80% of breast biopsies turn out to be benign. Unfortunately greed is
leading to unjustifiable open biopsies, which mean that if there was cancer
present, women will have two surgeries back to back. But, with the new research
about cancer and wound healing, there is more to the story. We need to
carefully review those articles I have sent you and come to the conclusion that
I have that even simple needle biopsies carry risk of spreading cancer. So
a safe preventive approach using IV vitamin C makes real sense if the
patient is you or loved one.
This article from the New York Times has some proof that greed is driving
the cancer market. One doctor seeing these statistics stated that "it was
outrageous that 30 percent of breast biopsies were done by surgery. He
said some of the unnecessary procedures were being performed by surgeons who
did not want to lose biopsy fees by sending patients to a radiologist"
Of course, all this can be avoided now when we finally realize that annual
use of breast cancer screening tests using tests like thermography and the
caprofile.net or the new Johnson and Johnson test for cancer. Simply
throw out useless and dangerous mammograms, which are feeding these mercenary
surgeons that push for open biopsies that almost no one needs!
Garry F. Gordon MD,DO,MD(H)
President, Gordon Research Institute
www.gordonresearch.com
________________________________________________
https://www.nytimes.com/2011/02/19/health/19cancer.html
February 18, 2011
Study of Breast Biopsies Finds Surgery Used Too Extensively
By DENISE GRADY
Too many women with abnormal mammograms or other breast problems are
undergoing surgical biopsies when they should be having needle biopsies, which
are safer, less invasive and cheaper, new research shows.
A study in Florida found that 30 percent of the breast biopsies there from
2003 to 2008 were surgical. The rate should be 10 percent or less,
according to medical guidelines.
The figures in the rest of the country are likely to be similar to Florida
s, researchers say, which would translate to more than 300,000 women a
year having unnecessary surgery, at a cost of hundreds of millions of dollars.
Many of these women do not even have cancer: about 80 percent of breast
biopsies are benign. For women who do have cancer, a surgical biopsy means
two operations instead of one, and may make the cancer surgery more difficult
than it would have been if a needle biopsy had been done.
Dr. Stephen R. Grobmyer, the senior author of the Florida study, said he
and his colleagues started their research because they kept seeing patients
referred from other hospitals who had undergone surgical biopsies (also
called open biopsies) when a needle should have been used.
After a while you keep seeing this, you say something's going on here,�
said Dr. Grobmyer, who is director of the breast cancer program at the
University of Florida in Gainesville.
The reason for the overuse of open biopsies is not known. Researchers say
the problem may occur because not all doctors keep up with medical advances
and guidelines. But they also say that some surgeons keep doing open
biopsies because needle biopsies are usually performed by radiologists. The
surgeon would have to refer the patient to a radiologist, and lose the biopsy
fee.
A surgical biopsy requires an inchlong incision, stitches and sometimes
sedation or general anesthesia. It leaves a scar. A needle biopsy requires
only numbing with a local anesthetic, uses a tiny incision and no stitches
and carries less risk of infection and scarring.
If the abnormality in the breast is too small to be felt and has been
detected by a mammogram or other imaging method, the needle biopsy must also be
guided by imaging, mammography, ultrasound or M.R.I. and will often
have to be performed by a radiologist. If a lump can be felt, imaging is not
needed to guide the needle, and a surgeon can perform it.
Surgeons really have to let go of the patient when they have an image
abnormality,� said Dr. I. Michael Leitman, the chief of general surgery at
Beth Israel Medical Center in Manhattan. They are giving away a potential
surgery. But the standards require it. And I'm a surgeon.�
Dr. Grobmyer's study, published by The American Journal of Surgery, is
based on 172,342 biopsies entered into a state database in Florida. It is the
largest study of open biopsy rates in the United States, and the first to
include patients with and without cancer.
About 1.6 million breast biopsies a year are performed in the United
States. But in 2010, only about 261,000 found cancer (207,000 women had invasive
breast cancer, and another 54,000 had a condition called ductal carcinoma
in situ, in which cancer cells have not invaded the surrounding tissue).
Hospitals charge $5,000 to $6,000 for a needle biopsy, and double that for
an open biopsy, according to Dr. Grobmyer's article. Doctors fees for an
open biopsy range from $1,500 to $2,500, he said, and $750 to $1,500 for a
needle biopsy.
A surgeon who was not part of Dr. Grobmyer's study said she often
encountered patients referred from other hospitals whose open biopsies should
have
been done with a needle.
I see it all the time, said the surgeon, Dr. Elisa R. Port, the chief
of breast surgery at Mount Sinai Medical Center in Manhattan. People are
causing harm and should be held accountable.�
Dr. Melvin J. Silverstein, a breast cancer surgeon at Hoag Memorial
Hospital Presbyterian in Newport Beach, Calif., and a clinical professor of
surgery at the University of Southern California, said it was outrageous�
that
30 percent of breast biopsies were done by surgery.
He said some of the unnecessary procedures were being performed by
surgeons who did not want to lose biopsy fees by sending patients to a
radiologist.
I hate to even say that, Dr. Silverstein said. But I don't know how
else to explain these numbers.�
A study at Beth Israel Medical Center in Manhattan (Dr. Leitman was an
author), published in 2009, found that the rate of open breast biopsies in
2007 varied with the type of surgeon.
Breast surgeons employed by the hospital and involved in teaching had a 10
percent rate. Breast surgeons in private practice who operated at Beth
Israel had a 35 percent rate. Among general surgeons, who do not specialize in
breast surgery (some who were on staff at the hospital and some who were
not), the rate was 37 percent. All the doctors earn biopsy fees, so they all
had the same incentive.
The lead author of the study, Dr. Susan K. Boolbol, chief of breast
surgery at Beth Israel, said the difference could be explained, in part, by
training. She said the academic breast surgeons on the hospital staff were more
likely than the others to keep up with new developments in the field and to
work closely with radiologists. As for the idea that the motivation was
money, she said, A huge part of me doesn't want to believe it's true.�
She said that when she asked surgeons in the study why they were doing
open biopsies, many said patients wanted them. “My comeback was, Do you
think you had an inherent bias in the way you explained it?� In the past
seven years, she said she had only one patient choose an open biopsy over a
needle biopsy.
Dr. Boolbol says some patients fear that sticking a needle into a cancer
will cause it to spread, and she spends a lot of time explaining that it is
not true. She said that open biopsy rates declined among surgeons at Beth
Israel who were told about her study's findings, but newcomers still tended
to have higher rates.
This is a constant education process for surgeons, she said.
One way for hospitals to stop excess open biopsies is to ban them, Dr.
Silverstein said, unless they are truly necessary, as in uncommon cases in
which a needle cannot reach the spot.
We made a rule, he said. If it can be done with a needle, it has to
be. We embarrass you if you do an open biopsy. We bring you before a tumor
board to explain.�
Dr. Silverstein says that when he lectures and asks how many surgeons in
the audience perform open biopsies, no hands go up. Nobody will admit it,�
he said.
He said there is more to be gained by taking his message straight to the
patients. He and other doctors say that any woman who is told that she needs
a surgical biopsy should ask why, and consider a second opinion.
Maybe we have to get patients to say, This guy took a big chunk out of
me and I didn't even have cancer, and now I'm deformed, Dr.
Silverstein said. Who just overthrew Mubarak? The people. This is exactly
the same
thing.�
Breast Biopsies by Surgery Too Extensive
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