Some dangers of biopsies
Posted by Jonathan Chamberlain on May 1, 2008
There’s really a lot of info on this site so do browse. This supports and extends the info and critical discussion in my two cancer books. For more information go to www.fightingcancer.com
“This book tells me everything. Why didn’t my doctor tell me this?”- Rev. Bill Newbern
Link to Biopsy Medical Articles
http://www.breastca ncerchoices. org/medartbiopsy .html
After being screened for breast cancer, a suspicious lump has been found.
How is the lump biopsied?
Primarily, there are three ways to biopsy a suspicious lump:
(1) fine needle biopsy (FNA),
(2) large gauge needle (core) biopsy, and
(3) excisional biopsy during which the whole lump is surgically removed.
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?
Needle biopsies pierce the suspicious breast mass to draw out tissue for
Some researchers fear these procedures may spread (or seed) the cancer,
causing something called “needle track metastasis.” Others feel this possibility is
significant concern or that the immune system, surgery and/or radiation that
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.
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 ‘ 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
The implication of this discovery is that a woman without lymph node
would have been staged at a low level, now will be staged higher,her disease
considered more advanced, and more aggressive treatment might be
Over the years, several researchers have voiced serious reservations about
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 .
Cancer authority, Ralph Moss, comments in his February 6th, 2005 Moss Reports
“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
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
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.
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
<FONT COLOR=”#000000″ BACK=”#ffffff” style=”BACKGROUND- COLOR: #ffffff” SIZE=3 PTSIZE=12 FAMILY=”SANSSERIF” FACE=”V
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
metastases will promote a regional recurrence or affect overall survival is
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
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,  in the MEDICAL ARTICLES BIOPSY section.)
What is the impact of the increased incidence of SN metastases on overall
The American College of Surgeons’ Z0010 study will address the significance
micrometastases in the regional lymph nodes of patients with invasive breast
The Chen (2002) needle biopsy study and other studies suggest needle
biopsies may not only raise the risk of spreading within the
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 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://findarticles .com/p/articles/ mi_m0ISW/ is_251/ai_ n6112675
Townsend Letter for Doctors and Patients, June, 2004 by Whitney S. Hibbard
Are there any risks inherent in the stereotactic needle biopsy procedure?
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)
What is the frequency of malignant needle track seeding?
The frequency with which this occurs and the degree to which this leads to
metastases is uncertain. Studies range from an insignificant .003% frequency
malignant needle track seeding to a horrifying 89%. (2) Clearly, more
needed to assess accurately the actual incidence. It is extremely important
understand, however, as Dr. Austin clarifies in Breast Cancer: What You
(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.”
Isn’t this really a moot concern because if a biopsy reveals a malignant
lesion it will be removed anyway?
Maybe. The question is whether the whole needle track would be removed
during surgery, i.e., surgeons unaware of the malignant needle track seeding
may not do the necessary excision. Furthermore, it must also be asked as to
it takes for malignant cells leaked into a vascular channel to be distributed
areas of the body (e.g., neighboring lymph nodes)? In all likelihood this
would be fait
accompli long before a scheduled surgery.
What are a patient’s diagnostic procedural options if she chooses not to
undergo fine needle biopsy?
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)
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)
stereotactic needle biopsy?
Allegedly, the X-ray guided needling in the stereotactic procedure will
greatly the number of “false negatives” which run as high as 23% in
needle biopsy procedures! (4)
Is there a danger inherent in the additional radiation exposure?
Clearly “yes.” According to Dr. Gofman, MD, PhD, in Radiation and Human
Health: A Comprehensive Investigation of the Evidence Relating Low Level
to Cancer and Other Diseases, ionizing radiation is a known carcinogen, there
safe exposure level to ionizing radiation, and the effects of radiation
cumulative throughout one’s life. Specific to breast cancer, Dr. Gofman
compelling evidence in his new book, Preventing Breast Cancer: The Story of a
Proven, Preventable Cause of This Disease, that about 75% of those cancers
caused by exposure to ionizing radiation, principally from medical X-rays.
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
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
doctorate in medical physics, who headed a $24,500,000 seven-year study on
effects of radiation on human health.
[end of excerpt]
See full article, Hibbard W, “Stereotactic Breast Biopsy”,2004 article in
ARTICLES BIOPSY section.)
———— ——— ——— ——— ——— ——— –
Since both FNA and may be associated with a higher
incidence of sentinel lymph node metastases than that associated with
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
advocates altering the surgical technique to avoid trauma to the breast in
prevent any possible creation of injury-induced micrometastases, which he
Dr. Rosser writes, “The surgical technique should be altered to avoid
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
cutting around it.”
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
has now been studied in the context of needle biopsy as well as in that of
surgery. It appears that timing breast piercing or surgery after ovulation is
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, .
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
explain improved survival when tumors are surgically removed in the luteal
ovulation] phase. This study examined if timing of mammography/ core biopsy
(MAM-CB) also affected breast cancer prognosis (histological tumor grade).
Eighty-five premenopausal women undergoing MAM-CB at one clinic between March
1995 and February 1998 were retrospectively studied. All patients had Stage I
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 can
cer 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.
———— ——— ——— ——— ——— ——— –
I do not want anyone cutting into my breast. Are there alternatives to
member has shrunken hers with hormone modulation, and another used an
alternative medicine program to help shrink hers, but neither person shrank
tumor to the point of disappearance. Conventional medicine might suggest
adjuvant” chemotherapy to shrink the mass, but this methodology is
in conjunction with a later surgery–which is why it’s also called
What about these cancer salves I read about? Do they remove the tumor
Cancer salves may work, but no one associated with the
experienced any lasting benefit associated with using them to treat breast
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
after a breast cancer diagnosis, but bear in mind that studies and articles
expeditious surgery may counteract potentially negative effects of cells
past needle biopsies.