O.C. Report Touts Less Invasive Test for Breast Cancer
The number of surgeries to determine whether breast lumps are cancerous can be dramatically reduced with needle biopsies, with no increased risk that cancer will go undetected, according to a report by a team of breast care physicians.
The increased use of needle biopsies requires teamwork by specially trained physicians, but it dramatically reduces medical costs and avoids the pain and scarring of surgery, said Dr. John Link, oncologist with the Breast Center at Orange Coast Memorial Medical Center in Fountain Valley.
The report was presented at a national symposium Saturday in Florida. It is based on the experience of members of the breast care team at Long Beach Memorial Medical Center, many of whom--including Link--are now affiliated with the Orange Coast hospital (formerly FHP Hospital).
Link and colleagues--a radiologist, pathologist and surgeon--reduced the number of benign surgical biopsies at the Long Beach hospital by two-thirds from 1985 to 1993, at an estimated savings of $1.78 million, according to the abstract presented at the Third Annual Multidisciplinary Symposium on Breast Disease. At the same time, the number of cancers detected there increased by 30%, according to the team’s abstract.
Traditionally, physicians have surgically removed entire suspicious lumps from the breast so pathologists could examine the tissue. Less invasive needle biopsies, using a fine needle or a larger needle for a “core” biopsy, take samples of the lump tissue, leaving the rest of the lump in place.
Although most lumps are benign, the traditional thinking has been that removing the entire lump is the most certain method of ruling out cancer, because the needle might miss a cancerous section of the lump, leading the physician to erroneously believe there is no malignancy, Link said.
But with advanced technology, improved imaging and special training, fine needle and core biopsies can replace the vast majority of those surgical biopsies, Link said in an interview.
In 1985, two years before Link and three colleagues established a breast center at Long Beach Memorial, 785 breast biopsies were performed that found benign lumps, at a cost of $3.14 million. In 1993, 275 benign surgical biopsies and 410 benign needle biopsies were performed, at a total cost of $1.36 million.
(Link’s team estimated that a surgical biopsy, including anesthesia, surgeon, pathologist and operating room, costs $4,000, while a needle biopsy costs $650. Figures for 1985 and 1993 were based on current costs.)
Further, Link’s abstract states, follow-up on the needle biopsy patients four years later determined there had been no missed diagnoses of cancer.
“This is very good news for women,” Link said, adding that one of every two women at some time in her life will see a doctor about a breast lump.
“It used to be that surgery was necessary. But using the technology we now have, we don’t have to operate in the Dark Ages, cutting and removing,” he said.
There are two types of needle biopsies. Fine needle biopsies use a needle slightly wider than a human hair to aspirate a mixture of cells from the lump. A “core” biopsy uses a bigger needle, which takes a bigger sample that also shows the construction of the lump, and requires a local anesthetic. Dr. Susan Roux, the team’s radiologist, said the lumps are viewed using ultrasound while both types of needle biopsies are performed.
Link said it is important that the needle biopsies are performed by a physician well-experienced in the technique to make sure proper samples are taken. In Link’s group, all needle biopsies are performed by the radiologist.
Dr. Joel A. Berman, a surgeon who is co-director of the Center for Breast Care at the Orange County Regional Cancer Center, on the campus of Fountain Valley Regional Hospital and Medical Center, agreed that needle biopsies “are the way of the future, and even the present.”
However, there always remains the risk of a false negative, a determination that a lump is benign when in fact there is a malignancy, Berman said. “There are always going to be some [lumps] that fall outside the normal pattern.”
There are still occasions when a surgical biopsy is necessary, Link and Berman said.
If the needle biopsy reveals cells that are abnormal but not cancerous, further exploration is needed by removing the lump, Link said. Also, sometimes when lumps are near enough to the skin’s surface to irritate, women will want them removed, he said. Berman said very young women may want a visible lump removed so that they do not have to worry about it the rest of their lives.
In some cases, a mammogram clearly shows that a lump is malignant, and surgery to remove it is performed without doing a biopsy first, Link said.
When a needle biopsy reveals a malignancy, the lump must be surgically removed, but the surgeon is aided ahead of time by knowing what kind of cancer is involved, Link said. Further, a surgeon knows to remove more tissue around the lump, compared with the lesser amount that is removed during a biopsy, he said.
(BEGIN TEXT OF INFOBOX / INFOGRAPHIC)
Prevention
Health care officials offer these suggestions for early detection and lowering risk of breast cancer:
* Self-examine often for lumps and moles
* Get a mammogram. See your doctor about frequency
* Eat a lot of vegetables and fruits
* Do not smoke or drink
* Avoid fatty foods
* Exercise at least 30 minutes three times a week
For More Information
Call the American Cancer Society’s Orange County office in Santa Ana at (714) 261-9446. Or visit its Web site at https://www.ca.cancer.org
Sources: American Cancer Society, UC Irvine Epidemiology Division; Researched by MARCIDA DODSON and APRIL JACKSON/Los Angeles Times
Cancer Declining
Breast cancer in Orange County has declined significantly since 1996 due, in part, to early detection. Number of cases:
1994: 1,725
1998*: 1,650
* Estimate
Source: American Cancer Society
