Breast Cancer

It’s bad enough to go through the scary and often disfiguring treatment for breast cancer, but imagine if you later discover you never had the cancer. This happens usually because the pathologist whose job it is to look at the biopsy under the microscope lacks experience to make the proper call. This is a big problem with diagnosis of “ductal carcinoma in situ” (DCIS), an early form of cancer that may or may not progress to truly invasive cancer. The criteria for DCIS are sometimes subtle and not all pathologists agree on them. (See our patient safety tips on this issue below.)

Most breast lumps found in women need to be looked at under the microscope to make sure they’re not cancer. The numbers are large: Of the 1.6 million breast biopsies done every year in the U.S., about one in eight (200,000) results in a diagnosis of invasive cancer, which requires more treatment. That means that about seven in eight women who undergo biopsy receive the good news of no cancer (or the pre-invasive diagnosis of DCIS- ductal carcinoma in situ). Needle biopsy is the gold standard for the initial investigation of most suspicious breast lumps, except for those that a needle cannot reach. It can be done with local anesthetic and a needle stick. Sometimes they need to use x-ray imaging to guide the needle to the right place, when the lump cannot be felt. In that case the needle biopsy is done by a radiologist, not a surgeon. On the other hand, an open biopsy requires a one-inch incision, which leaves a scar, and must be done with either general anesthesia or sedation. It costs about twice as much as a needle biopsy, both for the surgeon’s fee and the hospital’s fee. Researchers believe money could be the motive for the persistently high rates of open biopsies still done in the U.S.

Recent research has found that many women with early breast cancer do not need to have their armpit lymph nodes removed. This painful procedure has long been routine, because physicians thought removing lymph nodes would prolong women’s lives by keeping the cancer from spreading or coming back. However, the study shows that removing the cancerous lymph nodes is unnecessary when women receive chemotherapy and radiation, which wipes out most of the disease in the nodes.