KANSAS CITY, Kan. - One of a woman’s scariest moments should not be more expensive and painful than it has to be, but an NBC Action News investigation found thousands of women are going under the knife to detect breast cancer when a safer, cheaper and equally reliable option is available.
If something abnormal appears during a mammogram, the next step is to get a biopsy to see if it is cancerous. Medical guidelines say the procedure should rarely require surgery.
However, statistics show that is far from the case. And one of the biggest reasons could be money.
Is money the motive for too many surgeries?
Dr. Marc Inciardi, a radiologist at the University of Kansas Hospital , has been performing needle biopsies since 1991. Back then, surgical biopsies were seen as the preferred method to test for breast cancer.
Over the years as technology has improved and the needle biopsy has become the new standard of patient care.
“It is much less costly. It’s quick. And it’s proven to be just as accurate,” Inciardi said.
The needle procedure also takes less time to heal and leaves a much smaller scar. The majority of biopsies are benign, but if the tumor turns out to be cancerous, it also eliminates the possibility of a patient having two operations instead of just one.
So why do studies show too many women are still having surgical biopsies? Doctors like Inciardi believe one of the reasons is money.
Surgeons who are not trained to performed needle biopsies would have to refer patients to radiologists, thus losing the income from that operation. In other words, it can be a medical turf battle.
“I hate to rain on my surgical colleagues, but it’s probably a combination of dollars and cents at times,” said Inciardi. “Perhaps, it’s also not being fully educated about the latest research and what the standard of care really is.”
Studies show surgical biopsies still too common
According to the National Cancer Data Base (NCDB), needle biopsies should be performed at least 90 percent of the time.
There are a few situations where a surgical biopsy is recommended. For instance, if the patient’s abnormality is located too close to the chest wall.
But a recently published study by NCDB found nobody is hitting the biopsy benchmark. In the Midwest region—which includes Missouri and Kansas—the needle biopsy rate was about 84 percent. Several regions scored worse.
“We’ve come a long way, but still have room for improvement,” said Dr. Richelle Williams, one of the study’s lead authors. “It’s possible that money plays a role in the data. We speculate that’s happening, but there was no way to confirm.”
Another study conducted in Florida really turned heads when it found 30 percent of breast biopsies were surgical, the first analysis to include patients with and without cancer (the NCDB data only has biopsies that were cancerous).
The Florida study concluded its findings translate to hundreds of thousands of women having unnecessary operations at a cost of hundreds of millions of dollars. Hospitals charge up to $6,000 for a needle biopsy, but a surgical biopsy can have a price tag of $12,000.
What questions should you ask your doctor?
Dr. John Shook is a long-time breast surgeon at Saint Luke’s Hospital of Kansas City . While Shook is trained to perform both biopsy procedures, he is aware of the hypothesis that some of his surgical colleagues are reluctant to pass up the fee from a surgical biopsy.
“Everyone is kind of embarrassed to think it’s a financially-motivated procedure,” said Shook. “We’d like to think that is not the case, but maybe it is.”
Studies revealed one strong indicator connected to money: poorer, underinsured patients had a higher percentage of needle biopsies; wealthier patients with good insurance tended to have surgery.
Shook said if a patient’s doctor initially recommends a surgical biopsy, there should be a good explanation.
“My first question would be, ‘Why?’ Patients need to be aware there are other options,” Shook said.
If the surgeon cannot provide a legitimate reason, it might be time for a second opinion. On the flip side, Shook said doctors often have the responsibility to convince patients a needle biopsy is the best option because some people still have the perception that the surgical method is more accurate.
The good news is the rate is trending in the right direction. The NCDB study’s analysis of biopsies in 2003 thru 2008 showed a steady tick upward in the number of needle biopsies.
“We are telling all of our accredited hospitals that this is something we will be keeping an eye on,” said Williams.
Will insurance companies get involved?
Dr. Shook wondered if insurance companies will begin requiring some kind of pre-authorization process before a surgical biopsy is approved, considering the added cost.
Dr. Inciardi also felt it is something insurance companies should take a closer look at, but added, "I gave a long time ago trying to predict what they will do."
Sue Johnson, a spokeswoman for BlueCross