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Norris Cotton Cancer Center Applauds Breast Biopsy Editorial

The Comprehensive Breast Program's policy advocates percutaneous biopsy.

February 25, 2011
Lebanon, NH

The Comprehensive Breast Program at Dartmouth-Hitchcock Norris Cotton Cancer Center is pleased to see the editorial published in the New York Times February 24, 2011, encouraging women to get a second opinion when they are told by their doctor that they need surgery to determine if cancer is present following an abnormal mammogram.

Unnecessary surgeries following an abnormal mammogram cause anxiety and scarring in patients and add expense to an already burdened health care system, points out Kari Rosencranz, MD, Medical Director of the Comprehensive Breast Program. "While there are rare cases where a radiologic biopsy is not obtainable and surgical biopsy is necessary, it has been our policy at Dartmouth-Hitchcock Medical Center (DHMC) for many years to diagnose mammographic abnormalities with a percutanous biopsy (using a needle through the skin)," she said. "We would encourage any patients who are recommended to have a surgical biopsy to question their providers and/or to obtain a second opinion from a comprehensive breast center."

The editorial follows a report in the Times on a study in Florida, published earlier this month in the Journal of American Surgery, that found 30 percent of the breast biopsies performed in the state from 2003 to 2008 were surgical. According to medical guidelines, the rate should be much lower – national organizations, including the American Society of Breast Surgeons, advocate an excisional (surgical) biopsy rate of five percent or less. "The figures in the rest of the country are likely to be similar to Florida's, researchers say, which would translate to more than 300,000 women a year having unnecessary surgery, at a cost of hundreds of millions of dollars," the newspaper reported. "Many of these women do not even have cancer: about 80 percent of breast biopsies are benign."

Research conducted by Steve Poplack, MD, co-director of the Breast Imaging/Mammography Program at the Cancer Center and DHMC, in 2005 and based on nearly 100,000 mammography screenings conducted in New Hampshire in 1996-2000, found that three percent of women required biopsy, with 76 percent of the biopsies resulting in benign findings. The types of biopsy were 57 percent percutaneous and 43 percent excisional. The research article, published in the journal Radiology, concluded that the findings "show that significant cost savings could be achieved by performing a larger percentage of percutaneous biopsy procedures…"

"The new health care reform should begin to rein in excessive, unnecessary procedures. It has economic incentives for hospitals and doctors to join forces to manage a patient's care in the most medically appropriate, cost-effective way possible," the Times opined. "The numbers could be reduced right now if hospitals were to ban surgical biopsies where a needle biopsy would suffice – and if patients were to demand a second opinion before submitting to a surgical biopsy."

About Dartmouth-Hitchcock Norris Cotton Cancer Center
Norris Cotton Cancer Center combines advanced cancer research at Dartmouth College and Dartmouth Medical School with patient-centered cancer care provided at Dartmouth-Hitchcock Medical Center, at Dartmouth-Hitchcock regional locations in Manchester and Keene, NH, and St. Johnsbury, VT, and at 11 partner hospitals throughout New Hampshire and Vermont. It is recognized by the National Cancer Institute as one of just 40 Comprehensive Cancer Centers in the U.S. Learn more about Norris Cotton Cancer Center research, programs, and clinical trials online at cancer.dartmouth.edu

For more information contact Steve Bjerklie at (603) 653-9056.

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