This is a newly published systematic review of varying quality studies that were previously published — however, there is no new information here – something the story could have made clear. At leading breast centers the ‘best practice’ is to get a breast cancer diagnosis without open surgery, and usually via a core needle biopsy (CNB), but that practice has not been adopted everywhere, sometimes because of the machines (image guided bioppsy) that are needed to complete these types of biopsies are not available, or because breast surgeons are involved in care so they just remove a suspicious mass with a surgical biopsy.
Women should know that there are different types of breast biopsies following an abnormal mammogram. Core needle biospy (CNB) is less invasive and leaves less scaring that a surgical biopsy. There is also less chance of post-surgical infection with core needle v. surgical biopsy. The story here alludes to fewer complication with CNB v. surgery, dind’t explain what the side effects are.
Both methods appear to be accurate for detecting cancerous v. non-cancerous breast cells. The majority of women who are referred for breast biopsy do not have malignant lesions and do not require follow-up treatment, so the fewer surgical procedures a woman undergoes following an abnormal mammogram, the better. CNB may allow many women who are diagnosed with breast cancer to reduce the number of surgical procedures that they must undergo during treatment.
The real nitty gritty information that a woman would want from such a story was missing: quality of the evidence, data on false positives and false negatives, explanation of potential harms.
The story does not mention the individual or general health care cost of the different types of biopsies, or if the core needle biopsy guided by x-rays or ultrasound will ultimately cost less than surgical biopsy. The story also was silent on (unaware of?) the big tug of war between surgeons (who get paid for open biopsies) and radiologists (who get paid for the stereotactic biopsies).
The story does not compare the specificity of core needle biopsy v. surgical biopsy for accurately diagnosing breast cancer. The story does not mention that evidence from the recent analysis was for women with average risk of developing breast cancer. For women at higher risk, the accuracy may be different.
The story mentions "complications" and "side effects" but does not discuss exactly what these include with either procedure. Surgical biospy is more invasive and risks include infection, scars and slower wound healing compared with CNB. Women who have CNB and are diagnosed with breast cancer have fewer surgeries than women diagnosed via surgical biopsy. Women at higher risk of developing breast cancer (genetic factors, prior pre-cancerous lesions or biopsies, older age) may feel more confident of their results via surgical biopsy v. CNB.
The story provides little evidence from the source article in the Annals of Internal Medicine. The story does not provide data comparing false positives or false negatives with either procedure. The story does provide data comparing the rate of complications with each procedure. The story also does not mention the generally low quality of the studies in the meta analysis, but the focus is instead on the quanitiy of studies– 80 studies in this case– and few if any were high quality.
The story does not engage in disease mongering. The story discusses recent analysis that women may be able to avoid surgical biopsies in lieu of core needle biospies for diagnosis of breast cancer. The story appropriately notes that many women who undergo a biopsy following an abnormal mammogram do not have breast cancer.
The story has only one source who is a lead author of the study on which the story is based. It is not made explicit in the story that she is involved in the study. The story should include additional independent clinical sources to put the new information in perspective. An interview with an independent expert could help provide information on availability of various methods of CNB and their real world accuracy (e.g. are most surgeons adequately trained to perform core needle biopsies?).
The focus of the story is a recent meta-analysis that adds to a body of evidence sugesting core needle biopsies are as accurate and less risky compared with surgical open biopsies for diagnosing breast cancer. Since the focus of the story was less invasive methods of biopsy, it would have been good to describe the different kinds of core needle biopsies, as well as fine needle aspiration, which is even less invasive than the core biopsy and can be used for palpable masses. Nonethless, we’ll give the story the benefit of the doubt on this criterion.
The story does not mention if all hospitals offer women core needle biopsy as an option prior to, or instead of open surgical biopsy. We are not told if recent evidence has affected clinical guidelines for suggested biopsies following an abnormal mammogram. We are not told that some women may not be appropriate candidates for core needle biopsies. The article notes: The location and type of lesion, as well as other medical considerations, sometimes dictate the type of biopsy, but in many cases patient preference is the most important factor in the decision.
Only by back-door inference (the fact that 80 studies have been done) does the reader get any sense that core needle biopsy is not new. Many treatment centers have offered this to average-risk women as an alternative to surgical biopsy for some time. The story mentions that some are hesitant to adopt it, although it is widely used and considered a "best practice" and first line biopsy option of many average risk women. We’ll give the story the benefit of the doubt on this criterion.
It is difficult to tell if this story is generated directly from a news release, especially since the lead study author is the only source cited.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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