Biopsies after Breast Cancer

By Jane Farrell

In an analysis of more than 120,000 women diagnosed with and treated for early-stage breast cancer, researchers from The University of Texas MD Anderson Cancer Center have determined the rate of additional breast biopsies needed for these patients during follow-up care.

The findings were reported in JAMA Surgery.

“The important message is that the rate of biopsy for patients is relatively low, and the overwhelming majority of the biopsy results will be benign and not require further treatment,” said Henry Kuerer, M.D., Ph.D., the study’s corresponding author.

This is the first comprehensive nationwide population-based study regarding the need for breast biopsies performed during follow-up after treatment for invasive breast cancer. According to the American Cancer Society, 252,710 women will be diagnosed with breast cancer in 2017, and of those, 63,410 will have early-stage disease.

“This is a genuine concern for patients. Many feel very anxious over the future need for biopsies and the potential of another diagnosis,” Kuerer said in a news release from MD Anderson. “Women will often choose a mastectomy rather than have the fear and stress associated with future biopsies or another cancer diagnosis.”

To gather information that could shed light on the need for follow-up biopsies, the researchers analyzed two national databases. They looked at 41,510 breast cancer patients in MarketScan (the national database of patients with private insurance, age 64 years and younger), and 80,369 breast cancer patients in SEER-Medicare (patients age 65 years and older). All had Stage I – III disease and were diagnosed between 2000 and 2011. Diagnosis and procedural codes were used to identify biopsy rates during follow-up.

Five- and 10-year overall incidence of breast biopsy was 14.7 percent and 23.4 percent, respectively, in the MarketScan cohort, and 11.8 percent and 14.9 percent, respectively, in the SEER-Medicare cohort.

Of note, say the researchers, the five-year incidence of breast biopsy was higher in women treated with brachytherapy (a targeted radiation), compared with those treated with whole-breast radiation: 16.7 percent in the MarketScan cohort and 15.1 in the SEER-Medicare cohort. Also, after a mastectomy in one breast, the estimated five-year breast biopsy rates for the other breast were 10.4 and 7.8 in the MarketScan and SEER-Medicare cohorts, respectively.

Of the patients who underwent a breast biopsy, 29.8 percent in the MarketScan cohort and 23.2 in the SEER-Medicare cohort underwent subsequent cancer treatment.

Kuerer noted that the study has some limits, including that it is based on claims data. Also, he and his colleagues noted that both imaging and targeted therapy treatment for early-stage breast cancer may have improved since 2011, when the study concluded.

Still, Kuerer said, the research addresses an important issue that will allow surgeons to have more meaningful conversations with their patients.