five or so years ago, he says, needle biopsy rates made up only 73 percent of all biopsies in the country. In 2008, that number climbed to 86 percent — which, he adds, is close to what it should be.
Less Painful Procedure
Heidi Waterfield, 45, describes the needle biopsy as similar to an "elongated shot" — it caused some pain, she says, but it was tolerable. Waterfield has dense, fibro-cystic breasts, which means they're difficult to analyze on a mammogram.
Over the years, she's had both surgical and needle biopsies. And for her, there's no question the needle biopsy is preferable.
"It's a little bit painful but it's short; there are no scars," Waterfield says. "It's not invasive, and once you're done, if there's nothing to worry about, you are done."
And the reality is that for most women who undergo biopsy, there is no cancer.