Opportunity for Doctor and Patient Education
According to a Florida study, too many women are receiving surgery for breast lump biopsies. The study estimates that although approximately 30 percent of biopsies were surgical when, according to medical guidelines, that number should be closer to 10 percent.
During a surgical biopsy, also known as an open biopsy, the patient is placed under general anesthesia; the surgeon makes an inch-long incision and removes the tumor to undergo testing to find out whether it is benign or cancerous.
The alternative procedure is a needle biopsy. Patients receive local anesthesia, are injected with a needle, and a sample of the cells are analyzed to see if are harmless or malignant. There are different needle procedures based on the details of the patient's abnormality. If the tumor is too small to be felt, radiological equipment must be used to guide the needle. The entire procedure costs $5,000 to $6,000 - half the cost of a surgical biopsy.
The study couldn't give a definitive reason on why so many unnecessary surgical biopsies are done. Some doctors speculate that some surgeons don't want to pass up the surgery fee. According to some of the researchers in the study, doctors said that patients wanted an open biopsy, as opposed to a needle biopsy. Other doctors blame outdated training for the rate. According to the New York Times, breast surgeons in private practice at Beth Israel had a 30 percent rate of open biopsies while breast surgeons involved in teaching at the hospital had a 10 percent rate of open biopsies.
Dr. Melvin Silverstein - a clinical professor of surgery at the University of Southern California and breast cancer surgeon at Hoag Memorial Hospital Presbyterian -- mentions in the New York Times article that his hospital brings surgeons who want to do open surgeries in front of a tumor board.
The study is not just an opportunity for doctors to get educated, but for patients to get educated as well. For many people, the moment they hear the doctor say cancer, patients enter panic mode and want "it" out as aggressively and as quickly as possible. With the surgical biopsy, there is peace of mind that the bad thing is cut out, as opposed to simply being a stuck by a needle. Doctors should also take the proper steps to give patients clear facts about what will and won't happen for each procedure. Patients should be aware of all of their options before making a life-changing decision.
There has been some controversy about whether or not the needle biopsy spreads cancer cells. Doctors should be adequately trained on the details of the procedures and be able to effectively communicate that information to a patient who may be upset.
Photo courtesy of the National Cancer Institute, Linda Bartlett (photographer)