Biopsies are a medical procedure most often used to diagnose and stage cancer. They also play a critical role in helping physicians determine the best treatment options for a patient’s specific disease. Yet many patients are not only reluctant to do a biopsy, in some cases, they’re refusing to do them. In this blog we’ll take a look at why patients are forgoing this important test and whether or not the science supports their decision.
During a fine needle aspiration biopsy, the doctor inserts a thin, hollow needle attached to a syringe into a suspected tumor and/or surrounding area(s) of concern and collects a small sample of tissue. Then a pathologist looks at the tissue under a microscope to make a diagnosis.
Where did the fear of biopsies come from?
Tumor seeding, or needle track seeding, as it’s also called, refers to cancer cells dislodging and spreading when the needle is inserted into a tumor during a biopsy. Several studies have confirmed that tumor seeding is an exceptionally rare occurrence, and the benefits of this procedure far outweigh the risks. However, tumor seeding gained significant attention following the publication of a book in 2012 by former urologist Ronald Wheeler. In his book he strongly denounced biopsies for men with prostate cancer, suggesting they will indeed cause a cancer to spread. However, his claims had no science to support them and, due to numerous complains of unethical medical practices, Ronald Wheeler was on the radar of the Sarasota Police Department’s Criminal Investigations Division. In early 2017, the state of Florida revoked Wheeler’s medical license, and later that year he was arrested for defrauding patients and practicing medicine without a license. But by then the message in his book had received widespread attention and promulgated fear amongst cancer patients.
What The Science Says:
- One study of 2000 patients at Mayo Clinic’s Florida facility demonstrated that pancreatic cancer patients who received a biopsy had a better outcome and longer survival than those who did not have a biopsy. This study was published in the January 9, 2015 online issue of Gut.
- In a study of prostate cancer patients, published in BJU International in 2015, researchers reviewed 26 studies and found that the incidence of needle track seeding was low – less than 1% – and concluded that the benefits of appropriate cancer diagnoses from biopsies outweigh any potential risks from seeding.
- In a 2015 study published in Gut, researchers looked at a database of 2,034 Medicare patients with pancreatic cancer and found that biopsies were not associated with an increased risk of dying.
- More recently, in a 2019 study in Urology, researchers found that the core needle biopsy technique was safe and effective in 42 patients with bladder cancer and that seeding did not occur after 28 months of follow-up.
These are just a few of the studies out there. It’s important to keep in mind that there are millions of biopsies done every year in the U.S. alone, and while it’s not impossible for needle seeding to occur during a biopsy, as you can see, research demonstrates that it is, indeed, a very rare occurrence.
Importantly, biopsies offer valuable information. Not only can they diagnosis a cancer, they can tell doctors how aggressive a cancer is or whether or not it has spread. This is essential to developing an appropriate treatment protocol. It’s also important to note that biopsies can also rule out cancer, preventing a patient from undergoing any unnecessary treatments or surgeries.