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

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

Editor:

"The project is so compelling, the benefits to our community and region are so great, that I have no doubt we will reach our goal of $300,000 for our Stereotactic Breast Biopsy machine," wrote Mike Munck, the St. Peter's Hospital Foundation's executive vice president in Helena, Montana. Like numerous community hospitals across the country, fund-raising campaigns are in full gear to persuade the local community of the "desperate" need for this latest piece of high tech medical wizardry in the fight against breast cancer. Hearing only one side of the story, however, I wondered what the unasked and unanswered questions were, and I wondered if a fund raiser does not have a moral and ethical obligation to disclose all the facts. Potential donors would want, I am sure, all important questions elucidated and answered to their satisfaction before they make their contributions. So, to this end, a little research has uncovered the following questions and answers, which present "the other side of the story" and offer to counter-balance the unfortunately one-sided fund-raising campaign.

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

Answer. Yes. Asurvey 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.

Health Care Industry

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

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

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