Monday, March 7, 2011

Study finds unnecessary breast biopsies: maybe needles should stick to being lost in haystacks

By Linda Timmerman, Ed.D.

So who do you listen to?

I get frustrated when I hear about research studies that say women don’t need mammograms every year or before a certain age, not all lymph node dissections are necessary, and now many breast biopsies are done just to line the pockets of physicians and hospitals.

A recent article in the American Journal of Surgery suggested that physicians are doing too many biopsies and should favor doing fine needle aspirations or biopsies (the "FNA").

The FNA is a procedure where a needle is inserted into the tumor either based on palpation of the lump or by the use of a sonogram to guide it to the proper location.

Then using suction, some of the cells are removed and examined under the microscope.

I thought about my friend, Robbie, when I read the findings of the research study.

Robbie found a lump under her arm. She was still young, so the doc thought it was probably just a cyst or infected lymph node. They did a fine needle aspiration (FNA). Results: all clear.

We celebrated with margaritas and Mexican food at Don Jose’s!

Three months later, the “lump” was growing – another FNA – good results – more margaritas!

Six months passed and Robbie went for her well woman checkup. Her OB/Gyn just didn’t like the feel of the lump – so a third FNA followed by the celebratory margaritas!

Fast forward a few weeks. Robbie dropped by to say she was going back to the surgeon. “I know it’s nothing, “ she said, “but it just bothers me knowing it’s there. I’m asking him to take it out.”

“Lump” removed – positive for cancer – invasive ductal carcinoma with lymph node involvement. A modified mastectomy, 8 rounds of chemo, and 35 radiation treatments followed – and Robbie’s been cancer free for 15 years.

Now to be fair, biopsies in general are samples.

Think of a loaf of bread.

You decide you want to serve it for Thanksgiving but you're not sure its fresh. So you pull out several slices and examine them. All ok. No green stuff here.

You put it on the table and then one guest pulls out a different piece, and guess what? A Pasteur prize addition to your holiday meal.

But FNA's are even more of a sample: small fragments of cells pulled through a hypodermic needle. Analysis requires special training and certainly has a margin of error that is bigger than examining a larger piece of tissue.

Robbie is alive today because she listened to her body and followed her “gut feeling” that the lump needed to come out.

So what’s the takeaway message?

If you find a lump, go to a center that specializes in breast cancer.

Find a surgeon and radiologist you can trust.

And most of all follow your gut feelings.

Listen to your body.

Maybe you’ll be one of the fortunate ones whose breast biopsy was unnecessary.

Linda Timmerman, Ed. D. is a two-time cancer survivor and life long educator. She blogs regularly about cancer survival and real information from real people with the disease.

1 comment:

  1. Benefits and Risks of needle breast biopsy:
    A core needle biopsy is more accurate than an aspiration and less invasive than an open surgical or excisional biopsy. The needle biopsy will leave no external or internal scars, and so it will not affect future breast imaging studies. There is always the chance that the needle may miss a malignant area, but your doctor will try to minimize this possibility. A core needle biopsy is not a treatment, and it will not remove all of a malignancy. If your results come back positive for cancer, you will need to consider more tests and treatment.