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.
Screening for early detection remains a controversial issue for breast, prostate and other cancers. That's partly because screening guidelines have been changing dramatically in some cases, and are still disputed by medical associations in other cases.
Dr. David Winchester's research on needle biopsies among women suggests that some screening guidelines are getting doctors' attention nationally. He also says patients should learn more about their options — and ask about less invasive screening.
But other experts say there's still a long way to go in helping patients avoid unnecessary, costly procedures like surgical biopsies when those patients' chances of having cancer are very slim.
H. Gilbert Welch, professor of medicine at Dartmouth Medical School and author of Overdiagnosed: Making People Sick in the Pursuit of Health, says most patients still aren't fully informed of the benefits and harms of looking early for cancer.
"As an industry, we've exaggerated the benefits of early detection and not discussed or [have] ignored the harms," Welch says.
Doctors are more likely to discuss the harms of prostate biopsies, he says, than the harms of surgical breast biopsies. "Breast cancer has been a touchier subject. And doctors haven't been as open because they're subject to more pressures to do surgical biopsies," he notes.
But he says he has seen some small improvements in patients' understanding of the complexities of screening, and says he believes they are beginning to better understand some of the harms of biopsies.
"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.