A panel of top cancer specialists maintains that if a mammogram indicates a biopsy is needed, whenever possible, doctors should perform a minimally invasive breast biopsy rather than a traditional open surgical biopsy.
A panel of top cancer specialists maintains that if amammogram indicates a biopsy is needed, whenever possible, doctors shouldperform a minimally invasive breast biopsy rather than a traditional opensurgical biopsy.
This conclusion is one of many reached by a group of 22 cancer experts in aconsensus paper entitled, "Image-Detected Breast Cancer: State-of-the-ArtDiagnosis and Treatment," that was published in a recent issue of the Journal of the American College of Surgeons (193:297-302, 2001). The paperwas also presented in a panel discussion before the start of the annual meetingof the American College of Surgeons held this year in New Orleans.
The consensus panel comprised leading surgeons, radiologists, andpathologists who work with breast cancer patients. They urged doctors to adoptmore speedily the proven technologies in mammography, breast ultrasound, andminimally invasive breast biopsy, and encouraged insurance carriers to providebetter reimbursement. Limited access to currently available techniques andtreatments and inadequate reimbursement of physicians are threatening continuedstrides in the diagnosis and treatment of breast cancer, the panel concluded.The specialists drafted their consensus paper at a breast cancer conferencesponsored by the University of Southern California (USC)/Norris ComprehensiveCancer Center and the Keck School of Medicine of USC.
The panel included Melvin J. Silverstein, MD, professor of surgery at theKeck School and conference chair; Michael Edwards, MD, associate professor ofsurgery at the University of Louisville (James Graham Brown Cancer Center); JayHarness, M, professor of clinical surgery, UC Davis (Alameda County MedicalCenter); and Michael Lagios, MD, clinical associate professor of pathology,Stanford University.
At a Crossroads
"Over the last 20 years, we’ve seen major improvements in the medicalcommunity’s ability to diagnose and treat patients with breast cancer,"said Dr. Silverstein. "However, we’re now at a crossroads, and moredoctors need to adopt the newer state-of-the-art technologies and techniquesthat until now have only been common practice in the leading institutions. Wideruse of currently available techniques will further improve patient selection,reduce breast cancer recurrence, mortality, and morbidity of therapy, improvecosmetic results, and decrease overall costs."
Panel members recommend more widespread adoption of minimally invasive breastbiopsies, which are often less traumatic and costly than traditional biopsies.Traditional surgical biopsies account for the majority of the more than1 million biopsies performed in the nation each year.
According to the consensus panel, a minimally invasive breast biopsy ispreferred over an open surgical biopsy for image-detected abnormalities,whenever possible. Shifting to minimally invasive biopsies can spareapproximately 80% of women a trip to the operating room and allow for betterplanning if a woman is diagnosed with breast cancer.
The panel also urged insurance companies to better cover mammographyscreenings. Panel members called for more training and use of breast ultrasoundamong physicians, and also noted that magnetic resonance imaging holds promisefor diagnosis, and among high-risk women, even for detection. The panel foresawan important role for sentinel node biopsy as a diagnostic technique fordetermining the spread of breast cancer; however, they emphasized "the needfor adequate training and education prior to adopting it as standardpractice."
They also encouraged advanced treatment techniques, such as oncoplasticsurgery, as well as further study of emerging practices such as partial breastirradiation and radiation seed implants for breast cancer.
The consensus conference was supported by an educational grant from EthiconEndo-Surgery, Inc.