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Biopsy Of The Breast


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Background: Mammograms and other imaging techniques cannot prove that an abnormal area is cancer. If an area continues to look suspicious, a biopsy will be recommended. A biopsy is the definitive way to know whether a mass is cancer or not. 

A biopsy is the removal of part of the lump or suspicious area by a very thin needle or by surgery. The sample is then examined under a microscope.

  • The procedure permits a medical doctor known as a pathologist to look at cells from your body and determine whether they are cancerous (malignant) or not cancerous (benign). 
  • 4 out of 5 biopsies do not find a malignancy.
    • Usually the breast change is a fibrocystic change or a benign breast tumor.
    • A fibrocystic change is a benign change in breast tissue.This change often happens just before a menstrual period is about to begin. Lumps and areas of thickening caused by fibrocystic changes are almost always harmless.
    • A benign breast tumor is a non-cancerous area where breast cells have grown abnormally and rapidly, often forming a lump. Unlike cysts, which are filled with fluid, tumors are solid. Benign breast tumors are sometimes uncomfortable, but they
  • Initial biopsies are usually performed by a medical doctor known as a radiation oncologist.
  • A biopsy starts with the removal of cells or tissues from the body for examination by a pathologist. The pathologist may study the tissue under a microscope or perform other tests on the cells or tissue. If the biopsy shows that cancer is present, the pathologist's findings become a primary basis for helping to determine the best treatment.
  • There are a variety of biopsy procedures. The method that will be recommended in any particular situation depends on the size and location of the area of interest. The most common types of biopsies are: 
    • Incisional biopsy, in which only a sample of tissue is removed.
    • Excisional biopsy, in which an entire lump or suspicious area is removed. 
    • Needle biopsy, in which a sample of tissue or fluid is removed with a needle through the skin. 
      • When a wide needle is used, the procedure is called a core biopsy. 
      • When a thin needle is used, the procedure is called a fine-needle aspiration biopsy.

Before agreeing to a biopsy: 

  • Understand the type of biopsy the doctor recommends and what is involved. Ask questions such as: 
    • Does the doctor plan to use a pain killing anesthetic during the procedure?
    • If not, why not?
    • If so, ask:
      • Which anesthetic plan the doctor plans to use. 
      • What the alternatives are to the plan he or she is suggesting
      • The circumstances under which he or she may decide to administer another drug during the course of the procedure. 
      • For additional questions to ask, click here.
    • Check to see that the consent form you will be asked to sign before the procedure describes what you think you have agreed to, including the identity of the person you think will be performing the procedure.
    • Check to see that the person who will perform the biopsy is covered by your insurance. Do not assume that just because the facility is covered, the doctor is also covered by your insurance and vice versa.
  • If the biopsy reveals that the sample is cancer, a common next step is to remove the cancer with surgery. 
    • Discuss whether to proceed to surgery at the same time as the biopsy, and if so, what kind of surgery. For information about one or two steps, click here.  (For questions to ask before agreeing to surgery, click here.)
    • If you agree to a one step procedure of biopsy and surgery, check with your insurance company to determine whether a one step procedure is covered. It is not unusual for insurance companies to require a second opinion before covering surgery.  
  • Especially if you will have a local anesthetic and will be awake during the biopsy, ask the doctor not to tell you his or her preliminary thoughts about the results. The pathologist's report is necessary to determine the results with certainty.
  • Check your health insurance to see if it is covered. (Biopsies are generally covered by health insurance).
    • If it is covered, how much will you have to pay?
    • If the biopsy is not covered, what is the cost?  See Uninsured. (link to T49 ) Keep in mind that all medical bills are negotiable. To learn how to negotiate a medical bill, click here
  • Look at the section of this article which discusses the steps to take to prepare for a biopsy.

After a biopsy, a doctor known as a pathologist will examine the sample and prepare a report of the results. The report is known as a pathology report. 

  • The pathology report will be sent to your gynecologist or other referring doctor. That doctor will review the pathology report with you.
  • We suggest you ask for a copy of the report so you can discuss it in a meaningful way. 
    • You are entitled to receive a copy of the pathology report. 
    • Having a copy on hand means that it will be available without delay when other doctors need it.
    • By law, the report is supposed to be written so that lay people with no medical knowledge can understand it.
  • Particularly ask whether the report contains any uncertainty. An accurate diagnosis is key to identifying the best treatment.
  • For assistance reading a pathology report, click here.   If you have difficulty understanding the report, call the American Cancer Society for a copy of Dictionary of Breast Cancer Terms. Call 800.ACS.2345.
  • If there are any questions, consider getting a second pathology opinion. For example, from a pathologist at a major academic cancer center or a National Cancer Institute certified comprehensive cancer center. You can locate such a center by clicking here offsite link.

If a biopsy shows that you have cancer, before choosing a treatment option, consider getting a second opinion from a radiologist or surgical oncologist who is not connected with the originating doctor or facility. If you decide to get a second opinion: 

  • Find out from the doctor that will provide the second opinion what documentation is needed. Generally this will be the original biopsy records rather than a copy.
  • Check to find out whether the second opinion will be covered by your health insurance. If so, what portion will you have to pay? If insurance does not cover it, find out how much the second opinion will cost.

For additional information, see:

When you are ready to consider treatments, we suggest that you read: How To Choose A Treatment.  Also see: Breast Cancer Surgery

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