Women Need to Discuss their Breast Biopsy Choices with their Physicians

• Summary Findings of NABCO Breast Biopsy Survey
• Voluntary Quality Standards for Minimally Invasive Breast Biopsy
• Additional Resources and References

According to a October 1, 1998 report released by the National Association of Breast Cancer Organizations (NABCO), the majority of women who undergo breast biopsies are not informed that newer, less-invasive invasive biopsy techniques are available. The nationwide survey of 250 American women who had undergone breast biopsies between 1995 and 1998 showed that 80% received traditional open surgical procedures and only 20% received less invasive, percutaneous ("through the skin") biopsy procedures such as vacuum-assisted or core needle biopsies. Fully two-thirds of those polled had been unaware of the new minimally invasive biopsy methods and said their doctors did not discuss different biopsy options with them.

The survey was conducted by Roper Starch Worldwide, an independent polling firm and was commissioned by NABCO and Ethicon Endo-Surgery, Inc., a Johnson & Johnson company that makes a minimally invasive biopsy device called Mammotome.

In order to determine whether an area of concern in a breast (found by mammography, clinical exam or self exam) is malignant (cancerous) or benign (not cancerous), a physician may perform a biopsy. A breast biopsy is the removal of a sample of breast tissue for laboratory examination by a pathologist and is the only definitive way to determine if an abnormality is cancerous or not.

Open surgical biopsies remove considerably more tissue than minimally invasive biopsies and generally lead to more complications than the newer minimally invasive techniques. Open biopsies can be performed under general anesthesia, which carries additional risks, and involve more post-operative bleeding and infection. They also may require an overnight (inpatient) hospital stay.

Minimally invasive techniques, including vacuum assisted biopsy and core needle biopsy, involve removing less tissue, yield less scarring and pain, involve only local anesthesia and can be done on an outpatient basis. Minimally invasive biopsy relies on advanced imaging to help guide the interventional radiologist or surgeon to the breast abnormality. With percutaneous biopsy, only small samples of tissue are removed, as opposed to open biopsy, which removes the entire suspicious area(s). Since 65% to 80% of biopsies are benign, removing the entire suspicious area is not necessary in many of cases.

"The information {about the availability of minimally invasive techniques} is just not out there among the physicians or the ladies themselves," said interventional radiologist Dr. Steve H. Parker, medical director of the Sally Jobe Breast Centre in Denver. Image-guided, minimally invasive breast biopsy techniques have been available since the early 1990s. "The technique of minimally invasive biopsies, I believe, ought to be the new gold standard," he said. "There are multiple peer-reviewed studies establishing that these newer techniques are just as accurate in diagnosing breast cancer as the older traditional surgical methods."

Click here for detailed descriptions of different breast biopsy methods.

Summary Findings of the NABCO Breast Biopsy Survey

• Nearly 70% of women surveyed wished they had been "comfortable enough to ask the doctor more questions" and wanted printed materials, a video, or to talk with a woman who had already gone through the biopsy.
• 25% of women surveyed said they had not been fully informed about the specifics of their procedure, including the type of biopsy they would have, the length of time it would take, or the amount of pain and scarring to expect.
• 55% surveyed said they wish they had more time to talk with their doctors before the biopsy was performed.
• More than 90% of the women surveyed said they experienced anxiety, stress, and fear about the biopsy experience and the cancer it might reveal. More than 20% said these emotions may have prevented them from asking their physicians questions.

Positive results of the NABCO survey:

• 76% of the women surveyed had been told of the eight-in-ten odds that their biopsy would return a benign (not cancerous) result.
• More than half of women (56%) said their breast abnormality was first discovered during a routine mammogram, indicating that many women are getting their recommended annual screening exams. Abnormalities discovered by routine screening mammography are more likely to be suitable for percutaneous needle biopsy. Those abnormalities discovered through physical breast exam are usually much larger and may not be suitable for percutaneous needle biopsy.

Voluntary Quality Standards for Minimally Invasive Breast Biopsy

Over one million breast biopsies are now performed annually in the United States: approximately 800,000 surgical biopsies and 200,000 minimally invasive percutaneous biopsies. There are approximately 2,000 facilities in the US that perform stereotactic, minimally invasive breast biopsy. Of these, about 300 are accredited by the American College of Radiology (ACR). The ACR's voluntary mammography accreditation program established quality standards that were the basis for FDA regulations under the Mammography Quality Standards Act (MQSA) in 1994. Similarly, voluntary accreditation by the ACR and the American College of Surgeons are currently the only quality measures available to those seeking an expert image-guided biopsy. Regulation of stereotactic breast biopsy under MQSA is currently being considered by the US Food and Drug Administration (FDA).

Additional Resources and References

• The October 1998 NABCO News article "Biopsy Survey Reveals Too Much Surgery, Too Little Talk" is available online at http://www.nabco.org/resources/nabco_news/1098/biopsy.asp.

Updated: May 4, 2008