A warning to all women whose mammograms show an abnormality: If your surgeon says you need a surgical biopsy to determine if you have cancer, be sure to get a second opinion. The odds are good that you should get a needle biopsy. That is safer, less invasive, and cheaper.
Denise Grady reported in The Times on a study of more than 170,000 biopsies in Florida between 2003 and 2008. It found that 30 percent were surgical, while guidelines suggested the rate should be 10 percent or less.
Why would the percentages be so high? Many surgeons may fail to keep up with the latest medical guidelines that favor needle biopsies in most cases. But surgeons also have a strong financial incentive to perform surgical biopsies rather than refer patients to the radiologists who perform most needle biopsies.
Either way, the result is much higher costs. Hospitals charge more than $10,000 for a surgical biopsy, and about half that for a needle biopsy. Surgeons charge $1,500 to $2,500 for a surgical biopsy; radiologists who do the needle biopsy charge between $750 to $1,500.
An excessive resort to surgery can also lead to needless injuries. A surgical biopsy requires an inch-long incision to cut out the abnormal area. A needle biopsy requires only a tiny incision to obtain a sample of cells, requires no stitches, and carries less risk of infection and scarring. Most patients who undergo biopsies, of either sort, don’t have cancer; some 80 percent of all breast biopsies turn out to be benign.
If the results of the Florida study, published in The American Journal of Surgery, are extrapolated to the entire country, more than 300,000 women a year are having unnecessary surgery, at a cost of hundreds of millions of dollars a year.