Too many American women getting surgical breast cancer biopsies

A story in The New York Times about a report to be published in The American Journal of Surgery suggests that far more American women are undergoing invasive surgical biopsies for breast cancer than is warranted.

Current guidelines hold that at most ten percent of all breast cancer biopsies should be surgical while the remainder should be performed simply with a needle. Surgical biopsy can cause additional pain, is more costly, leaves a scar, may require sedation and puts the patient at greater risk of unnecessary follow-up procedures. Yet it’s likely that approximately 300,000 women per year are needlessly getting this surgical procedure.

A number of reasons are offered for the over-prescribing of surgical breast cancer biopsies. At least one surgeon, Dr. I. Michael Leitman of Beth Israel Medical Center, notes that needle biopsies often require surgeons to refer patients to radiologists who can perform the work with the aid of their imaging devices. Implicit is the suggestion that breast cancer surgeons don’t want to lose the extra biopsy fee by sending patients to a radiologist, even if they are not the ones best qualified or capable of performing it.

Perhaps some surgeons may be practicing “defensive medicine” by advocating the most aggressive means of examining the breast tissue for cancerous cells. After all, if cancer does emerge later, a plaintiff’s lawyer might ask why the more radical step of doing a surgical biopsy wasn’t undertaken. ACSH’s Dr. Gilbert Ross says, however, that while “defensive medicine may be understandable to some extent, this is out of bounds when you’re not harming anyone by doing a needle biopsy. You have to hope that there are reputable experts who’ll be available to testify that the spread of the disease was unrelated to the method of the biopsy.”