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More Discussion About the Possible Adverse Consequences of a Simple Breast Biopsy

Posted Jan 15 2010 12:00am

In my blog note yesterday, I speculated about whether a simple diagnostic breast biopsy could, in and of itself, induce local inflammation and thereby simulate the invasion of a previously quiescent ductal carcinoma in-situ (DCIS) (see: Can a Simple Breast Biopsy Initiate Tissue Invasion by Intra-Ductal Cancer Cells?). Martin Trotter, a reader of this blog, responded with the following comment:

If DCIS is found on core biopsy then further surgery will be performed to remove the lesion. This surgery will also remove any "escaped DCIS" that resulted from the wound healing response to the previous biopsy. Time interval between biopsy and resection is short, so biological relevance of these "escaped" cells would likely be negligible. Just a thought.

Martin is referring to the fact that many women undergo lumpectomy following the diagnosis of intraductal carcinoma. Even if the inflammation following the initial diagnostic biopsy acts in some way to promote inflammation and stimulate the invasion of DCIS cells, the subsequent lumpectomy would remove the biopsy site as well as some of the surrounding breast parchenchyma. This second procedure would, in effect, excise the "cancer-promoting" inflamed tissue.

His question begins to delve into the question of the appropriate therapy following the diagnosis of DCIS. I did turn up one article on the web that seemed to me to be reliable (see: DCIS Treatment Options) and I quote from it. The initial treatment for DCIS is always surgery. There are two surgical approaches to DCIS treatment: lumpectomy, or a total mastectomy. If lumpectomy is chosen as the surgical method, the remainder of the breast is usually treated with radiation to minimize the chances of having a recurrence of DCIS in the breast. Radiation treatment is usually begun three to four weeks after the lumpectomy or when the wound has healed.

Let's assume that the patient in question selects total mastectomy. We can assume in this case that most of the breast tissue (and ducts) have been excised and that there will be little chance of the deleterious purported effects of post-operative inflammation. However, if the patient chooses lumpectomy, the inflammatory effects on the operated side could be exacerbated on the basis of both a biopsy and lumpectomy. I will assume that many DCIS's are multifocal. In this latter case, the assumption will probably be made that the post-lumpectomy radiation therapy is capable of mopping up the multifocal DCIS cells. I suspect that many of these lumpectomy patients are also treated with aromatase inhibitors (AI) which would suppress DCIS cell growth on both the operated side as well as in the contralateral breast.

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