Breast cancer diagnoses can be facilitated with use of a needle biopsy, however, a study has reported that needle biopsies are not used enough. The authors of the study stated that the results indicated that underuse of needle biopsies has a negative impact on breast cancer diagnosis and treatment. The study included data on the influence of surgeons on the use of needle biopsies for diagnosis.
The study was carried out at the University of Texas MD Anderson Cancer Center by a group of researchers led by Dr. Benjamin Smith. Nationwide medicare data from 2003 to 2007 were used and data from 89,712 patients with breast cancer who previously had surgery were included in the analysis. The study also included information about 12,405 surgeons who treated the patients.
Three outcome measures were analyzed in the study. Whether a surgeon was consulted before versus after a biopsy was one of the factors considered. Use of a needle biopsy (yes or no) was the second factor analyzed, and the third factor was the number of surgeries that were performed for cancer treatment on each patient. The study showed that 68 percent of the patients had a needle biopsy. Only about 54 percent of these patients were seen by a surgeon previous to having a biopsy. Medicaid coverage, rural residence more than about eight miles from a facility that performed needle biopsies and no mammogram within two months before consultation were found to be influences that played a role in the outcomes.
The study indicated that the risk of having multiple surgeries for breast cancer was about 34 percent for patients that had a needle biopsy and the risk of multiple cancer surgeries was about 70 percent for those who did not have a needle biopsy. This difference in the rates of having multiple surgeries was found to be statistically significant. This statistic suggested that the outcome is much better for those who have a needle biopsy for breast cancer diagnosis. The authors of the study stated that surgeon-level interventions may help to increase the use of needle biopsies for breast cancer diagnosis and thereby may increase the quality of care.
Surgeon experience was shown to be important in the study. Needle biopsies for breast cancer diagnosis were not used enough by inexperienced surgeons. A biopsy in which a sample is extracted through a small incision is the alternative to having a needle biopsy. An excisional biopsy requires a three to four centimeter incision to remove the tumor sample and this is more painful and will take longer to heal than the puncture wound of a needle biopsy.
The initial discovery of a potentially cancerous tumor in the breast usually results from a mammogram. Then the next step is to have a biopsy of the lump (or tumor). If the biopsy results are positive for cancer then surgery may be warranted. The process of diagnosing a breast lump can be challenging. The results from this study suggest that women should consider the experience level of a surgeon when facing the possibility of having breast cancer and they should also request having a needle biopsy if warranted. Needle biopsies not being used enough for breast cancer diagnosis means more women faced surgeries that possibly could have been avoided.
By Margaret Lutze