Spread of BC through delay and biopsy procedure

[CLTann]

Dear Friends,

I would like to address a very important issue that has been in our mind ( I am sure) but the medical community refuses to admit its importance, without sound scientific evidence.

The issue is that all cancer cells divide and multiply, in geometric proportion. By common sense, you all know that without intervention these bad cells are growing and growing. Therefore, time is undeniably a factor to arrest the growth. However, the medical community is united in defending its practice of putting patients appointments/treatments with no urgency, only for their convenience of scheduling. For instance, Saturdays and Sundays are never working days for them, as if cancer cells would not divide on those days.

Furthermore, in the biopsy process, the procedure punctures the tumor walls, thus physically causes the spread of millions of cancer cells to the adjacent areas. Some of these stray cells can easily travel through lymph or blood vessels to distant parts of the body. The core biopsy is obviously worse than the needle biopsy. Again, medical community hides under a blanket denial that the procedure of biopsy is not harmful in spreading cancer. That denial is again unscientific and without proof.

It is time for us to demand that doctors should be more responsive to us and make dates of treatment on a more urgent basis. Path reports can be made available within hours, rather then days. Doctors time are precious, but so are the life of their patients. A responsible medical community should not take the delay with the attitude of "you need me more than I need you". Just like hurricane and earth quake, cancers do not recognize weekends, nights and days.

Another separate issue: the high mortality rate of hospital stay. Statistics are plentiful to show the mere stay in hospital would increase the average patients prognosis (in all cases, not limited to cancer patients) to worsen by more than 35% in mortality rate. It is time for hospitals to make a thorough study in how to remedy this problem.

Ann

[mamacze]

Dear Ann,
It sounds like you have had some pretty bad experiences. It seems like you have been frustrated with lengthy delay of appointments and path reports. I am sorry for this and can understand your anger.
On the other hand; some of us have had positive experiences. I insisted on and received prompt medical treatment and followup care. My physicians have gone out of their way to be responsive and supportive. They all are looking out for my well being. I still have one physician sending me regular notes of support. The doctors in Seattle are also incredibly good and supportive.
Perhaps you need to look for another physician or hospital for treatment? If you feel free to say where you live, perhaps some of your sisters here can give you a recommendation?
Love Kim from CT

[Alice]

Hi,
I'm sorry to hear that you are having so much trouble with the "system".
The first Dr. I started with was good about ordering tests quickly but the facilities in my area are so swamped he and I were both frustrated.
Even though I liked him as a Dr. I knew I would continue to run into this throught the process unless I changed.
I quickly found a new Dr. in a different area and yes I have a commute for apointments and treatment but the Dr.s I have now are very willing and capable of getting things done quickly and they insist on it. All it usually takes is a phone call.I am very fortunate to have this team on my side they are also willing to go the distance with my insurance concidering the Dr.s and facility are not contracted.
Sometimes I have a wait when I get to my apointment but my Dr. always takes as much time with me as I need and I don't ever feel as though I'm getting the rush treatment.Whenever I do have to wait I think they are just taking the necessary time with another patient who is just as scared as I am.
As far as weekends are concerned they are human too and need time to revitalize. Most of the Dr.s I'm involved with spend much more time and dedication to their "job" than I would ever concider doing for mine.I know there are Dr.s out there that have become harsh and uncareing I hope if this is your case you are able to change Dr.s.
I cannot speak to your comment on the problems with biopsies. I'm not aware of any other way to sample tissue therefor reducing needless surgeries.If they didn't do biopsies would they go straight into surgery to remove the tissue?
If so what if it was unnecessary?
Good luck to you and I hope your experience will improve!
(pardon the spelling)
Alice

[Lyn]

From my experiences I have to agree with you, as soon as I have had a biopsy the tumour/lump grows, the first tripled in a week to the size of an orange, I proved this point with my last biopsy, I started myself on Xeloda 1 week before my biopsy, I knew when I was to have it so I was on it for a week before, as expected the lump did not increase in size or get out of control like my others. I mentioned this to a fill in onc and he agreed it was something worth thinking about, I said considering the fact it was just take a pill for a time before hand there can't be any harm, lets face it how many people have been given chemo when they didn't even have C, so I don't see the harm in being careful.



Love & Hugs Lyn

[CLTann]

Sisters,

After my posting of the message on this thread, I received two comments suggesting that I probably got mistreated in my local facilities and was just venting my frustration. The truth is that I have not been mistreated. But I work in the major hospital in my area and I have observed the attitude of the medical staff, particularly to the breast cancer patients. For a person being paid more than the President of the United States, the doctor is expected to the attentive to the needs of the patients. Don't treat the doctor as a god, he or she is doing the professional job the public expects him or her to do. Having said the above, there are plenty rooms for improvement they can make. Since their patients are never outspoken, they just took advantage of our silence. Long waiting to see a doctor is our American culture now.

As to the spread of cancer from biopsy trauma, no research is done to see how the procedure can be improved. People know that an alcohol wipe before and after an injection is a normal procedure to prevent germ from entering the body. There must be ways to plug up the wound caused from the biopsy trauma. In the case of biopsying DCIS, by opening up the ductal wall in sampling, the DCIS cells now find an easy way out to become invasive ductal cancers without even trying to penetrate the ductal walls by themselves. Since this type of research is not monetary rewarding nor headline attracting, no money is spent to improve upon the procedure.

By raising these important issues, I hope that in a small way I can make a contribution to the public health care system.

[Montana]

I have researched a little info on "tumor seeding":

http://www.ikp.unibe.ch/lab2/Seeding.html
Tumor seeding after fine needle puncture or biopsy of hepatic lesions
Prof. Dr. med. J. Reichen

• Tumor seeding after both, conventional biopsy and fine needle puncture does occur and can negate the benefits of subsequent surgery. A nice tabulation of case reports has recently been published (17).
• Tumor seeding is particularly high (12.5 %) after radiofrequency ablation of HCC (19).
• The incidence is approximately 0.5 - 2 % (6, 20). In a a recent series of 137 consecutive patients local excision was curative (20). However, in another review of cases of HCC, an incidence of 5.1 % - leading to major surgery - has been reported (18).
• Measures have been advocated to avoid tumor seeding (9) but most authors feel that neither biopsy nor FNP is warranted when the lesion is deemed to be resectable (7, 8, 11).
• Recently, tumor seeding has also been described after percutaneous ethanol injection (16, 18).
• My personal opinion is that biopsy or FNP should only be performed by radiologists or internists after discussion of the case with a hepatobiliary surgeon.

=========================
Other links with reports of tumor seeding:
Malignant seeding of the needle track during stereotaxic core needle breast biopsy

LP Harter, JS Curtis, G Ponto and PH Craig
Breast Care Center, Goleta Valley Community Hospital, Santa Barbara, CA 93111.

Early reports demonstrated the diagnostic advantage of large-core (14- gauge) biopsy over fine-needle aspiration biopsy of nonpalpable lesions of the breast without apparent significant increase in morbidity. A case of malignant seeding of the needle track after a large-core biopsy of a mucinous carcinoma of the breast is documented. The potential for increased risk of tract seeding of malignancy must be considered.
http://radiology.rsnajnls.org/cgi/co...ract/185/3/713


http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstract


http://radiology.rsnajnls.org/cgi/co...ract/178/1/253

http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstract

http://www.karlloren.com/biopsy/p28.htm

There are many more links if you google

[lu ann]

This could be the reason my tumor spread to stage 4. I found the lump in my breast July 1991 when my infant daughter was 4 months old. I had fine needle biopsy Aug. 1st, biopsy Sept. 26, lumpectomy Oct.7, finally mastectomy, because they could not get clear margins, November 1. Follow up with chemo, but no radiation. Blessings, Lu Ann.

[AlaskaAngel]

I started out by seeing a fully qualified and licensed surgeon here thinking that really meant something. (But then, I take my own job seriously and expect a lot from myself.) The surgeon urned out to be a reasonably nice person, but one that didn't follow up on her promise to get back to me after she compared the ultrasound done in her office with the one just done a day or so prior by a competent radiologist at the hospital... Long story short, my insurance paid for 5 ultrasounds total (2 by the surgeon, 3 more by 3 separate radiologists, all of whom repeatedly recommended biopsy). When I called the surgeon she was "out of town" (was it Paris? Or just London?) Anyway, when she finally returned my call she argued with me saying that "we" had decided not to biopsy. I could not figure out where she was coming from, and there is only one surgery clinic within hundreds of miles here. I forced the issue by ordering the third ultrasound, which it took over a month to then get in the only facility we have here.

When she did biopsy, she found it difficult due to dense breasts and had a hard time not pushing the visible "lump" around instead of obtaining the core biopsy. So she decided to attempt it from the other side of the breast near the sternum. She gave that up after a couple of attempts and went back to a more direct approach. Eventually she obtained a marginal core biopsy sample.

Ever since the "biopsy" (if that indeed is what it was, considering the process involved) I have had neuropathic pain from the alternate site near the breastbone, for which I take a pain medication.

I then chose to have my surgery done at a major cancer care facility in the Lower 48 by someone that I consider to be a real surgeon.

I am 3 years out, and perhaps the blast of CAF plus rads plus hormonal treatment has protected me so far in terms of seeding. But cancers can take years to grow. If our medical schools and medical licensing boards and physician colleagues who refer patients to surgeons can't tell whether a surgeon is skillful and qualified to minimize any seeding by FNA or core biopsy, then I have to lean toward agreeing with Ann.

AlaskaAngel

[CLTann]

Thanks for the last three postings on this important matter. I found several "needle track" threads indicating that indeed cancer cells can spread from the biopsy procedure. I say again that there must be a safer way to handle the biopsy. Some articles on this subject say that the chance of recurrence of cancer due to needle track can be around 5%. Of course, this is the chance we are willing to get by doing chemo and other treatments, gaining just the 5%.

We should not take the bad attitude and incompetence lying down. Of course, way out in Alaska, you just don't have much choice. The doctor knows that too, thus the bad practice goes on and on.

I sure hope that there is a better way to deal with the unfortunate situations.

[Cathya]

A nurse friend of mine is married to a doctor and when she discovered a lump in her breast her husband and his friends had the biopsy done with a special needle that prevents cancerous cells from escaping during the procedure. As an aside, I cannot imagine how this is even possible but this is what I was told by her. I believe it is a needle within a needle. Unfortunately somehow the results of her biopsy were erroneous and she was misdiagnosed. Perhaps the procedure is new and the tumor was actually missed, I really don't know. In any case, she was another long period of time before they realized that her lump was cancerous.

Cathy

[AlaskaAngel]

You can elect to have an excisional biopsy instead, although it generally isn't offered and most of us don't know that at time of biopsy. If you have lumpy breasts and have more than 1 or 2 biopsies, or very small breasts, it might be disfiguring to do that. If I need another breast biopsy, I would go for the excisional biopsy.

Alaska has its drawbacks -- but UCLA produced the surgeon in question, with residency performed at Stanford.... We like to THINK that qualifying at prominent institutions actually means something...

[RhondaH]

to prevent the spread. I had an excisional biopsy on 2/1/05 (right off the bat rather than a needle biopsy, my surgeon asked me if I would like it removed rather than biopsied and I said "YES" as I didn't want something "foreign" in me, cancer or no cancer) 2/7/05 I had a partial mastectomy (my surgeon RESCHEDULED another procedure he had on this day so that I wouldn't have to wait) and all my margins and nodes were negative. I began chemotherapy (dose dense TEC- Taxotere, Epirubicin and Cytoxan) on 3/10/05 (finished on 5/18/05) and finished 33 rads on 8/1/05. Began Herceptin every 3 weeks on 8/18/05. I've read were some people w/ similar dx and treatment like me began BEFORE me and were still not completed. I feel VERY lucky for the treatment I've had/have.

[mts]

If only there was a method to extract the entire tumor without having a biopsy... that would be great. I can't help but feel however that medicine is still quite primitive.

If the most competent, renowned, pioneering surgical oncologist provided a biopsy and some cancer spread we all would say, "this is common and expected". If a so-so surgical onc did the procedure and the cancer spread, then we would say "what a lousy doctor".

As long as we have poison (a.k.a., chemotherapy) and radiation and surgery, cancer treatment probably won't improve in the biopsy part of it for some while.

Maria