Can biopsies cause cancer to spread?
I just thought this would be a good topic for discussion.
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I think it does yes. Tami
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Then why all the biopsies?
I understand needing tissue samples for a diagnosis....but if biopsies are causing cancer to spread then we all could be/are, in trouble.
Great. What a way to start off my day.
Edit: Oops..DCIS thread, just realised. Sorry, the thread topic just stood out.
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Well, yes, biopsies CAN cause cancer to spread. There are very few things in life that are absolute. For example, it is possible for all the air in the room in which you are sitting to travel to the other side of the room, leaving you to suffocate. It is not very likely AT ALL. Of course, the risk of seeding is much greater than this.
But its not a simple question at all.
Different cancers can have different behaviours.
For breast cancers, the studies I've seen say that epithelial cell movement during biopsy occurs frequently. The issue is whether they survive.
For breast cancer, it is generally thought that while biopsies can definitly move cancer cells (http://www.ncbi.nlm.nih.gov/pubmed/17674195), if you get the usual therapy for your condition, probably most do not survive usual treatment (excision of the needle track or radiation.)
This abstract describes the risk as 'small'. http://www.ncbi.nlm.nih.gov/pubmed/19360459
This abstract suggests seeding occured in this case. http://www.ncbi.nlm.nih.gov/pubmed/19701680
This study found, looking at several studies, there was no excess morbidity with CNB, though the data is limited. http://www.ncbi.nlm.nih.gov/pubmed/191671
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No.
Yes.
And what does it mean anyway?
The "No" is for DCIS. In order for DCIS cancer cells to survive and thrive outside of the milk ducts, they must undergo one final biological change. DCIS cancer cells need this one final step before they can become invasive. So even if DCIS cells are moved outside of the duct during a biopsy, these cells won't become invasive. They will remain DCIS cells and they will not have the ability to spread or move outside of the breast.
The "Yes" is for IDC. IDC cancer cells can be moved by surgical equipment. This is called "seeding". While I suspect that some seeded cells will die off on their own, I'm sure it's possible that some may continue to thrive and multiply and spread.
The "And what does it mean anyway?" refers to the implications. Let's say that 10,000 women have a biopsy. Of the 10,000 women, 2000 will be found to have breast cancer. Of the 2000 women who have breast cancer, 400 will have DCIS and 1,600 will have IDC. So it's these 1,600 who have the risk that their biopsies may have spread some cancer cells. Of the 1,600 women, approx. 600 will have mastectomies. So if the biopsy moved some cancer cells to an area of the breast away from the main tumor, it really won't matter because all the breast tissue will be removed anyway. Of the remaining 1,000 women who have lumpectomies, over 900 will have radiation. The purpose of radiation is to kill off any rogue cancer cells that might be left beyond the surgical margins. If there was seeding, and if the cancer cells were placed away from the primary tumor site (along the needle track, for example), these would be exactly the type of rogue cells that radiation is meant to go after. And if radiation doesn't kill of these cells, those who have chemo and/or who take Tamoxifen or an AI will have another shot at killing these cells off. So it's the remaining <100 women, those who had a lumpectomy but don't have radiation and also don't take Tamoxifen or an AI, who face the greatest risk. In all likelihood, women who have invasive cancer but choose not to have radiation or take hormone therapy probably had a very early stage cancer - likely only a very small amount of low grade IDC. And probably they had very wide margins. So it's very possible that any seeded cells might have been removed during surgery (within those wide margins), or they might die off on their own. And if they don't? Well, how many of these women might have had seeding? 10%? 20%? Given all the biopsies that are done everyday, and given the general lack of concern about seeding, it's unlikely that the rate of seeding would be higher than that. So I'd guess that at most, 2 women might be affected. This means that of the 2,000 women who were diagnosed with BC (out of the 10,000 women who had a biospy), 0.1% might be negatively affected by seeding.
That's how I see it.
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I've too have often wondered if my micro invasion was caused by my biopsy since my micro invasion was in the exact same area as my biopsy according to the pathology report. Additionally mine was very close to the skin so during my re-excision, my surgeon removed extra skin just to be sure. I've asked my surgeon and a few of my oncologists if my micro-invasion could have been caused by the biopsy; one said we're not sure, the others have said that there are studies stating that this is a possibility.
I've also researched this topic; some studies have said yes and some no. And those studies that have said there a possibility, they did say that it does not happen very often at all. Beesie does an excllent job at breaking down the stats.
I personaly think it's possible but do believe that it is very rare. I've also read that due to this possiblity, most doctors during bc surgery remove the biopsy tract line.
Obviously we have no other choice but to do biopsies until they develop a non-invasive way of diagnosing bc.
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Liz, the information that DCIS requires a biological change before it can become invasive has been understood/accepted for less than two years. Before that, doctors likely would have thought that a microinvasion possibly could be caused by a biopsy. But today I suspect that most doctors wouldn't believe this, based on what is now understood about the biology of DCIS. Have you seen any recent articles - from the past year - that suggest that this is possible? That would be interesting. Everything I've read that's recent talks to the fact that DCIS becomes invasive only after a genetic change, which would suggest that simply moving a DCIS cell into the breast tissue, outside of the duct, isn't going to create a microinvasion.
Of course, that's based on today's understanding; who knows what the next study will show!
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Hi Beesie-
my husband and I asked my doctors when I was initially diagnosed well over 2 years ago and the articles that I came across were most likely well over a year ago. I don't recall how old the studies were but I've always focused on the most recebt info. We know how outdated "some" of the info on the web can be about breast cancer. I no longer research the topic since I don't focus on what was the cause of the micro invasion, it was there, can't change that fact so I just accepted it and chose to move on. I really try to focus on the postive; fortunately the microinvasion was caught very early & a SNB was done and it was negative. 0 -
I know the Core Biopsy can spread cancer or cause a more rapid growth from personal experience. I found a tiny lump on 27th September 2008, had a breast ultrasound done which found 3 lumps very close together, one was 0.4cm, one was 0.5cm and one was 0.8cm, radiologist thought lymph nodes clear. I had a core needle biopsy on 4th October which diagnosed cancer, then lump grew really fast, 6cm by the time it was removed on 15th October and 1 lymph node involved. I was told surgery wasn't urgent, go away and think about it......i pushed for earliest surgery date as just wanted it out, even so was stunned at 6cm tumour removed. Anyone else with similar experience?
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i was concerned about this too, but i was reassured by my surgeon that a biopsy does not cause breast cancer to spread. i have had many tests done since mid february. mammograms, ultrasounds, mri, bone scan, oh yes, and biopsy (done march 24th). i actually went yesterday for an self imposed ultrasound because i don't like the way my right breast has been feeling since the biopsy. i have been feeling frequent bruising pressure pain in my breast and it is slightly bigger than the other side. i mentioned it to my surgeon when i saw him on tuesday. he examined me and didn't seem to be worried. however, that didn't help me so i went to an ultrasound clinic and now i wait until next week for the report to get to my family physician and the phone call. i am scheduled for a double mastectomy on tuesday june 1. i have also sent a letter to a reputable surgeon in toronto princess margaret hospital to meet with him for a second opinion. hopefully i'll be able to meet him before june 1.
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Good luck with your surgery and many "happy thoughts" your way. Let us know how everything goes.
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Couple of Q,
1. So, if there is a risk that biopsies spread cancer, even if it is small, then should treatment be given asap after an invasive diagnostic?
2. Also, if there are mc and tumor, then should mc be biopsied first since they either are benign or in situ which does not metastize?
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Hi Leaf
You seem very knowledgable so I'm hoping you might know the answer to my question! My LCIS was diagnosed while they were poking around a fibrocystic lump I'd had for 12 years with disseminated Ca in it.
I've been reading up about LCIS and read somewhere that ~30% of ladies who die and are autopsied have LCIS and of course, never know. Are those ladies taken into account for the stats of LCIS... for instance I've been told that my risk of getting an invasive cancer is now 1 in 5, do those stats take into account only ladies like me who find they have LCIS as a lucky break or do they include a factor equivalent to the 30% of autopsied ladies? A bizarre question I know but I'm trying to assess my risks
Thanks
Robin
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Hi Orange12,
Did you small lumps engulf each other - in a two - three week period? That's scarey
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Hi RobinLM, I guess so, I only felt a lump the size of a pea before i went to the Dr, As soon as the Biopsy was done, the area swelled and seemed to increase in size, I assumed it was bruising, that's what google told me, then I went into hospital for the surgery and had to have a mammogram done before the op, then the cancer seemed to grow ferociously out of my chest....I am only an A cup bra, so you can imagine how big the lump was sticking out of my chest.... the mammogram was 2 days before surgery. I just think the tumour was very aggressive and did not like being investigated!!!
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I found a small pea size lump in the top of my left breast which a mammogram didn't pick up, which was located during an ultrasound estimating it to be 1.2cms, the doctor did 3 core biopsies of the tumour for diagnosis, I joked "that should kill it". He told us straight away it was cancer. My husband asked "now if that biopsy makes it grow, should she have an operation very soon?" to which he replied, "no biopsies don't make a tumour grow in size, it takes years".
I got into the hospital the next week to see a breast care nurse who booked surgery in 30 DAYS, what a shock to have to wait. Begged for a mastectomy, would only do a lumpectomy & sentinal node dissection. After surgery I waited 10 days for the histology of the cancer (pathology machine broken?) suddenly I was booked for 3 days later emergency mastectomy and total node removal which found 6cms multifocal IDC and a further mass of 9cms IDC insitu, with 3 nodes positive for metastic cancer - all in a matter of 6 weeks. It is HER2+ which I have been told is very aggressive.
So what does that show? Might go have a chat to that certain doctor about his assurances and give the hospital some "feedback" of my thoughts on the waiting times for surgery after breast cancer biopsies ...
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stphns_m, really interested to hear your story......I thought i was the only one with such a fast growing tumour. I see you also had a core biopsy like myself, the core biopsy is really aggressive isn't it, it's like they 'bite' the tumour several times, why don't they do a fine needle which seems much less invasive? I also had 10cm DCIS, there was a little there before biopsy, but not 10cm.
How are you doing now after Herceptin and everything?
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My wife was diagnosed with DCIS and on her mastectomy, after having had two other prior surgeries, a biopsy of the sentinel nodes found micromestatasis of non invasive cells on one of two. Her doctor could not believe the report and explained to me that during surgery, it is possible that some cells get loose and make the nodes positive. She went on further to say that stardards for reporting DCIS Cells as micrometastases is new and in the past, if the same thing was presented it would had been considered a negative node.
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Thank you for that information regarding "surgically removing the biopsy track line". I didn't know this but it makes me feel better knowing this is part of the protocol. I hope my surgeon did this because they were really digging around there during my biopsy.
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I have often wondered if the inflammation from a core biopsy can stimulate an aggressive breast cancer to go toward explosive growth. It seems to be reflected in so many of the stories of tumors going from less than a cm to 5 or 6 cm in just a few weeks.
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Roberto, my understanding is just slightly different than yours. In your wife's situation, if non-invasive cancer cells were found on one or two of her lymph nodes, then what likely happened is that the surgical tools were not properly cleaned or changed between the removal of the breast tissue and the removal of the lymph nodes. As a result, when the lymph nodes were being removed they were contaminated with DCIS cancer cells that were on the surgical tools. This is a very logical explanation of how non-invasive cancer cells can end up on a lymph node. But it is a bit different than saying that the cells got loose and moved during surgery. The cells didn't move on their own - they were moved by the surgeon's tools. And that is caused by sloppyiness on the part of the surgeon.
MsBliss, I've been on this board for a long time and I don't recall seeing very many posts where tumors went from less than a cm to 5 or 6 cms in just a few weeks. I know that those are the types of situations that are being described in the posts above, but usually there is an explanation and usually that explanation is not that the cancer grew so quickly and so suddenly. I'm not saying that this can't happen or didn't happen in the cases being described here, but it would be pretty unusual.
On the other hand, it's not unusual at all for the final pathology to show a larger area of cancer than what was expected. Usually this is because part of the cancerous area didn't show up on the mammo or ultrasound. That's what happened in my case. My mammo showed two areas of calcifications but when all my surgery was done, it turned out that I'd had DCIS throughout most of my breast. A good portion of my DCIS calcs were too fine to show up on the mammogram, but there's no doubt that they were there from the start. I think this happens a lot. This is why many surgeons want to have mammos, ultrasounds and particularly MRIs done prior to surgery. By looking at what's shown on all 3 different types of films, they go into the operation with a better idea of how much cancer might be in the breast. Still, even using all 3 diagnostic tools, the estimate of how much cancer there is can still be wrong. In my case, while my cancer didn't show up at all on my ultrasound and only showed up in two areas on my mammo (those were the two most aggressive areas), my whole breast lit up when I had the MRI.
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I had a biopsy showing DCIS in April. Surgery done June 29 was invasive II/III. I wondered about the biopsy allowing it to spread out as well.
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Sorry for reviving a somewhat older post but....
what if the core biopsy results came back negative but the patient really did have cancer after surgical biopsy.... since the core needle pathology didn't identify cancerous cells, is it unlikely that cancer cells were "moved"? thnx.
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BeepBeep, I recall thinking about that back when I was diagnosed, and I cannot recall exactly what piece of information settled my mind, but I DO remember at least thinking after what all they threw at me for a very large growth and two other cancers in my breast, a few cells just basically rearranged like that are not going to survive to travel.
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Yes. I had my core bx done a week before my mastectomy. When they did my mastectomy they found atypical cells on not in one of my lymph nodes. They suspect they traveled down from the core bx.because it was just resting on the LN which fortunately for me was the sentinal they removed.0
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I had stereotactic biopsy done prior to the BMX. As I had chosen (and it was possible) to have skin-sparing BMX, the surgeon was very careful to remove the scar of the stereotactic biopsy and the area around it, as well as the "line of the needle" right under the skin to make sure no "seeding" would have escaped the BMX.
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Day - I am glad your surgeon proceeded the way you describe - I had a localized recurrence about a year after my MX and the lump was right where the core biopsy scar was. I had 3 biopsies, one was diagnostic and the other 2 were part of a clinical trial so maybe I upped my chances for "needle seeding" ...
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now I can't say one way or the other, but I watched the screen when they did a core biopsy on my second lump and it exploded...went all over the place and it was breast cancer...so take a guess as
to what I think...
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I have often wondered this myself, and have in fact recently convinced myself that this could be true. How did I go with rather small tumors and no lymph nodes via ultrasound, MRI and PET/CT scan (ok, I had ONE node that was slightly lit up, but then looked bening on a CT scan and this was AFTER I had had this node biopsied so they were not at all surprised to see it light up)...sooo back to topic... How did I go with no nodes to four nodes at surgery? This is what I sometimes believe. That I had no nodes, that I had a Fine-needle aspiration biopsy on my DCIS followed by a Core needle biopsy during an ultrasound the next day on the tumors and also a biopsy at this time on the one node the radiologist said "if it were to go into any node, this would be the one as it is the largest and she was 99% sure it would be cancer free"...then one month later the surgery and four nodes. I don't think there is any proof that this could be true though. I asked my surgeon if the surgery could push cancer into the nodes and she said yes, but it would be a very small amount and the amount I had was visible to the eye so it couldn't have been caused by the surgery....So this all bothers me and I think about it a lot. I think this is because I am stage III and though it has been almost a year and a half (not long at all really), I am still very bothered by all of this...0
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Sorry I also didn't see the thread title. I hope I didn't scare the &#$%# out of anyone! 0
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I think this happened to me. My RO (who is the Chair of RO at Dana Farber) agrees. Here is my scenario:
I had Mammotome biopsy in June 2010, and developed huge hematomas (5 cm worth). I had a lumpectomy and SNB in July and my BS considered removing the hematomas while she was in there, but they were too big and had a vascular component. Because I was Stage 1, under 3 cm and no nodes involved and over the age of 50, I then had Mammosite radiation (brachytherapy) so only the tumor bed was radiated. I finished that at the end of July and went on Femara as I was slightly ER+. In December my tumor markers started to rise, in mid-February I developed a seroma. The BS looked at it in early March and sent me for a biopsy. It proved to be IDC with exactly the same pathology as my first instance, right down to the Ki67 rate, which was 90% By that time it had spread to my axilla lymph nodes and mammary nodes.
The consensus seems to be that there were cancer cells in the hematomas as that is where the "recurrence" showed up. And because they were just under the skin, I had extension to my skin. Not a good thing.
Not really a recurrence but there is no classification for "leftovers" according to my RO.
After a BMX in April and finishing 8 rounds of chemo, a PET in October showed the cancer is finally gone. Too bad I didn't have that done when I finished treatment last year, I might have my breasts and better odds for long-term survival.
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