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Biopsy Remains Superior to Noninvasive Tests for Breast Cancer Following Abnormal Mammogram

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After reviewing prior studies of four common noninvasive tests available to detect breast cancer following an abnormal mammogram, The Agency for Healthcare and Research Quality (AHRQ) reports that none is accurate enough to replace a standard biopsy.Since a breast biopsy requires the use of a needle or an incision to sample the suspicious area, they are considered invasive procedures.AHRQ reviewed studies of: (1) Positive Emission Tomograpy (PET) scans; (2) Magnetic Resonance Imaging (MRI); (3) Ultrasonography (ultrasound); and (4) Scintimammography (mammogram enhanced by a radioactive tracer).

According to AHRQ director, Dr.Carolyn Clancy: “We found that these tests, while reasonably accurate, could still miss a substantial number of cancers if used to try to avoid a biopsy. The risk of missing a cancer is sufficiently high that we conclude that these tests should not routinely replace a biopsy.”

As with any cancer, early detection is the single most important factor experts point to when discussing survival rates or the chances of curing the disease altogether. Thus, a biopsy remains remains “the most effective technique when mammography or physical examination reveals a potential problem,” Clancy stated.

According to the report, the noninvasive tests considered would miss about 4% to 9% of cancers in women of average risk for cancer. This rate is potentially greater for women who are at a higher risk for cancer.

According to Clancy: “Our goal is to provide information for providers and consumers and other health care decision makers about their use as a substitute for biopsy. Only about one in five women currently getting a biopsy for an abnormal mammogram or breast examination will be found to have breast cancer. This is significant, because it means some 80% of women with an abnormality suspicious for cancer must undergo the biopsy procedure even though they ultimately prove not to have cancer.”

While the report found the noninvasive tests should not replace regular a biopsy, it is not intended to dismiss any of the tests since they are “commonly and effectively used for other types of diagnostic imaging,” Clancy says.

Women are encouraged to talk to their doctors about their options after an abnormal mammogram or abnormal breast exam. “Having an abnormal mammogram encompasses a wide range of potential risks, from 1% to over 90% risk of cancer. A woman needs to understand her individual risk and how the diagnostic alternatives can help manage this risk,” says Clancy.

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