Surgery Used Too Often in Breast Biopsies

According to Dr. Stephen R. Grobmeyer, director of the breast cancer program at the University of Florida and senior author of the study published in the The American Journal of Surgery, too many surgical breast biopsies are being performed when the protocol calls for a needle biopsy. While it’s not clear the reason for the excessive use of surgical biopsies, it’s clear to Dr. Grobmeyer too many women with abnormal mammograms are undergoing surgical procedures when a needle biopsy is safer, less invasive, and cheaper.

The new study estimates that 300,00 women in the US are having unnecessary breast surgery. According to the front page article in the New York Times published Saturday, “The figures in the rest of the country are likely to be similar to Florida’s, researchers say, which would translate to more than 300,000 women a year having unnecessary surgery, at a cost of hundreds of millions of dollars. Many of these women do not even have cancer: about 80 percent of breast biopsies are benign. For women who do have cancer, a surgical biopsy means two operations instead of one, and may make the cancer surgery more difficult than it would have been if a needle biopsy had been done.”

While the study itself draws no conclusions as to the reason for the excessive surgical biopsies, some surgeons point to a more nefarious reason. The NY Times interviewed several surgeons in preparation for publishing the article.

“Dr. Melvin J. Silverstein, a breast cancer surgeon at Hoag Memorial Hospital Presbyterian in Newport Beach, Calif., and a clinical professor of surgery at the University of Southern California, said it was “outrageous” that 30 percent of breast biopsies were done by surgery. He said some of the unnecessary procedures were being performed by surgeons who did not want to lose biopsy fees by sending patients to a radiologist.“I hate to even say that,” Dr. Silverstein said. “But I don’t know how else to explain these numbers.”

Silverstein’s comments are especially revealing in light of the fact that needle biopsies require a tiny incision, no stitching, and less risk of infection and scarring. Also needle biopsies are half the price of the open biopsy.