First of all, there is no way of getting around a biopsy. There are side effects with any procedure but in order to properly treat a patient, a good biopsy specimen is absolutely critical. The benefit of being able to select the proper surgery and subsequent treatment clearly outweighs the risk.
That said, many women come to me concerned that their biopsy might have spread their cancer along the line where the needle traversed the breast (known as the needle tract). More cancer (or higher stage cancer) is often found when a woman has surgery after the biopsy and more tissue is removed. For this reason, it’s understandable to wonder whether the biopsy procedure itself actually caused the cancer to spread or progress further. On top of this, in other cancers such as testicular, doctors are taught never to biopsy the tumor with a needle because of concern it could seed the tumor along the needle tract, though this is unproven. The organ is simply removed whole.
So should you worry about this? The short answer is no. Let me explain.
The risk of “seeding the tract” is theoretical. It has never been proven in a strong, reliable, scientific breast cancer study. For sure, almost anything is possible and it is considered prudent by surgeons to use the shortest needle tract possible to get to the tumor for biopsy in order to lower this theoretical risk and to decrease the risk of other complications as well. But there is no reliable evidence that “seeding the tract” actually happens.
Can a biopsy turn DCIS into an invasive cancer?
Here too, the answer is no. Normal cells turn into DCIS, which then turn into invasive cancer by a process known as tumorigenesis. This is a complex, molecular change that occurs over many years and is not affected by a biopsy.
The only way to completely eliminate this theoretical risk would be to perform a mastectomy, where the entire needle tract (and breast) is removed. We know that women who have breast-conserving surgery with radiation (where the needle tract is mostly left in) do just as well as women who have mastectomy in terms of the cancer coming back. If the needle-tract risk was something to worry about (real or not), women with breast-conserving treatment would do worse — but this is not the case.
I care for patients with breast cancer every day. The amount of anxiety they are subject to is overwhelming. There are many real concerns for women that will impact their chance of being cured: getting the right diagnosis and treatment, side effect management, financial security, and follow-up. But there is no solid evidence that biopsies can cause breast cancer to spread, and that’s one less thing to worry about.
Is it needle track or tract?
Hello exbrnxgrl,
The scientific term is tract, although I would not be surprised if it was referred to as track in everyday usage.
Thanks for commenting!
Dr. Wojciechowski
I appreciate this article Dr. Wojciechowski and I would certainly agree that the benefits of a biopsy certainly outweigh the risks of NOT having one and if cancer was present, then hopefully treatment with radiation or chemo would address any cells left in the needles path. But personally I must say I have had a different concern but relative to this conversation. 5 years prior to my cancer diagnosis I had what was determined to be a benign mass surgically removed from the exact location where my cancer eventually appeared. The thought has crossed my mind that the surgical removal of that mass might have “encouraged” the cancer cell production. Am I over thinking this or has this ever been looked at? Thanks for all your contribitions to BC.org!
I had a needle biopsy and I ended up with a hematoma as the radiologist hit a blood vessel. My concern is that they could not find the tumor afterwards. I am worried that the tumor was broken up and spread. I have since had a lumpectomy ( the tumor was a different size than originally thought) I still wonder if the tumor was completely removed or if splinters of it are lurking in my breast waiting to rear their ugly heads.
The pathologist showed me the slide that had both my DCIS and my Invasive Ductal Carcinoma on it. They were very close and they looked alike except the invasive did not have the wall of a duct around it. That was how he knew it was invasive.
Has anyone done any experiments to see what happens when a duct that is filled with DCIS cells is cut? I would be interested in reading about that.
Can cutting through a duct, tumor, or even a benign growth can make the cells turn into cancer? I give a lecture to physician assistant students every year called the Biology of Cancer. In it, I describe the process by which a normal cell becomes cancerous: cells take many ‘hits’ to their genetic material over years. As the hits accumulate, the cells slowly change and become more like cancer cells, until they finally develop the capacity to spread and grow uncontrollably. Cutting or removing or stirring up the cells cannot do this. It is a gradual change in the cells over time that makes them cancerous.
Thanks for commenting!
A informative article which has put all doubts at rest regarding spreading of cancer due to biopsy.
Having had numerous biopsies over the past 50 years, I now wondering about damage done by needle tracts. Do needle tracts heal and completely seal or do they remain open? How long does it take for a needle tract to close? Does scar tissue form in the needle tract? I always assumed that needle tracts sealed. do needle tracts and biopsies make reading scans, mammos, & mris more difficult?
I agree that a biopsy is oftentimes necessary, but I feel there IS a possibility for cancer cells to be released from the biopsy site when dissected.
My doctor removed a growth that was located under my
breast very close to the breast wall and said is was cancer.
She said it was not invasive, slow growing. No need for radiation or chemo just a pill for 5 years. However when the lab report came back she said it was hormone dependent and the lav report said b report said I would need further surgery because their was not enough healthy tissue around the lump. Doesn’t the operating room have a way of
checking the tissue before you are closed up?
You say “cells take many ‘hits’ to their genetic material over years” For the benefit of our sisters and daughters, are these “hits” something we can control or avoid?
Thank you, and Happy New Year.
The cells inside the ducts in Ductual Carcinoma in situ are carcinoma. The cells outside the ducts in Invasive Ductual Carcinoma are carcinoma. How can we be sure that some carcinoma cells packed inside an overfilled duct can’t be forced out when the ducts are sliced open in a core biopsy? There may be no solid evidence that core biopsies can cause breast cancer to spread, but I would like to see solid evidence that they can’t. I appreciate that doctors want to reassure their patients when they are faced with a cancer diagnosis, but I would be more reassured by evidence from research.