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Breast Cancer Patients Suffer Too Many Unnecessary Surgeries, Study Shows

Posted Feb 21 2011 6:19am
A lot of news about breast cancer recently, news that will save lives and, not incidentally, a significant amount of money among women screened for breast cancer.


A study presented at the annual Radiological Society of North America confirmed that women between the ages of 40-50 can greatly reduce the risk of a mastectomy following breast cancer by having a yearly mammogram


Additionally, Danish researchers reported i n the Lancet medical journal that a link has been found between breast cancer in women and exposure to organochlorines pesticides that that mimic estrogen – particularly dieldrin.


The New York Times recently reported on research conducted by the director of the breast cancer program at the University of Florida in Gainesville, and published in the American Journal of Surgery, which concluded that too many women with breast abnormalities are undergoing invasive surgical biopsies (which result in an inchlong incision that requires stitches and often sedation) when they would be better served by the safer, cheaper, less invasive needle biopsy   which requires only a numbing with local anesthetic and a small incision without stitches and less risk of infection or scar.


What was surprising was the stud’s finding that 80% of breast biopsies are benign, which means the great majority of   biopsy surgeries are proven nonessential.  


Although the American Journal of Surgery establishes the guideline that 10% or fewer of breast biopsies should be surgical, the Florida study found that as many as 30 percent of   breast biopsies conducted in a five year period were surgical – a figure that is consistent, more or less, from state to state --- suggesting that as many as 300,000 women each year are having unnecessary surgery, i.e. surgical biopsies instead of needle biopsies.


The news is negative for the 20% whose biopsies are not benign – their surgical biopsy will be followed by a second surgery, which creates additional risks for the cancer patient, e.g.   greater exposure to anesthesia, etc.  


So why are surgical biopsies overused?   It could be for the simple reason that surgeons perform surgical biopsies; needle biopsies are performed by interventional radiologists.   In other words, surgeons may simply be reluctant to give away a potential surgery and therefore fee.   Chief of general surgery at Beth Israel Medical Center Dr. I. Michael Leitman, was quoted in a New York Times article, saying “Surgeons really have to let go of the patient when they have an image abnormality, the standards require it.”


Simple math says the surgeon has an obvious disincentive – the 1,600,000 biopsies conducted last year at an average of $2500 per cost patients a collective $4,000,000,000.


Surgeons such as   the chief of breast surgery at Mount Sinai Medical Center in Manhattan and a   breast cancer surgeon at Hoag Memorial Hospital Presbyterian in Newport Beach, Calif say the practice of overperforming surgical biopsies is ‘outrageous’ and ‘causing harm’.  


The study demonstrated that one effective way for hospitals to stop excess open biopsies is to outright ban them, as one hospital reports it has done with the institution of a tumor board where surgeons much justify their decision to not recommend a needle biopsy over an open procedure.


The Rise of Integrative and Complementary Medicine

The knowledge that 8 in 10 open biopsies were unnecessary should give patients a significant impetus to always ‘why’ when an open biopsy for breast cancer is recommended, and seek a second opinion.    Women might also consider a systems biology or functional medicine approach to breast cancer treatment, which integrates  conventional western medical approach with holistic naturopathic approaches that focus on the patient as a system, and not just a disease.  


It is an approach that has gained more acceptance (see Duke's program here, and Mayo's program of complementary/integrative medical care here ) as cancer rates continue to grow unabated in the face of traditional treatment techniques, and many call functional medicine not just the future of cancer treament but the future of all medicine. 

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