If you’ve been told you need a breast biopsy, you need to read this first

It’s what every woman fears the most – your mammogram or ultrasound turned up something suspicious.

Now you’re waiting for a biopsy result that has the power to give you a clean bill of health – or sentence you to painful surgery or sickening chemo and radiation.

We’ve been told the biopsy is the gold standard of tests. That it’s the fool-proof final word on whether we have cancer.

But according to a frightening new study in JAMA, that may all be a myth.

Because it turns out botched biopsy results could be forcing thousands of healthy women a year into aggressive breast cancer treatment they never needed. And if you’re one of 160,000 women a year with a common breast condition, your biopsy results may be no more reliable than the flip of a coin.

Shades of gray

“As a surgeon, I only know what to do based on the guidance of my pathologist,” said Dr. Elisa Port. And she should certainly know, being the chief of breast surgery at Mount Sinai Hospital in New York City.

But if breast cancer surgeons are in the dark without their pathologists, then we may be looking at a case of the blind leading the blind.

A group of researchers from prestigious hospitals all around North America found that breast biopsies are often misdiagnosed by pathologists.

The lead author of the study said that most patients believe that getting a biopsy will give you “definitive answers”– but that’s far from the truth.

The researchers asked a panel of top pathologists – including experts who have written textbooks on diagnosing cancer – to examine slides from breast biopsies and give their opinions. Then a group of practicing pathologists reviewed the slides to see if they got the same results.

When it came to “invasive” cases of cancer, both groups reached the same conclusion 96 percent of the time.

That’s the good news. It’s the only good news.

The pathologists wrongly diagnosed women with ductal carcinoma in situ (D.C.I.S.) — which is often treated with aggressive surgery and radiation.

In fact, if you had perfectly healthy breast tissue, there was still a one-in-seven chance that a pathologist would tell you your biopsy results were abnormal.

And when you enter the “gray zone” called atypia — which are abnormal, but not cancerous cells in breast ducts — the results were even more frightening. The two groups came to the same conclusion only about half the time.

There are about 160,000 women a year who are diagnosed with atypia and given the heartbreaking news that they’re at a heightened risk for cancer. And thousands of these women may be worrying and suffering needlessly right now, thanks to a botched biopsy reading.

Doctors are calling the findings “disconcerting.” How’s that for an understatement?

But the thing to remember here is the comment made by Dr. Port. You may go to a lot of trouble to find the very best doctor or surgeon, but it’s actually someone behind the scenes – some pathologist you may never meet — who will dictate which treatments you receive.

That’s why being a knowledgeable patient is so important these days.

So here’s how to help protect yourself. I know this is something you’ve heard before, but you may not think it applies when you’re talking about a biopsy:

Get a second opinion

If your breast biopsy shows abnormalities – especially those vague and hazy ones called atypia or D.C.I.S. — don’t let a doctor hustle you into surgery or radiation.

Get a second opinion.

A second opinion does not mean another biopsy must be taken. All you’re doing is asking additional pathologists to look at your slide under the microscope.

And it won’t be an insult to your doctor or anyone else. In fact, that’s exactly what all the doctors who commented on the new JAMA study suggested patients do.

Because if there was ever a case of something being worse than having breast cancer, it’s getting breast cancer treatments when there was nothing wrong with you in the first place.

Source:

“Breast biopsies leave room for doubt, study finds” Denise Grady, March 17, 2015, The New York Times, nytimes.com