Advocate for Just a Biopsy
TLDR - After you are diagnosed with cancer, advocate for "Just a Biopsy" then talk to an oncologist and a specialized surgeon
When faced with a potential breast cancer diagnosis, many women understandably want to take swift action to remove any suspicious lumps or masses. However, rushing to surgery without first obtaining a biopsy can lead to more aggressive and toxic treatment (see links at the end of this post). As a breast cancer survivor and advocate, I want to highlight why women must insist on getting a biopsy before any surgical removal of breast tumors. This is not medical advice or a recommendation for a path of treatment - I’m not qualified to do either - but it is about having as much information as possible so that you and your doctors can evaluate all your treatment options.
The Importance of Starting with Just a Biopsy
Current breast cancer treatment guidelines strongly recommend obtaining a pathologic diagnosis through biopsy before any surgical intervention. This practice ensures optimal diagnostic accuracy and allows for personalized treatment planning based on the specific characteristics of the tumor.
A core needle biopsy provides critical information about the tumor type, grade, hormone receptor status, and other biomarkers that guide treatment decisions. This data helps determine whether chemotherapy should be given before or after surgery, and what type of surgery (lumpectomy vs. mastectomy) is most appropriate.
Biopsy also reduces unnecessary surgeries - studies show core biopsy can decrease surgical excisions for benign breast disease by up to 30%. This spares many women from undergoing invasive procedures for lumps that turn out to be non-cancerous.
The Risks of Premature Tumor Removal
Unfortunately, some surgeons still recommend removing suspicious breast masses without first performing a biopsy. This approach carries several risks:
It prevents optimal sequencing of treatments. For many breast cancers, doing chemotherapy before surgery (called neoadjuvant chemotherapy) leads to better outcomes. However, this requires having an intact tumor to monitor response.
It can lead to more aggressive treatments than necessary. Without biopsy data, doctors may default to more toxic chemotherapy regimens "just to be safe."
It limits eligibility for specific treatments. Some newer, less toxic therapies are only available for patients with tumors still in place.
Real Patient Stories
To illustrate these risks, here are a few real examples of women who did not receive biopsies before tumor removal:
Sarah was diagnosed with early-stage triple-negative breast cancer. Her surgeon removed the tumor immediately, which turned out to be aggressive and had spread to a lymph node. Because the tumor was gone, Sarah was ineligible for less toxic chemotherapy regimens and had to endure harsh AC chemotherapy.
Lisa has lobular breast cancer. She underwent a bilateral mastectomy before her chemotherapy plan was determined. She now faces AC chemo without knowing if it will be effective for her specific tumor type.
Carla was told to get a mastectomy first for her newly diagnosed breast cancer. She then had to endure very toxic AC chemo without being able to monitor if it was working, followed by radiation to an unclear target area. The radiation damaged her implants, and she's now considering additional reconstructive surgery.
Contrast this with my experience: I was diagnosed the day before a planned prophylactic mastectomy. My breast surgeon canceled the surgery, recognizing that doing chemo first would likely lead to better outcomes. Because my tumor remained intact, my oncologist was able to use a less toxic initial chemotherapy regimen. If that hadn't been entirely successful, we could have then moved to more aggressive treatment. However, keeping the tumor in place gave my doctors crucial flexibility to evaluate the chemotherapy efficacy and then to remove the remnants of the now-obliterated tumor during surgery.
How to Advocate for Yourself
If you're facing a potential breast cancer diagnosis, here are some key steps to take:
Resist the overwhelming urge to get the tumor out of your body as fast as possible. I understand, and I felt that way too. But it's often not the path to the best outcomes per the current guidelines for treating breast cancer especially Triple Negative Breast Cancer (TNBC) and HER2+ breast cancers, according to the American Society of Clinical Oncology (ASCO). The best outcome trumps anxiety-driven surgery.
Insist on a biopsy before any surgical intervention. I found the ultrasound-guided fine needle aspiration to be virtually painless. The ultrasound-guided core needle biopsy was painful.
Ask about tumor characteristics, biomarker status, and how they impact treatment options.
Discuss the pros and cons of neoadjuvant (before surgery) chemotherapy with your oncologist.
If surgery is recommended, ask why and what impact that may have on subsequent treatment options. Remember, current guidelines recommend chemotherapy first for cancers that require it.
Consider getting a second opinion, ideally from a breast surgeon at an academic medical center.
Remember, you can ask questions and be fully informed about your treatment plan. While dealing with a cancer diagnosis is overwhelming, taking the time to ensure proper diagnostic steps can make a huge difference in your care. By advocating for a biopsy first, you'll set yourself up for the most personalized, effective treatment possible.
Scientific studies informing the current guidelines.