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Doctors can face a similar challenge when trying to determine whether a woman has breast cancer. Research clearly shows that women with suspicious mammograms don't necessarily have to have to surgery. Still, as NPR's Patti Neighmond reports, doctors in different states are adapting to these findings at different rates.

PATTI NEIGHMOND: If you live in Florida and have an abnormal mammogram which raises the possibility of cancer, you may find yourself in the OR, undergoing surgery to remove a lump of breast tissue. According to Dr. Stephen Grobmyer of the University of Florida, like all surgeries, there's a risk of complications.

Dr. STEPHEN GROBMYER (General Surgeon, Surgical Oncologist University of Florida): That would include the potential for a wound infection - and of course, there's always the issue of scarring, which occurs whenever you make an incision on the body.

NEIGHMOND: And here's the irony: For most women, the surgery is unnecessary. The American College of Surgeons says most women - almost 90 percent of them -would do just as well with a diagnostic test called a needle biopsy. Its less invasive, less complicated and according to lots of research, just as accurate as surgery.

Radiologist Carol Lee sees patients at Memorial Sloan Kettering Cancer Center in New York, and performs needle biopsies.

Dr. CAROL LEE (Radiologist, Memorial Sloan Kettering Cancer Center): We would give local anesthesia similar to what the dentist uses; we make a tiny, little nick in the skin - its a quarter of an inch or less.

NEIGHMOND: Then, guided by ultrasound, Lee inserts a needle into the breast and takes several tiny tissue samples, which are sent to a pathologist to determine if there's cancer. The procedure isn't terribly painful, but its no walk in the park.

Ms. HEIDI WATERFIELD: It felt like an elongated shot.

(Soundbite of laughter)

WATERFIELD: So, it wasn't great.

NEIGHMOND: Heidi Waterfield is in her mid-40s. Over the years, she's had both surgical and needle biopsies because of lumps in her breasts. And for her, there's no question: The needle biopsy is preferable.

Ms. WATERFIELD: It is a little bit painful, but its short. And there are no scars and its not invasive, and so once you're done, if they find that it's nothing to worry about, then youre done.

NEIGHMOND: That's not the case with surgical biopsies. Waterfield had two of them more than 15 years ago, when she was just in her 20s.

Ms. WATERFIELD: At that time, I was very conservative about such things and thought, just get it out. I was young, and I was frightened.

(Soundbite of laughter)

NEIGHMOND: Which is a common reaction among women when the doctor tells them they're concerned about cancer. In Heidi Waterfield's case, all her biopsies were benign, and she never really needed surgery.

She's not alone. Dr. Grobmyer just completed a study in Florida.

Dr. GROBMYER: Approximately 30 percent of biopsies are being done using an open surgical technique. This is three to five times higher than is the national recommendation.

NEIGHMOND: And its not just Florida. Surgical biopsy rates are also higher than recommended in New York, New Jersey and Pennsylvania.

Dr. DAVID WINCHESTER (American College of Surgeons): We think it may primarily be an educational issue. The needle biopsy has been accepted for only the last 10 to 15 years.

NEIGHMOND: But nationwide, the tides are shifting, says Dr. David P. Winchester, with the American College of Surgeons. Hes just finished a study that shows doctors in most states are using needle biopsies, and he expects the slower states will catch up over the new few years, propelled in large part by the patients themselves.

Dr. WINCHESTER: Women in this country are pretty savvy about how to get information online, and they now come into doctors' offices well-armed with information about how to approach, not only diagnosis, but treatment.

NEIGHMOND: There are some cases where a needle biopsy is not feasible. But if your doctor doesn't suggest it, then radiologist Lee says you need to bring it up.

Dr. LEE: If a woman is not given the option of needle biopsy, I certainly think she should ask why not.

NEIGHMOND: Because the vast majority of women who have biopsies don't have cancer.

Patti Neighmond, NPR News.

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