Too many women with abnormal mammograms or other breast problems are undergoing surgical biopsies when they should be having needle biopsies, which are safer, less invasive and cheaper, new research shows.
A study in Florida found that 30 percent of the breast biopsies there from 2003 to 2008 were surgical. The rate should be 10 percent or less, according to medical guidelines.
The figures in the rest of the country are likely to be similar to Florida’s, researchers say, which would translate to more than 300,000 women a year having unnecessary surgery, at a cost of hundreds of millions of dollars. Many of these women do not even have cancer: About 80 percent of breast biopsies are benign. For women who do have cancer, a surgical biopsy means two operations instead of one, and may makethe cancer surgery more difficult than it would have been if a needle biopsy had been done.
Dr. Stephen Grobmyer, the senior author of the Florida study, said he and his colleagues started their research because they kept seeing patients referred from other hospitals who had undergone surgical biopsies (also called open biopsies) when a needle should have been used.
“After a while you keep seeing this, you say something’s going on here,” said Grobmyer, who is director of the breast cancer program at the University of Florida in Gainesville.
The reason for the overuse of open biopsies is notknown. Researchers say the problem may occur because not all doctors keep up with medical advances and guidelines. But they also say that some surgeons keep doing open biopsies because needle biopsies are usually performed by radiologists. The surgeon would have to refer the patient to a radiologist, and lose the biopsy fee.
A surgical biopsy requires an inch-long incision, stitches and sometimes sedation or general anesthesia. It leaves a scar.
A needle biopsy requires only numbing with a local anesthetic, uses a tiny incision and no stitches and carries less risk of infection and scarring.
If the abnormality in the breast is too small to be felt and has been detected by amammogram or other imaging method, the needle biopsy must also be guided by imaging - mammography, ultrasound or MRI - and will often have to be performed by a radiologist.
If a lump can be felt, imaging is not needed to guide the needle, and a surgeon can perform it.
“Surgeons really have to let go of the patient when they have an image abnormality,” said Dr. I. Michael Leitman, the chief of general surgery at Beth Israel Medical Center in Manhattan.
“They are giving away a potential surgery. But the standards require it. And I’m a surgeon.”
Grobmyer’s study, published by The American Journal of Surgery, is based on 172,342 biopsies entered intoa state database in Florida.
It is the largest study of open biopsy rates in the United States, and the first to include patients with and without cancer.
About 1.6 million breast biopsies a year are performed in the United States. But in 2010, only about 261,000 found cancer (207,000 women had invasive breast cancer, and another 54,000 had a condition called ductal carcinoma in situ, in which cancer cells have not invaded the surrounding tissue).
Hospitals charge $5,000 to $6,000 for a needle biopsy, and double that for an open biopsy, according to Grobmyer’s article.
Doctors’ fees for an open biopsy range from $1,500 to $2,500, he said, and $750 to $1,500 for a needle biopsy.
Front Section, Pages 4 on 02/20/2011