[AlaskaAngel]

Thank all of you who took the time to respond to the poll and the questions involved with this situation.

When I originally posted the 2 threads about it, I thought that I might simply not be clearly understanding the rationale of the breast cancer center in scheduling my relative for a stereotactic breast biopsy based on the second-hand information that I had, or that maybe there had been some legitimate change in the basis for the sequence of events normally used for biopsies. I don't claim to be an expert about the latest and greatest and to me that meant I needed to see what others might be seeing elsewhere in the world, but I am reasonably knowledgeable.

I remain concerned. The breast care center is where the patient was referred by her HMO. The concern I have is for those like this woman, who at age 48 had never had an abnormal mammo and has no knowledge as to what is standard practice for her situation. She is dependent upon her medical providers, her own slow research at a time of crisis, and her friends and family for guidance.

A mammogram and mammogram report are intended to provide the initial analysis by a professional radiologist for her PCP to help in making further decisions. This mammogram was designated as BI-RADS 4b and that is a recommendation for consideration of biopsy rather than "wait-and-see" if anything else develops in the short future. Normally in my experience the BI-RADS 4 level is not assigned unless the radiologist has either seen and mentioned clear evidence for it in the report or has done additional imaging that brought out additional supporting evidence for a reasonable need for a biopsy. The information given in the mammo report was more at the level of what one would see in a BI-RADS 3 level designation, so I questioned it. The fact that the radiologist had also specified the type of biopsy raised concern for me, as that in itself infers that neither the PCP nor the patient should authorize any other type of biopsy. That, to me, is highly questionable. A patient should always have the full range of options open and explained fully to her, whether she elects to have no biopsy, a fine needle biopsy, a core biopsy, a stereotactic biopsy, or an excisional biopsy. If there is a very specific reason why a stereotactic biopsy is preferred, it should be clearly so indicated on the mammographic report, and there was no such indication on her report.

Some here feel the need for the earliest possible confirmation by biopsy, and may not understand why the step-by-step approach is so important. But what I think is at stake here is the rush to sacrifice logic and patient choice for expediency and/or cost.

I consulted an online specialist, who confirmed both that a biopsy was needed (because that is the only way to definitively determine what the cells are doing), but also said that further preliminary imaging is important" "ultrasound & MRI scans NOT ONLY to find other ways of doing biopsies but ALSO to gain more information of/from the mass" prior to biopsy. Also, additional imaging can provide further information about any other questionable mass that simply hasn't shown up on the mammogram by calcification. Mammograms are usually the first step not because they do such a great job, but because they are inexpensive enough to reach the most patients for screening purposes.

The vast majority of biopsies show no cancer. At this point after considering this issue, I don't believe it is standard practice to biopsy immediately all patients based on mammographic clustering of coarse calcifications and patient history alone. I also believe that the specific recommendation of a stereotactic biopsy without any clear supporting reason for that particular type of biopsy is ethically problematic. I think going along with these practices does not protect the rights of the patients -- OUR rights and those of others.

Again, thank you all for taking your time to consider this issue.

AlaskaAngel