About Breast Biopsy¹

A breast biopsy is performed to determine whether a mass or lesion detected in the breast is cancerous.  About 1.7 million biopsies are performed each year to evaluate breast abnormalities. These are often “image detected” lesions that cannot be felt on manual examination, thus found most commonly during a mammogram or ultrasound examination. Others are first noted on physical exam by a physician or are detected by women themselves. A biopsy is used to obtain a sample of the suspicious tissue to be examined by a pathologist. This will determine if the abnormality is benign (not cancerous) or malignant (cancerous). 

MIBB Diagnosis Before Surgery Reduces Number of Surgeries
Experts say that between 60-80% of image-detected abnormalities are benign. A high priority for both physicians and patients when an abnormality is detected is to quickly and conclusively make a diagnosis of “cancer” or “not cancer.” Physicians in organizations ranging from the specialists in the American College of Breast Surgeons to general surgeons in the American College of Surgery agree that except in unusual cases, a diagnostic biopsy should be done before surgery is performed to treat the cancer.  The rationale for this is that for the majority of women, the abnormality will be benign and no surgery will be needed. For those where the results are inconclusive or show cancer, the surgery and treatment can be carefully planned and carried out with only one exposure to anesthesia for the patient.

There are several techniques for a physician to carry out a breast biopsy. Techniques include minimally invasive breast biopsy (MIBB) or open excisional biopsy.  Minimally invasive approaches include fine needle aspiration, a core needle biopsy with or without imaging such as mammography, MRI or ultrasound or a vacuum assisted biopsy.  A minimally invasive biopsy is recommended by breast cancer experts as the preferred approach to biopsy.  The rationale is that it is equally effective as other methods at obtaining a tissue sample for pathology.  An additional advantage is that if a minimally invasive biopsy is done and the results conclusively show benign tissue, a large number of unnecessary surgeries can be completely avoided. [Some patients may still require surgical biopsy if the initial biopsy is inconclusive.]

Too Many Unnecessary Breast Surgeries
The quality gap identified by the American Society of Breast Disease and many other organizations, is that in practice, surgical biopsies are often performed even when a minimally invasive breast biopsy could have provided the same information and reassurance to the woman. An open biopsy is associated with greater pain and scarring for the patient, plus additional risks. If the initial biopsy is done with open surgery and the patient has cancer, the patient will need at least two breast surgeries – one for making the diagnosis and one for treating the cancer. MIBB eliminates the need for surgery in the large percentage of women with benign findings. 

Breast Centers of Excellence
There is a significant difference in practice patterns between health providers that devote the majority of their practice to breast care and those that do not.  More experienced centers have lower numbers of biopsies in general and have very low rates of open surgical biopsy. Breast centers also have pathologists specializing in breast disease, which is critical to getting a correct diagnosis.  Accredited centers are required to track the rates of open versus minimally invasive biopsies, a requirement that helps breast centers to evaluate their performance and promote best practices. This results in better clinical outcomes and significantly decreased rates of surgical breast biopsy.  PPOs have an essential role in promoting use of breast care centers of excellence and encouraging evidence based best practice in breast diagnosis and treatment.

• The Quality Gap
• Physician Guidelines and Resources
• For PPOs – Strategies to Promote Evidence Based MIBB
• Information for Patients from PPOs
• References 

¹ Statistics and information cited on this web page can be found in the research articles and other publication cited here