Needle biopsy benefits outweigh the risks
DEAR DR. ROACH: After not having a mammogram for about 10 years, I developed soreness in one breast. I was recently examined by my doctor, and a lump was detected in my breast at "10 o'clock," about 7 centimeters from the nipple. I had a standard mammogram that showed a 2.5 cm mass, and I was recalled for follow-up for a spot compression mammogram and ultrasound of the breast. The radiologist's report called the mass "BI-RADS 4."
I have read reports and studies regarding needle biopsies that indicate that the tissue damage, if there are cancer cells, can cause the spread of cancer to other parts of your body that can stay dormant for up to five years and then develop into metastatic cancer. The core needle biopsy is supposed to be more problematic than the fine needle biopsy in causing this; however, both can be an issue.
My first thought is that I would rather wait and repeat the mammogram and ultrasound in six months to see if there are any changes that would still require a recommendation for a needle biopsy. I would really appreciate your opinion on this. I am waiting for an appointment for the biopsy, but because of COVID and a backlog of tests and surgeries, it could be a while before I get it. -- D.
ANSWER: Mammograms use the BI-RADS system to give an idea of the likelihood that there is cancer present. A BI-RADS score of zero means the evaluation is incomplete; otherwise, numbers 1-5 give increasing risk of cancer, where 1 means the evaluation is completely normal, with very little risk of cancer, and 5 means a 95% or higher risk. A BI-RADS score of 4 is suspicious, and in practice, about 75% of these will get a biopsy, of which about 20% will prove to be cancer. (Some radiologists use 4A, 4B and 4C to further stratify risk.)
Many people are concerned that a needle biopsy, whether the fine needle usually used or the core biopsy used for larger masses, can cause the disease to spread. This appears to be at most very rare, and the benefit of making a diagnosis quickly greatly outweighs any potential harm. If you are recommended for a biopsy, I would certainly agree with you getting it as quickly as possible. Since many women did not get a mammogram during the height of the pandemic, there are a lot of women being diagnosed now with breast masses.
DEAR DR. ROACH: My blood pressure is higher in the office than at home. My doctor had me monitor my BP at home. I've found that doing a form of meditation at the office has reduced my initial reading by several points. Why does this happen to some of us? -- T.M.H.
ANSWER: Many people have office blood pressure readings that are higher than home readings. Time pressure, being nervous about the results and seeing your weight are all published reasons that cause office blood pressure readings to be high. Some people have high blood pressure in the office without feeling anxious at all. Thus, home readings, when done by a high-quality automated machine, are a better guide to someone's true blood pressure than office readings. Best of all are the results from a 24-hour blood pressure machine. These results give the best guide of true blood pressure; unfortunately, these are hard to get.
Meditation reduces blood pressure immediately and long-term, and may have other benefits.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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