Doctors advocate less invasive ways to diagnose breast cancer

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Capital News Service
LANSING – Surgically removing a lump in the breast may seem like the best first course of action when it’s detected but it isn’t always necessary, new research shows.
A national study by doctors from University of Florida, Gainesville, indicates that the rate of open surgery biopsies – surgically removing lumps – remains higher than appropriate despite many advantages associated with less surgically aggressive procedures.
But that may not be the picture in Michigan.
“Needle biopsies dominate in major medical institutions in Michigan,” said Vincent Cimmino, professor of surgery at the University of Michigan Health System in Ann Arbor.
Cimmino said that minimally invasive procedures are the  widely accepted standards of practice in larger hospitals in the state.
“Even when a lump that cannot be detected by routine examination is found during mammography, the general practice is to use X-rays to identify and lead to the lesion, using a thin hollow needle and a wire to extract tissue samples for diagnosis,” he said.
But certain situations call for open surgery.
When a lump is detected near the chest wall or around the nipples, surgeons follow medical guidelines that require open surgery biopsies, Cimmino said.
E. J. Siegl, a senior nurse consultant with the  state’s Breast and Cervical Cancer Control Program, has been involved with breast cancer management for several years.
“We’re seeing a trend moving toward minimally invasive procedures,” she said.  “Most of our surgeons are recommending needle biopsies as the first step towards cancer management.”
The program is run by the Department of Community Health and funded by the federal Centers for Disease Control and Prevention.
Siegl said times have changed and all women don’t have to undergo the unnecessary pain and discomfort caused by open surgery.
Minimally invasive breast biopsies are cost-efficient, less painful and disrupt patients’ lives less, according to the Florida study.
Patients’ preferences sometimes trump medical advice.
“Many times we suggest one way but the patient may say, ‘I just want the lump out,’ and we have to accommodate their wishes,” Cimmino said.
He also said some patients are uncomfortable with lumps in their breasts, even when tests for cancer cells come out negative.
In such cases, surgeons must do open surgery to remove the lumps.
Siegl said those are unnecessary because most benign lumps are normal parts of a woman’s body.
The study also called for more training and changes in existing practices.
Cimmino said that’s not so necessary, however.
“I’m not sure that more training is the answer,” he said.  “You cannot apply training without commensurate technology.”
He said that improved regionalization of services might be a better solution.
“This way, physicians with less technology or equipment can send their patients to better-equipped institutions,” he said.
But that alternative isn’t possible if patients aren’t willing to travel, Cimmino said.
The state program refers women to surgeons depending on where they live, and professionals like Siegl have noticed one trend cited in the study.
“We are seeing more open surgery procedures done in medical institutions not affiliated with academic institutions,” she said.
The study said the use of minimally invasive biopsies is more common at academic hospitals compared to non-academic ones.
Medical institutions like U-M’s Comprehensive Cancer Center, where Cimmino practices, are better equipped with technology and expertise, said Christina Jacobs, a breast imaging radiologist with the Bronson Advanced Radiology Services in Kalamazoo.
Jacob also practices at the Michigan State University-affiliated Bronson Methodist Hospital in Kalamazoo where she said surgeons prefer minimally invasive procedures.
She said about 30 to 40 percent of their patients test positive for cancer cells and that’s when they undergo surgical biopsies.
Jacob often encounters situations where patients fear that needle biopsies will spread cancer cells into their bloodstream.
“Needle biopsies have been done for 15 to 20 years in this country and nothing shows that there’s increasing spread of cancer cells in the body,” she said.
Cimmino said that most patients are more knowledgeable than in the past although the study recommends more efforts to educate women about their options.
“There’s a lot of information today available for women and they’re coming to us better informed about their options,”  he said.

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