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FAQ Biopsies

_http://www.breastcancerchoices.org/faqbiopsies.htm_

(http://www.breastcancerchoices.org/faqbiopsies.htm)

 

_Link to _ (http://www.breastcancerchoices.org/medartbiopsy.html) _Biopsy _

(http://www.breastcancerchoices.org/medartbiopsy.html) _Medical _

(http://www.breastcancerchoices.org/medartbiopsy.html) _Articles_

(http://www.breastcancerchoices.org/medartbiopsy.html)

_http://www.breastcancerchoices.org/medartbiopsy.html_

(http://www.breastcancerchoices.org/medartbiopsy.html)

 

Qestion:

I have just had a mammogram and my doctor sees a suspicious mass in my

breast. My doctor has suggested a needle biopsy. Is there any downside to this

procedure?

 

Background: Needle biopsies pierce the suspicious breast mass to draw out

tissue for analysis. Some researchers fear these procedures may spread (or

seed) the cancer, causing something called " needle track metastasis. " Others

feel this possibility is not a significant concern or that the immune system,

surgery and/or radiation that follows will clean up the area. Each individual

must review the information that is presented in this BIOPSY section with her

doctor and decide for herself whether or not to undergo these procedures.

 

Hot News:

In June 2004, the results of the bombshell Hansen study, **Manipulation of

The Primary Breast Tumor and The Incidence of Sentinel Node Metastases From

Invasive Breast Cancer,** were published in the American Medical Association*s

prestigious journal, Archives of Surgery, revealing that patients undergoing

fine needle biopsies were 50% more likely to have micrometastases spread to

the sentinel lymph node than those patients having the entire tumor removed

for biopsy.

 

The implication of this discovery is that a woman without lymph node

involvement, who would have been staged at a low level, now will be staged

higher,

her disease considered more advanced, and more aggressive treatment might be

recommended.

 

Over the years, several researchers have voiced serious reservations about

routine needle biopsies, but they were mostly ignored by their colleagues.

Hansen's research team cited their predecessors, and the research path leads

back several decades. It's hard to understand why The Archives of Surgery

study, which embodies all of these reservations about needle biopsies, didn't

make

the front page of the New York Times.

 

Cancer authority, Ralph Moss, comments in his February 6th, 2005 Moss

Reports Newsletter:

 

**Imagine the outrage these patients will feel when they learn that many of

these sentinel node metastases were caused not by the natural progression of

their disease but directly by the actions of well-intentioned (but ill

informed) doctors. Imagine, further, what will happen when patients find out

that

questions have been raised about the safety and advisability of needle

biopsies for a number of years by some of the finest minds in oncology. Imagine

the

disruption of the smooth functioning of the *cancer industry* when patients

start demanding less invasive ways of diagnosing tumors. And imagine the

class action lawsuits.**

 

Significant parts of the Hansen study below are highlighted in red. Patients

may want to include it in their Patient Portfolio.

 

Manipulation of the Primary Breast Tumor and the Incidence of Sentinel Node

Metastases From Invasive Breast Cancer

 

Nora M. Hansen, MD; Xing Ye, MS; Baiba J. Grube, MD; Armando E. Giuliano, MD

 

Arch Surg. 2004;139:634-640. Hypothesis The incidence of sentinel node (SN)

metastases from invasive breast cancer might be affected by the technique

used to obtain biopsy specimens from the primary tumor before sentinel lymph

node dissection. Design Prospective database study. Setting The John Wayne

Cancer Institute.

 

Patients and Methods

We identified 663 patients with biopsy-proven invasive breast cancer who

underwent sentinel lymph node dissection between January 1, 1995, and April 30,

1999. Patients were divided into 3 groups based on type of biopsy:

fine-needle aspiration (FNA), large-gauge needle core, and excisional. A

logistic

regression model was used to correlate tumor size, tumor grade, and type of

biopsy with the incidence of SN metastases.

 

Results

Of the 676 cancers, 126 were biopsied by FNA, 227 by large-gauge needle core

biopsy, and 323 by excisional biopsy before sentinel lymph node dissection.

Mean patient age was 58 years (range, 28-96 years), and mean tumor size was

1.85 cm (range, 0.1-9.0 cm). In multivariate analysis based on known

prognostic factors, the incidence of SN metastases was higher in patients whose

cancer

was diagnosed by FNA (odds ratio, 1.531; 95% confidence interval,

0.973-2.406; P = .07, Wald test) or large-gauge needle core biopsy (odds ratio,

1.484;

95% confidence interval, 1.018-2.164; P = .04, Wald test) than by excision.

Tumor size (P<.001) and grade (P = .06) also were significant prognostic

factors.

 

Conclusions

Manipulation of an intact tumor by FNA or large-gauge needle core biopsy is

associated with an increase in the incidence of SN metastases, perhaps due in

part to the mechanical disruption of the tumor by the needle. The clinical

significance of this phenomenon is unclear.

 

----

According to the Hansen study, whether the increased incidence of sentinel

node metastases will promote a regional recurrence or affect overall survival

is unknown. Will a core biopsy increase the chance of a local recurrence?

Another research team, led by A. Chen, published **Local Recurrence of Breast

Cancer After Breast Cancer Therapy in Patients Examined by Means of

Stereotactic Core-Needle Biopsy,** in the journal Radiology in 2002 after

finding that a

core biopsy followd by a lumpectomy and radiation does not increase the risk

of a local recurrence. It is worth noting that the authors of this study

speculate that there might be an increased risk of a local recurrence unless

adjuvant radiation is used. (See Thurfjell, et al., Acta Radiologica, [2000 ]

and Chen, et al.,Radiology,[2002] in the MEDICAL ARTICLES BIOPSY section.)

 

 

What is the impact of the increased incidence of SN metastases on overall

survival?

 

The American College of Surgeons* Z0010 study will address the significance

of micrometastases in the regional lymph nodes of patients with invasive

breast cancer.

------

The Chen (2002) needle biopsy study and other studies suggest needle

biopsies may not only raise the risk of spreading cancer cells within the

breast

tissue itself to such a degree that radiation therapy is recommended, but

Hansen (2004) suggests that these biopsies may also spread them farther,

beyond the breast, to the sentinel node.

 

The take home question is:

 

Do you really want to undergo a diagnostic procedure, such as a needle

biopsy,

which may increase your risk of spreading cancer cells when removing the

whole tumor with an excisional biopsy is an option?

------------

 

Cited below are relevant excerpts from the much respected Townsend Letter

for Doctors and Patients ( 2004). The article elaborates upon the problems with

stereotactic (also called **core** biopsies because a bigger needle is used

to draw out tissue) biopsies.

 

_Stereotactic Breast Biopsy: what you should know but probably weren't

told_ (http://www.findarticles.com/p/articles/mi_m0ISW/is_251/ai_n6112675)

_http://findarticles.com/p/articles/mi_m0ISW/is_251/ai_n6112675_

(http://findarticles.com/p/articles/mi_m0ISW/is_251/ai_n6112675)

 

 

Townsend Letter for Doctors and Patients, June, 2004 by Whitney S. Hibbard

[excerpted]

 

Question.

Are there any risks inherent in the stereotactic needle biopsy procedure?

 

Answer.

Yes. A survey of histological studies reveals that there is a clear danger

of seeding needle tracks with malignant cells **displaced in breast stroma or

in lymphovascular channels, associated with the traumatic effects of a

needling procedure,** according to Dr. Rosen, Department of Pathology, Memorial

Sloan- Kettering Cancer Center. Consequently, Dr. Rosen warns that **with tissue

disruption, lymphatic and vascular channels may also be breached, and it is

conceivable that detached epithelial fragments may enter vascular channels and

perhaps even be transported to lymph nodes.** (1)

 

Question.

What is the frequency of malignant needle track seeding?

 

Answer.

The frequency with which this occurs and the degree to which this leads to

metastases is uncertain. Studies range from an insignificant .003% frequency

of malignant needle track seeding to a horrifying 89%. (2) Clearly, more

research is needed to assess accurately the actual incidence. It is extremely

important to understand, however, as Dr. Austin clarifies in Breast Cancer:

What

You Should Know (But May Not Be Told) About Prevention, Diagnosis, and

Treatment, that it is not breast cancer per se that kills: **What kills

patients

is the spread of cancer to distant parts of the body--distal metastasis.**

 

Question.

Isn't this really a moot concern because if a biopsy reveals a malignant

lesion it will be removed anyway?

 

Answer.

Maybe. The question is whether the whole needle track would be removed

during surgery, i.e., surgeons unaware of the malignant needle track seeding

problem may not do the necessary excision. Furthermore, it must also be asked

as

to how long it takes for malignant cells leaked into a vascular channel to be

distributed to other areas of the body (e.g., neighboring lymph nodes)? In

all likelihood this would be fait accompli long before a scheduled surgery.

 

Question.

What are a patient*s diagnostic procedural options if she chooses not to

undergo fine needle biopsy?

 

Answer.

Critics of the procedure recommend lumpectomy with subsequent histological

examination once the tumor is safely removed, or surgical excision of the

needle track after biopsy. (3)

 

Question.

Is there a problem of *false negatives* (i.e., even though a malignant tumor

is present, it is missed with the needle so the pathology report is

negative) with stereotactic needle biopsy?

 

Answer.

Allegedly, the X-ray guided needling in the stereotactic procedure will

reduce greatly the number of *false negatives* which run as high as 23% in

non-stereotactic needle biopsy procedures! (4)

 

Question.

Is there a danger inherent in the additional radiation exposure?

 

Answer.

Clearly *yes.* According to Dr. Gofman, MD, PhD, in Radiation and Human

Health: A Comprehensive Investigation of the Evidence Relating Low Level

Radiation to Cancer and Other Diseases, ionizing radiation is a known

carcinogen,

there is no safe exposure level to ionizing radiation, and the effects of

radiation exposure are cumulative throughout one*s life. Specific to breast

cancer,

Dr. Gofman presents compelling evidence in his new book, Preventing Breast

Cancer: The Story of a Major, Proven, Preventable Cause of This Disease, that

about 75% of those cancers are caused by exposure to ionizing radiation,

principally from medical X-rays. People should not forget the massive and

heavily

promoted early detection mammogram program in the 1950s and 1960s of women

under 50 which was scrapped by the National Cancer Institute because the

incidence of cancers caused by repeated radiation exposure was unacceptable.

That

program **caused between 55,000 and 65,000 future cancer deaths per year!**

according to Dr. Gofman, a radiologist with a doctorate in medical physics,

who headed a $24,500,000 seven-year study on the effects of radiation on

human health.

 

[end of excerpt]

 

See full article, Hibbard W, *Stereotactic Breast Biopsy*,2004 article in

MEDICAL ARTICLES BIOPSY section.)

 

 

----

Question:

Since both FNA and core needle biopsies may be associated with a higher

incidence of sentinel lymph node metastases than that associated with surgical

biopsy, is there any downside to undergoing excisional surgical biopsy, which

will remove the whole tumor?

 

In the previously cited article published in The Breast (2000), Dr. Robert

Rosser advocates altering the surgical technique to avoid trauma to the breast

in order to prevent any possible creation of injury-induced micrometastases,

which he calls traumets.

 

Dr. Rosser writes, **The surgical technique should be altered to avoid

grasping a tumor at any time. Retraction and control of the tumor would be

better

accomplished by placing a large retention suture through the tumor, perhaps

several times through the tumor and using the suture to control the tumor

while cutting around it.**

 

Question:

I*ve decided to take my chances with a needle biopsy. If I am premenopausal,

is there any advantage to timing the biopsy procedure with a particular part

of my menstrual cycle?

 

For premenopausal women, timing the surgical procedure with the menstrual

cycle has now been studied in the context of needle biopsy as well as in that

of breast surgery. It appears that timing breast piercing or surgery after

ovulation is worth considering. A relevant study follows:

 

J Surg Oncol. 2000 Jul;74(3):232-6. Menses and breast cancer: does timing of

mammographically directed core biopsy affect outcome? Macleod J, Fraser R,

Horeczko N. Department of Surgery, University of Alberta, Edmonton, Canada.

 

BACKGROUND AND OBJECTIVES: Studies have shown molecular, genetic and

cellular changes in breast cancer during the menstrual cycle. Changes in

proliferative and metastatic potential of breast cancer cells during menses

could

explain improved survival when tumors are surgically removed in the luteal

[after

ovulation] phase. This study examined if timing of mammography/core biopsy

(MAM-CB) also affected breast cancer prognosis (histological tumor grade).

METHODS: Eighty-five premenopausal women undergoing MAM-CB at one clinic

between

March 1995 and February 1998 were retrospectively studied. All patients had

Stage I or II breast cancer surgically treated. Patients were grouped by phase

of menses at MAM-CB:follicular (F, Days 0-14) or luteal (L, Days 15-35).

Groups were comparable in age,menarche, family history, nulliparity,

breastfeeding, and total percentage of clinically palpable tumors. Pathological

characteristics of the tumors (tumor size, tumor type, estrogen and

progesterone

receptor status, axillary lymph node status, the presence of lymphatic or

vascular invasion and extranodal metastasis) was also comparable across the 2

groups. RESULTS: Low-grade tumors were more frequent in the MAM-CB group L,

whereas

high-grade tumors were more common in the MAM-CB group F (P = 0.002, chi2(4)

= 17.06). CONCLUSIONS: Timing of MAM-CB in relation to menses may be a

factor influencing breast cancer outcome. Future studies examining the effect

of

menses on the outcome of breast cancer should consider the potential effect of

the timing of MAM-CB.

------

Question:

I do not want anyone cutting into my breast. Are there alternatives to

surgery?

 

No Amazon member has definitively gotten rid of a tumor without surgery. One

member has shrunken hers with hormone modulation, and another used an

alternative medicine program to help shrink hers, but neither person shrank her

tumor to the point of disappearance. Conventional medicine might suggest

using " neo- adjuvant " chemotherapy to shrink the mass, but this methodology is

customarily used in conjunction with a later surgery--which is why it's also

called pre-operative chemotherapy.

 

Question:

What about these cancer salves I read about? Do they remove the tumor

without surgery?

 

Cancer salves may work, but no one associated with the Amazon Group has

experienced any lasting benefit associated with using them to treat breast

tumors.

 

Question:

My biopsy came back positive for cancer. I want a second and maybe a third

opinion. How long do I have to make a decision about what kind of surgical

procedure to have?

 

Any reputable doctor will tell you there is time to schedule second and

third opinions after a breast cancer diagnosis, but bear in mind that studies

and

articles show that expeditious surgery may counteract potentially negative

effects of cells displaced by past needle biopsies.

 

 

_Link to _ (http://www.breastcancerchoices.org/medartbiopsy.html) _Biopsy _

(http://www.breastcancerchoices.org/medartbiopsy.html) _Medical _

(http://www.breastcancerchoices.org/medartbiopsy.html) _Articles_

(http://www.breastcancerchoices.org/medartbiopsy.html)

_http://www.breastcancerchoices.org/medartbiopsy.html_

(http://www.breastcancerchoices.org/medartbiopsy.html)

 

 

 

 

 

 

 

 

 

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Bill Sardi just wrote piece yesterday where he that claims that if you

leave breast cancer alone, the body will absorb it and no one will know

the better. In the same article, he also said that mammograms cause a

22% increase in breast cancer rates. Can't find the link.

 

 

 

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