Sunday, March 20, 2011

Unneccesary Breast Biopsies: Needle Biopsies vs Scalpels

This is a family blog. At times, I have had to expunge comments for inappropriate content. My criteria for comment eradication include:

  • Raw language
  • Personal attacks
  • Overt commercial objectives
There was a time in my lifetime when breasts were considered an inappropriate topic in public discourse. You never saw Little Ricky suckling his mother’s milk on I Love Lucy. These days, of course, breast references and actual images are chic and ubiquitous. Relax, parents. The remainder of this post will remain family-friendly, so there is no need for you to consult your 14-year-old on how to implement parental controls on your computer.

Here are 3 recent breaking breast developments that all inquiring minds will want to be abreast of.

  • Landmark medical study concluding that many women with breast cancer do not need to undergo pain and expense of removing lymph nodes. They do just as well if their nodes are not disturbed. Why does this matter? See prior landmark Whistleblower post.
  • U.S Representative Michelle Bachmann (R-Minn) pushed back at First Lady Michelle Obama’s promotion of breast feeding, in a proposal to make breast pumps tax deductible. In Bachmann’s words, “I’ve given birth to five babies and I breastfed every single one of these babies. To think that government has to go out and buy my breast pump for my babies. You wanna talk about the nanny state? I think we just got the new definition of a nanny.”
  • New study of breast biopsies concludes that physicians have been performing surgical biopsies of breast lesions excessively, instead of using a less invasive needle biopsy technique.
Why does this matter? If the new study is correct, then benefits to women and the rest of us include:

  • Hundreds of thousands of women would be spared unnecessary surgery every year.
  • Hundreds of millions of dollars would be saved. Anyone out there think we could use this money in the health care system?
  • Fortunately, only a minority of women with breast lesions have cancer. For technical reasons, a surgical biopsy can make the definitive cancer surgery trickier than if needle biopsy were used.
The New York Times article also alleged that surgeons may be motivated to perform open surgical biopsies for personal gain, as needle biopsies are performed by radiologists. Could this be a turf issue? The article reports that employed surgeons performed open surgical biopsies in 10% of cases while their private practice colleagues did so in 35% of cases.  Was avarice at play here?  This Times was really 'milking' this explanation for the biopsy rate discrepancy.

All of these breast developments deserve to be supported. I celebrate any medical study that demonstrates that less medicine means more healing. With regard to the Bachmann-Obama duel, I think that Bachmann has a point. With our deficit and national debt rising beyond the stratosphere, is pumping taxpayer cash into breast pumps a national priority?

To the kids reading, who were hoping that this post would include some graphic and titillating images, I’m so sorry to disappoint you. If you are seeking carnal and prurient material, then just ask your Mom or Dad to take you to a PG-13 movie.

8 comments:

Elaine Schattner said...

Hi Michael,
I find it curious that you lump together three recent health news stories having to do with breasts. Just saying -

Anonymous said...

To tar and feather general surgeons for the performance of breast biopsies is a stretch. Yes, there are some who do pursue this and ignore other evidence.The practice of Medicine is rife with excess, several years ago Topol detailed the existence of the exaggerated oculostenotic reflex in interventional cardiologists. Did that stop the phenomenon?
Michelle Bachman may have some sense in her rant against breast pumps (never thought I would agree with her).
The solution to our expense dilemma is that the consumer realize the cost of the milk from the healthcare udder they are addicted to sucking on.

Michael Kirsch, M.D. said...

@Elaine, Your point? True I wrote 'em, but you read' em!

A. Bailey said...

Is 35% too much or is 10% not enough?

When I was in the Armed Forces we had an expression: "what this patient needs is a fee-for-service doctor". Such a patient was a poor soul with numerous comorbidities who needed a high-risk procedure. Why would a salaried doctor want to do a procedure on them "for free"?

So, is it possible that the salaried physicians in the above study are just a bunch of slackers?

Your fiberoptic colleague.

Mesothelioma Asbestos Attorney said...

Sometimes clients of lawyers are asking more that would essentially benefit them. But I would rather suggest that, there should only have fare perspective between the establishments and the clients; unless the lawyers will do so.

susan256 said...

Unnecessary treatments are way too pervasive in our country. Remember to ask your doctor lots of questions to prevent this. This gives some good tips: http://whatstherealcost.org/video.php?post=five-questions

Core Biopsy Gun said...

You made my day about the last part of your post, haha. It's true that test like this (for breast cancer) do not need to undergo pain and expense of removing lymph.

Breast biopsy said...

No surgery... how do possible?

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