Breast Biopsy Intensity and Findings Following Breast Cancer Screening in Women With and Without a Personal History of Breast Cancer


Key Points

Question  What are biopsy rates and yield in the 90 days following screening among women with and without a personal history of breast cancer (PHBC)?

Findings  In this population-based cohort including 812 164 women undergoing screening (mammography vs magnetic resonance imaging [MRI] with or without mammography), there were 2-fold higher and 5-fold higher core and surgical biopsy rates following MRI compared with mammography among women with and without a PHBC, respectively, resulting in lower invasive cancer and ductal carcinoma in situ yield for both groups.

Meaning  Women with and without PHBC who undergo screening MRI experience higher biopsy rates coupled with significantly lower cancer yield compared with mammography alone.

Abstract

Importance  There is little evidence on population-based harms and benefits of screening breast magnetic resonance imaging (MRI) in women with and without a personal history of breast cancer (PHBC).

Objective  To evaluate biopsy rates and yield in the 90 days following screening (mammography vs magnetic resonance imaging with or without mammography) among women with and without a PHBC.

Design, Setting, and Participants  Observational cohort study of 6 Breast Cancer Surveillance Consortium (BCSC) registries. Population-based sample of 812 164 women undergoing screening, 2003 through 2013.

Exposures  A total of 2 048 994 digital mammography and/or breast MRI screening episodes (mammogram alone vs MRI with or without screening mammogram within 30 days).

Main Outcomes and Measures  Biopsy intensity (surgical greater than core greater than fine-needle aspiration) and yield (invasive cancer greater than ductal carcinoma in situ greater than high-risk benign greater than benign) within 90 days of a screening episode. We computed age-adjusted rates of biopsy intensity (per 1000 screening episodes) and biopsy yield (per 1000 screening episodes with biopsies). Outcomes were stratified by PHBC and by BCSC 5-year breast cancer risk among women without PHBC.

Results  We included 101 103 and 1 939 455 mammogram screening episodes in women with and without PHBC, respectively; MRI screening episodes included 3763 with PHBC and 4673 without PHBC. Age-adjusted core and surgical biopsy rates (per 1000 episodes) doubled (57.1; 95% CI, 50.3-65.1) following MRI compared with mammography (23.6; 95% CI, 22.4-24.8) in women with PHBC. Differences (per 1000 episodes) were even larger in women without PHBC: 84.7 (95% CI, 75.9-94.9) following MRI and 14.9 (95% CI, 14.7-15.0) following mammography episodes. Ductal carcinoma in situ and invasive biopsy yield (per 1000 episodes) was significantly higher following mammography compared with MRI episodes in women with PHBC (mammography, 404.6; 95% CI, 381.2-428.8; MRI, 267.6; 95% CI, 208.0-337.8) and nonsignificantly higher, but in the same direction, in women without PHBC (mammography, 279.3; 95% CI, 274.2-284.4; MRI, 214.6; 95% CI, 158.7-280.8). High-risk benign lesions were more commonly identified following MRI regardless of PHBC. Higher biopsy rates and lower cancer yield following MRI were not explained by increasing age or higher 5-year breast cancer risk.

Conclusions and Relevance  Women with and without PHBC who undergo screening MRI experience higher biopsy rates coupled with significantly lower cancer yield findings following biopsy compared with screening mammography alone. Further work is needed to identify women who will benefit from screening MRI to ensure an acceptable benefit-to-harm ratio.

Biopsy: 5 Things Every Patient Should Know


There is a member of your health care team who plays a vital role in your diagnosis and cancer care who you may never meet face to face: the pathologist. This is the doctor who analyzes the sample of tissue removed during a biopsy to make the correct diagnosis.

Here are 5 things this pathologist wants every patient to know about biopsy. ”share

1. Biopsy sample size and location matter.

Pathologists are trained to evaluate many different types of tissue. They use powerful microscopes to evaluate the cells within each tissue sample.

Sometimes a biopsy sample might not be big enough to evaluate. Other times, the pathologist can see that the sample was not taken from the correct area. In these cases, the pathologist will ask your doctor to repeat the biopsy, so the pathologist can make a conclusive and accurate diagnosis.

2. The time required for biopsy results will vary.

Some biopsies can be performed in a doctor’s office or an outpatient clinic. These include shave biopsies, punch biopsies, Pap tests and cervical biopsies, and even some fine needle aspiration biopsies (FNABs) for the thyroid or lymph nodes. These procedures are usually fairly quick and might take 15 to 30 minutes to perform, depending on the part of the body being biopsied.

Typically, the biopsy sample is then saved in a special type of preservative and sent to the pathology lab for processing. Tissue processing takes several steps, but it starts with making sure the correct test was done on the correct patient. Depending on the type of evaluation needed, the next steps might take a few hours or several days.

If your pathologist suspects certain types of cancer, such as lymphoma, he or she might need to perform additional testing to determine the subtype. This process takes an additional 24 to 96 hours, depending on the complexity of the cancer.

It can be agonizing to wait for biopsy results. But be assured that the pathologist is using his or her specialized expertise to make sure you get an accurate diagnosis.

3. Pathologists make sure biopsy tissue is used effectively to determine an accurate diagnosis.

Pathologists are the caretakers of tissue samples and must exercise good judgment with them. Samples allow us to make a correct diagnosis. But we can also use the samples to perform additional tests, such as immunostains, which can identify where a tumor started. This is really valuable in treating cancer that has spread from another part of the body, called metastasis.

Your pathologist will also make sure that biopsy samples are used to identify other factors affecting your treatment and recovery. These can include genetic changes that could guide treatment options or predict your chance of recovery. For example, in breast cancer, pathologists use the biopsy sample to identify hormone receptors such as estrogen and progesterone receptors (ER and PR) and human epidermal growth factor receptor (HER2). As we identify more precise characteristics of cancer from the biopsy sample, we can identify a growing number of patients who may benefit from new, more effective targeted therapies.

4. Biopsy samples are safely stored and secured to help manage future treatment.

Federal law requires laboratories to safely store specimens for a set amount of time. For example, cytology slides, like Pap tests, are usually stored for at least 5 years. Other types of stained tissue slides are typically kept for 10 years or more. Paraffin blocks (material where tissues are usually processed) are retained for at least 10 years. Some states may require even longer storage periods.

By saving biopsy tissue for a long time, the pathologist may review the primary tumor if a patient has that cancer come back or spread in the future. By looking at the sample again, we can find out if the original primary tumor has come back or if it is a new cancer. We also may review the samples again if new treatments based on a tumor’s genetics become available. At other times and only if the patient gives permission, biopsy samples may be used in research to help discover new treatments and targeted therapies.

5. Pathologists seek multiple opinions, and patients can, too.

Typically, pathologists share all cancer diagnoses with their associates, especially when a patient has a cancer that is difficult to diagnose or treat. Most accredited labs require a second pathologist to confirm the diagnosis for all cancers.

In addition, pathologists participate in tumor board review. Tumor board review is an approach to planning cancer treatment in which a team of doctors from different specialties work together to reach an opinion.

This multilayered team evaluation helps ensure that patients receive a detailed and accurate diagnosis. And because we understand the value of gaining a second opinion, all laboratories are willing to give patients their biopsy samples if they want a second opinion or treatment from another cancer center.

Writing Can Help Injuries Heal Faster: Scientific American


Expressive writing is known to help assuage psychological trauma and improve mood. Now studies suggest that such writing, characterized by descriptions of one’s deepest thoughts and feelings, also benefits physical health.

Researchers in New Zealand investigated whether expressive writing could help older adults heal faster after a medically necessary biopsy. In the study, 49 healthy adults aged 64 to 97 years wrote about either upsetting events or daily activities for 20 minutes, three days in a row. After a time lag of two weeks, to make sure any initial negative feelings stirred up by recalling upsetting events had passed, all the subjects had a biopsy on the arm, and photographs over the next 21 days tracked its healing. On the 11th day, 76 percent of the group that did expressive writing had fully healed as compared with 42 percent of the control group.

boy writing in hospital bed

“We think writing about distressing events helped participants make sense of the events and reduce distress,” says Elizabeth Broadbent, professor of medicine at the University of Auckland in New Zealand and co-author of the study, published in July in Psychosomatic Medicine. Long-term emotional upset can increase the body’s levels of stress hormones such as cortisol, which impedes the immune system. A paper in September in the British Journal of Health Psychology indeed found that writing about an emotional topic lowered participants’ cortisol levels.

The writing in Broadbent’s study may have also sped recovery by improving sleep. Participants who slept more in the week before the biopsy healed faster, perhaps because sleep ramps up many bodily processes involved in healing.

Why Take Follow-Up Biopsies in Celiac Disease?


Results provide status of mucosal healing, which is associated with risk for lymphoma.
Celiac disease is a risk factor for T-cell lymphomas of the intestine as well as a variety of other malignancies. Some experts believe that adherence to a gluten-free diet mitigates this risk. Guidelines suggest repeating serologic testing after several months on a gluten-free diet, but follow-up biopsy sampling to confirm healing is not routinely performed. Now, researchers consider its value for assessing cancer risk.

To examine the association between mucosal healing in celiac disease and the risk for lymphoproliferative malignancy (LPM), investigators in Sweden conducted a retrospective, population-based cohort study of 7625 patients with celiac disease who had at least one follow-up biopsy taken after diagnosis. Biopsies were taken at least 6 months after initiation of a gluten-free diet and at a median of 1.3 years after diagnosis. LPM occurrence was determined using a nationwide cancer registry.

In multivariate analysis, patients with persistent villous atrophy on follow-up biopsy had a higher risk for LPM compared with the general population (standardized incidence ratio, 3.78; 95% confidence interval, 2.71–5.12) and compared with patients with mucosal healing (hazard ratio, 2.26; 95% CI, 1.18–4.34). The risk estimate was highest for T-cell lymphoma, though not statistically significant. Total or subtotal villous atrophy was more strongly associated with T-cell lymphoma (HR, 9.23) than partial or no villous atrophy (HR, 3.4).

COMMENT

This study confirms the increased risk for lymphoproliferative malignancy in patients with celiac disease. Further, it documents for the first time that the risk for LPM, particularly T-cell lymphoma, is predicted by the degree of mucosal healing on follow-up biopsy. These findings strongly suggest that, as in inflammatory bowel disease, mucosal healing is an important therapeutic goal. Follow-up biopsy at 6 to 12 months after initiation of a gluten-free diet should be considered, with the goal of achieving resolution of villous atrophy.

Source: NEJM

Cancer Trials Can Lack Clear Information on Biopsies.


 Cancer drug trials often require participants to receive invasive procedures like biopsies, which are used to assess the drug’s effectiveness but have no therapeutic value – and can pose serious risks — for the patient.

Informed consent documents are supposed to inform study participants about these types of risks so they can make an educated decision on whether or not to participate in the trial, but a new study found this type of risk information to be seriously lacking.

Risks of Biopsies Not Clearly Stated

Writing in the Journal of Clinical Oncology, researchers stated:1

“A better representation of the risks and benefits of research biopsies in study protocols and informed consents is needed.”

This was their conclusion after finding that more than 5 percent of biopsies in cancer drug trials may cause complications, but the informed consent documents did not adequately explain this. In fact, on average the consent documents had only 39 words addressing risks from invasive biopsies – less than the number of words used to address risks for simple blood draws.

Of the 745 tumor biopsies reviewed for the study, 39 resulted in complications, including lung air leaks, bleeding and other major effects that required hospitalization or surgery.

Whether you’re participating in a drug trial, or considering a biopsy for another medical reason, you should know that while biopsy risks are rarely discussed, there are risks, indeed.

Serious Biopsy Complications Every Patient Should Know

During a biopsy, a piece of tissue from a tumor or organ is removed so that it can be examined under a microscope, often to determine if it is cancerous. Needle biopsies, for instance, are widely used as part of the traditional allopathic approach to diagnosing breast cancer. But they may accidentally cause malignant cells to break away from a tumor, resulting in its spreading to other areas of your body.

According to a study from the John Wayne Cancer Institute, it appears that a needle biopsy may increase the spread of cancer by 50 percent compared to patients who receive excisional biopsies, also known as lumpectomies.2

The procedure also involves a serious risk of infection. For prostate gland biopsies, specialists have begun to worry about a recent, significant increase in hard-to-treat bloodstream infections that can require weeks of treatment.

Prostate biopsies inherently pose a risk for infection because:

  • The needles that collect a tiny piece of prostate tissue can transport bacteria through your rectal wall into the prostate and bloodstream
  • The needles can spread harmful bacteria present in your gut into your bloodstream

Pain, bleeding (that can be so severe it requires a blood transfusion or surgery to stop it), infection and accidental injury to a nearby organ are established risks that are present no matter what type of biopsy you receive. And then there is the issue of its questionable effectiveness.

In the case of prostate biopsies, an estimated one-third of men who receive “negative” results for prostate cancer actually do have prostate cancer that was missed by the biopsy. For breast biopsies, estimates suggest that 17 percent of D.C.I.S. (ductal carcinoma in situ) cases found through needle biopsy are misdiagnosed. And oftentimes it is an inaccurate mammogram (mammograms carry a first-time false positive rate of up to 6 percent) that leads to the breast biopsy in the first place, making the procedure completely unnecessary.

So, certainly if you’re considering taking part in a drug trial, you need to carefully assess whether the biopsy risks are worth it to you … and this is also true anytime you’re faced with a recommendation of a biopsy. You must measure the potential benefits against the risks in order to make an informed decision.

5,000 Combinations Of 100 Existing Cancer Drugs Tested To Find More Effective Treatments

Whereas biopsies are one of the go-to procedures conventional medicine uses to diagnose cancer, chemotherapy is the go-to procedure to treat it. But one of the reasons why conventional cancer treatment is such a dismal failure in the United States is because it relies on chemotherapy. Despite its reputation as the gold-standard in cancer treatment, chemotherapy has an average 5-year survival success rate of just over 2 percent for all cancers, according to a study published in the journal Clinical Oncology.3

The researchers concluded:

“ … it is clear that cytotoxic chemotherapy only makes a minor contribution to cancer survival. To justify the continued funding and availability of drugs used in cytotoxic chemotherapy, a rigorous evaluation of the cost-effectiveness and impact on quality of life is urgently required.”

It’s no secret among the cancer industry that these drugs are often ineffective, or that oftentimes the cancer patient survives not because of — but despite — the treatment. Moreover, it’s now common for treatments to use combinations of drugs, as many cancers have become resistant to single drugs, rendering them useless. Chemotherapy often supports the more chemo-resistant and malignant cell subpopulations within tumors (e.g. cancer stem cells), as it kills both the more benign cells and/or senescent cells within the tumor that keep it slow-growing, or even harmless.

As a result, this unleashes a more aggressive, treatment-resistant type of cancer to wreak havoc on the body.

A new study recently tested 5,000 combinations of the 100 cancer drugs approved for use in patients in an attempt to find more effective treatments.4 They plan to move several of their novel combinations into clinical trials as quickly as possible, but is this really going to benefit cancer patients?

Chemo Drugs Destroy Your Healthy Cells, Including Your Immune System

Chemotherapy drugs are, by their very nature, extremely toxic and typically work against your body’s natural ability to fight cancer by harming your immune system (often irreparably) instead of supporting it. Combining them into new formulations could cause any number of unforeseen consequences. Already, it’s known that certain chemo drugs become so toxic when combined that they would have to be used at such a low dose they would no longer work against the cancer!

And one of the biggest drawbacks to chemotherapy of any kind is the fact that it destroys healthy cells throughout your body right along with cancer cells, a “side effect” that often leads to accelerated death, not healing.

Another study, “The National Confidential Enquiry into Patient Outcome and Death (NCEPOD)”, found that more than four in 10 patients who received chemotherapy toward the end of life experienced potentially fatal effects. And after reviewing data from over 600 cancer patients who died within 30 days of receiving treatment, it was found that chemotherapy hastened or caused death in 27 percent of those cases.

In the last 30 years the global cancer burden has doubled, and it will likely double again between 2000 and 2020, and nearly triple by 2030 — unless people begin to take cancer prevention seriously. We CAN turn this trend around, but to do so the medical community must stop overlooking the methods that can actually have a significant impact.

Why I Strongly Advise Avoiding Chemotherapy

I strongly advise everyone to avoid taking any chemotherapy drugs. In my experience the people who survive the chemotherapy do it in spite of the therapy not because of it. More typically, once a person starts chemo it can lead to death. It is the one form of cancer therapy that I strongly advise most to avoid.

Why?

Because the way your body fights cancer normally is through a healthy immune system, and if you take drugs to target and destroy your immune system you tend to radically reduce your likelihood of long-term survival. This is not the case for surgery and radiation, which although also overused, do not impair your immune system and may debulk the tumor enough to give your immune system a chance to fight it.

Please also be aware that avoiding chemo comes with massive responsibility and the need to do something positive. Typically this involves a radical application of my advanced nutrition plan in addition to severely limiting protein and carbs and using high-quality fats as a source of calories. This would include foods like avocados, coconut oil, butter, nuts, olive and olive oil. This will tend to lower the mTOR pathway and optimize leptin and insulin signaling.

Four Must-Know Tips for Cancer Prevention

If you’re facing a health challenge, I recommend seeking out a qualified natural health consultant. When it comes to cancer, you’ll want to identify someone that is well known and respected for their work in treating cancer patients. If you don’t find someone locally then scour the Internet and make calls to plenty of patients that the practitioner has seen.

For the rest of you, focusing on cancer prevention is essential. Here are four advancements that have not yet been accepted by conventional medicine, but are extremely powerful cancer preventive tools nonetheless:

1.  Avoid Fructose and Sugar

It’s quite clear that if you want to avoid cancer, or are currently undergoing cancer treatment, you absolutely MUST avoid all forms of sugar — especially fructose — and this is largely due to its relation to insulin resistance.

According to Lewis Cantley, director of the Cancer Center at Beth Israel Deaconess Medical Center at Harvard Medical School, as much as 80 percent of all cancers are “driven by either mutations or environmental factors that work to enhance or mimic the effect of insulin on the incipient tumor cells,” Gary Taubes reported,5 adding:

“As it was explained to me by Craig Thompson, who has done much of this research and is now president of Memorial Sloan-Kettering Cancer Center in New York, the cells of many human cancers come to depend on insulin to provide the fuel (blood sugar) and materials they need to grow and multiply. Insulin and insulin-like growth factor (and related growth factors) also provide the signal, in effect, to do it.

The more insulin, the better they do.

Some cancers develop mutations that serve the purpose of increasing the influence of insulin on the cell; others take advantage of the elevated insulin levels that are common to metabolic syndrome, obesity and type 2 diabetes.

Some do both.

Thompson believes that many pre-cancerous cells would never acquire the mutations that turn them into malignant tumors if they weren’t being driven by insulin to take up more and more blood sugar and metabolize it.”

Some cancer centers, such as the Cancer Centers of America, have fully embraced this knowledge and place their patients on strict low-sugar, low-grain diets. But conventional medicine in general has been woefully lax when it comes to highlighting the health dangers of this additive.

As a standard recommendation, I strongly advise keeping your TOTAL fructose consumption below 25 grams per day, including fruits. But for most people it would also be wise to limit your fructose from fruit to 15 grams or less, as you’re virtually guaranteed to consume “hidden” sources of fructose if you drink beverages other than water and eat processed food.

2.  Optimize Vitamin D

There’s overwhelming evidence pointing to the fact that vitamin D deficiency plays a crucial role in cancer development. Researchers within this field have estimated that about 30 percent of cancer deaths — which amounts to 2 million worldwide and 200,000 in the United States — could be prevented each year simply by optimizing the vitamin D levels in the general population.

On a personal level, you can decrease your risk of cancer by MORE THAN HALF simply by optimizing your vitamin D levels with sun exposure. And if you are being treated for cancer it is likely that higher blood levels — probably around 80-90 ng/ml — would be beneficial.

If the notion that sun exposure actually prevents cancer is still new to you, I highly recommend you watch my one-hour vitamin D lecture to clear up any confusion. It’s important to understand that the risk of skin cancer from the sun comes only from excessive exposure.

3.  Decrease Protein

Ideally your protein level should be around one gram of protein per pound of lean body mass. Be very careful not to exceed this level and be assiduous about calculating and following this important recommendation. If you exceed this level of protein you will activate your mTOR pathway, which has been strongly correlated with promoting tumor growth.

4.  Exercise

If you are like most people, when you think of reducing your risk of cancer, exercise doesn’t immediately come to mind. However, there is some fairly compelling evidence that exercise can slash your risk of cancer. One of the primary ways exercise lowers your risk for cancer is by reducing elevated insulin and blood sugar levels, which creates a microenvironment that discourages the growth and spread of cancer cells.

If you have cancer, exercising during and after cancer treatment can reduce your risk of dying from cancer; reduce your risk of cancer recurrence; boost energy; and minimize the side effects of conventional cancer treatment.6

It’s important to include a large variety of techniques in your exercise routine, such as strength training, aerobics, core-building activities, and stretching. Most important of all, however, is to make sure you include high-intensity, burst-type exercise, such as Peak Fitness.

Source: Dr. Mercola

Good practice in EBUS-guided transbronchial biopsy.


Radial probe endobronchial ultrasound (EBUS) employs a flexible catheter housing an ultrasound transducer which produces a 360-degree ultrasound image, and was first applied to guide transbronchial biopsy (TBB) by Herth et al. in 2002. EBUS-guided TBB has an advantage over conventional bronchoscopic…

Abstract

Background Although endobronchial ultrasound (EBUS)-guided transbronchial biopsy (TBB) has been shown to increase the diagnostic yield over conventional bronchoscopic techniques, an important issue regarding the optimal number of biopsy specimens required has not been thoroughly investigated.
Objectives We sought to examine whether the number of biopsy specimens taken was associated with the diagnostic yield of EBUS-guided TBB and, if this was the case, to determine the optimal number of specimens required for the maximum diagnostic yield in peripheral pulmonary lesions.
Methods The medical records of patients undergoing EBUS-guided TBB for the diagnosis of peripheral pulmonary lesions from 2008 to 2010 were retrospectively reviewed. The association of clinical and radiological features, including the number of biopsy specimens, with the diagnostic yield was analysed.
Results A total of 384 patients were included for analysis. The overall diagnostic yield of EBUS-guided TBB was 73%, and the only factor influencing the diagnostic yield was the position of the probe. Patients in which the EBUS probe was placed within the lesions had a significantly higher yield (85%) than those in which the probe was adjacent to or outside the lesions (38%; p < 0.001). When the number of biopsy specimens was determined based on their adequacy, it was an insignificant factor in predicting the diagnostic yield.
Conclusions Probe position independently predicts the diagnostic yield of EBUS-guided TBB. In real-world practice, the optimal number of biopsy specimens should be decided on a case-by-case basis.

Chun-Ta Huanga, b, Yi-Ju Tsaic, Wei-Yu Liaoa, Pei-Chen Wud, Chao-Chi Hoa, Chong-Jen Yua, Pan-Chyr Yanga

Departments of
aInternal Medicine and
bTraumatology, National Taiwan University Hospital,
cSchool of Medicine, College of Medicine, Fu-Jen Catholic University, and
dCenter for Genomic Medicine, National Taiwan University Hospital, Taipei, Taiwan, ROC

Source: www. getinsidehealth.com