stereotactic biopsy - risks

jeancmici

I've often wondered if this didn't cause a spread during the weeks before the lumpectomy. The lump was large enough to do without the guided x-ray - I sat up - and the mammogram clearly showed cancer before the biopsy. In fact before the radiologist opened her mouth, I said: My God, I have cancer and she replied: I'm afraid so.

Finally found this on the web. I hate to open a can of worms but I am wondering who had the stereotactic biopsy instead of the 'old-fashioned' excisional ( more expensive too!) and if you have the new method which is cheaper - ho-ho for modern science- did you have a recurrence.?

"Standard core biopsies require several needle insertions. There is some concern that if a cancerous mass is present, cancer cells might be displaced and spread, but whether this actually happens is not known and it does not appear to be clinically significant. "

Wondering,
Jean

elizagain

Well, here's what I think, fresh from my recent expereince. I just was diagnosed with a second primary cancer in the left breast. The mammograms showed calcifations, and the surgeon said it looked like DCIS. But after the core biopsy where they took 9 different bits of tissue, it looked like there was some invasion. Now, my nodes are 0 and my bone and cat scans are negative. However, based on this "invasion" I might need Taxol. Needless to say, I am wondering how, after going for mammograms every 6 months, I went from all clear to invasive ductal carcinoma. My very thought was that the invasion appeared due to the biopsy.

inkblot

Hi Jean:

Good to hear from you here! Opening cans of worms is a good thing actually, particularly when it can save someone else potential pain or difficulty.

There is often references in medical journals,
professional websites and other publications, which try to open cans of worms...that even excisional surgery may be suspect in "spreading" cancers. A lot to think about for sure. However, no one seems to know or can yet devise any method(s) for testing to know why or by what mechanism cancer recurs or mets. The thought is that cells can hide out in the body and remain dormant for many months or even many years and suddenly begin to grow again or never grow at all. That said, do renegade cancer cells get into the blood stream via procedures, such as biopsies/surgeries or did they get into the blood stream long before diagnosis even, via lymph? Considering the cells do survive in some cases, then how so, if one had chemo, rads or both, post surgery?

Clearly, chemo/rads don't always net the desired effect but something we hope for as we endure those atrocious treatments.

In other articles, much is postulated that in many cases of breast cancer, surgery alone is actually believed to be "curative", although one may still be advised to undergo chemo/rads, per pathology. Again, no one knows or can demonstrate whether that postulation is correct in any cases at all and doctor's are not willing to say that surgery alone took care of it. They can "think" maybe it did but have no way to know.
Since we're all biologically different, two of us with the same dx and path, may have different future events or none at all. That's why statistics don't mean a lot to any one individual, in most cases. Many survive mets and recurrence. Why not everyone? No one can answer that for us. It's part of the mystery and frustration of cancer. Many questions and few solid answers.

In cases where women have elected to have mastectomy, when lumpectomy may have been advised/offered, bc can still survive and sometimes returns in the minute amount of breast tissue which remains, even following radicals. Mets also occur in mastectomies. How? Since current mast. methods cannot possibly remove all breast tissue, there are no guarantees, by removal of the breast. Again, there is no way to know if and whether any cancer cells will survive and whether they will begin to grow again if they do, for any one individual.

I had fine needle aspiration biopsy. One needle was injected into the tumor, once. Later,lumpectomy. In my own logic, it seems a possibility that even fine needle could potentially serve to disturb and release cells, upon withdrawal of the needle, out through the tissue. My tumor wasn't deep but even being close to the surface, I think the chances of spreading cells by that method could still exist. It is not something I dwell on though as there is no point. However, taking that thought one step further, since I had chemo and rads, did that serve to destory any and all potentially released cells, post surgery? No way to know. Or did other cells travel before I even knew I had bc? Anyone's guess is the logical answer.
No way to know. I could have recurrence or mets, next year or 20 years from now or never, but no one will be able to tell me why or why not. So it's a moot point for me.

The bottom line, in my opinion, is that DETECTION
just isn't there yet. No way to find a single or group of cancer cells that may survive in our bodies, post surgery and treatment(s). Not even a reliable way to know if we're developing a met or recurrence, until there is a lump or symptoms to point the docs in the right direction for investigation. Tumor markers are not reliable indicators yet. Mammo's, Bone scans and MRI's, etc. can miss a newly developing cancer, until it's large enough to pick up, until it is palpable or produces symptoms. In most cases of DCIS, it isn't palpable and so, relying on mammo's/pets and careful self exams, is all we have.

Perhaps one day, better technology will be developed which can tell us if we have any cancer cells in our bodies, long before they can organise and begin to grow, whether we have a cancer history or not. Until that time, we do the best we can with what we have to work with, even though that often seems too little, too vague or too risky.

More focus is needed within the medical community and cancer support organisations, on PREVENTION and BETTER, EARLIER DETECTION. That old adage about: An ounce of prevention being worth a pound of cure, still stands, I think. Until our environment is less toxic, our food supply less contaminated, our air cleaner and our water safer, it's very difficult to try to maintain the healthiest lifestyles, keeping our bodies more prepared and able to fend off diseases such as cancer. Some supplements help, I believe, but they cannot undo the cumulative daily damage we encounter, just by living, eating and breathing. I totally and firmly believe that. We do much to poison ourselves daily, thanks to our government's lenient guidelines and commerical industies' greed for greater profit, etc.. Which is a whole 'nother can of worms!

Jean, you did all you could do at the time of your dx. Just like the rest of us, you got informed and made your best decisions. Many of us gain some info which, in hindsight, may have led us differently, but that goes with the territory, because full disclosure is not something those diagnosing us or the scientific community is want to share with us. Sometimes, it isn't even something they are aware of and if so, may discount it. On the contrary, they even take pains to minimize certain issues, when they can get away with it. It's a fine line they walk and I wouldn't want to be in their shoes for one minute. There's a lot of lattitude in what they choose to tell us and what they choose not to. It would be good for everyone, I believe, if that weren't the case and they'd be obligated to tell us everything up front. But TIME IS MONEY, so that isn't going to happen. So, we're back to researching, studying, sharing info, talking with experts and survivors and investigating on our own. We're our own best advocates and that's our lot. Discovery of certain facts, conjectures, studies, etc. often come to us from searching and sharing, not from our doctor's mouth's. They may elaborate, once we bring it up, but most don't bother enlightening us, otherwise. They take care of the obligatory minimum, with "consent to treat" forms and that's pretty much that.

Just my thoughts at this time, about stereo. bio. and many other procedures/tests and their inherrent/potential risks, known, unknown and/or suspected.

Take good care of you, girl!

Love, light and light,
Ink

judiek

Jean,

So good to see you post...how are you doing. I just about sent you an email over the weekend. Hope your feeling much better.

Warmly,

Judie

Watercolor

I've had a few biopsies. My experience. Had a suspicious microcalcification cluster in the left breast. Did not want a surgical biopsy, so in October '97 had stereotactic core biopsy. Negative results, but I realized those weren't definitive results. Continued to watch the cluster with semi-annual mammos. In October '02, the cluster had changed. Had Mammatome biopsy. This time -- DCIS / stage 0. I believe both biopsies were on the same cluster / tumor (?). Lumpectomy, radiation, on Tamoxifen. I'm fine.

I did ask someone recently (don't remember who) about cancer cells being "set free" during biopsy. Didn't really get an answer. My Van Nuys score was 8-9 so accounts for radiation treatments being reccomended which hopefully, and I expect, got all the cancer cells. Mary D.

PeggyMurphy

Sure it speads cancer cells. 

Sure it speads cancer cells.  Its written now in all the nih.gov and other medical websites.  We should get the MRI guided biopsy with the contrast dye to see the arteries.  Did you see me post on how they spread malignant cells in my breast for a 1.1 cm early tumor?  Now I have to get a mastecomy!