Longer Wait for Mammogram After Benign Breast Biopsy May Be Warranted

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Longer Wait for Mammogram After Benign Breast Biopsy May Be Warranted

By Kathleen Doheny
HealthDay Reporter

THURSDAY, May 2 (HealthDay News) -- Women who have a breast biopsy that turns out to be benign are typically told to undergo another imaging test, such as a mammogram, in six to 12 months. Now, a new study suggests that the longer interval might be better.

Researchers who followed women who had benign breast biopsies say having that test less than a year later finds few cancers and is a drain on health care dollars.

''Doing a follow-up imaging study six months after a benign needle breast biopsy has a low likelihood of finding breast cancer at the biopsy site," said study author Dr. Andrea Barrio, an attending breast surgeon at Bryn Mawr Hospital, in Pennsylvania.

Most of these women, she said, can wait longer than six months before repeating the mammogram, ultrasound or MRI.

Dr. Demitra Manjoros, a breast fellow at Bryn Mawr, is due to present the research Thursday at the American Society of Breast Surgeons' annual meeting, in Chicago.

A biopsy is done after an abnormality is found on an imaging test such as a mammogram. The standard of care is to perform an image-guided needle biopsy, Barrio said.

"However, when you do a needle biopsy, you only sample the lesion or abnormality, instead of removing it," she said.

So, the follow-up imaging was suggested. Under current National Comprehensive Cancer Network guidelines, the repeat imaging is recommended six to 12 months after a benign breast biopsy.

"In my practice, I perceived that this short-term imaging did not seem to add anything to the care of the patient," Barrio said.

So, she launched the study, focusing on 337 women who had benign biopsies and met one other criterion: Their pathologic findings explained the finding on the image. Researchers then looked to see if the interval for repeat imaging made a difference in finding cancer.

Of the 337 women, 169 had imaging repeated less than 12 months after their benign biopsy result. Another 101 had no documented imaging test repeated. And another 67 had repeat imaging 12 months or later after the biopsy.

Of the 169, just one breast cancer was identified. Of the 67 who had repeat imaging at 12 months, no malignancies were found.

The cost of detecting a missing cancer with the shorter interval follow-up was nearly $193,000 in this group.

The study findings support a policy of discontinuing repeat testing less than 12 months after such a benign finding, Barrio said.

The findings don't mean no one should have shorter-term imaging follow up, Barrio said. While in general, routine short-term repeat imaging after such a benign biopsy is not needed, she said, "I'm not saying nobody should do it."

"Certain women would require six months follow-up," she said. For instance, a woman whose initial imaging findings were vague or not specific might be advised to get repeat imaging in less than a year, she said.

A breast cancer expert commented on the new research.

The study is sound, said Dr. Laura Kruper, director of the Cooper Finkel Women's Health Center and co-director of the breast cancer program at the City of Hope Comprehensive Cancer Center in Duarte, Calif.

"I think most women would be fine having repeat imaging in 12 months," she said, "but it should be done on a selective basis." A doctor must take the whole patient into account, she said, weighing such factors as family history and a woman's views of the testing intervals.

"There are some patients who are going to be so nervous waiting a year," Kruper said.

The data and conclusions of research presented at medical meetings should be viewed as preliminary until published in a peer-reviewed journal.

Copyright © 2013 HealthDay. All rights reserved. SOURCES: Andrea Barrio, M.D., attending breast surgeon, Bryn Mawr Hospital, Bryn Mawr, Pa.; Laura Kruper, M.D., director, Cooper Finkel Women's Health Center, and co-director, breast cancer program, City of Hope Comprehensive Cancer Center, Duarte, Calif.; May 2, 2013, presentation, American Society of Breast Surgeons annual meeting, Chicago

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Caution Warranted as E15 Launches in Kansas

From Kansas we hear that a gas station owner in Lawrence has become the first in the country to offer E15 fuel – gasoline with 15 percent ethanol instead of the 10 percent blend that’s standard around the U.S. According to the New York Times, Scott Zaremba may expand E15 to more of his eight stations.

Before motorists in the Lawrence area rush down to fill up, they might take the time to check their vehicle warranties. Even though the EPA has approved E15 for cars and light trucks from model year 2001 forward, a Coordinating Research Council study showed that the fuel can cause engine damage. Automobile manufacturers have said vehicle warranties will not cover damage from E15. Bob Greco, API downstream group director:

“We need to press the pause button on EPA’s rush to allow higher amounts of ethanol in our gasoline. The new fuel could lead to engine damage in more than 5 million vehicles on the road today and could void the manufacturer’s warranty.”

Greco said E15 also could damage engines in boats, recreational vehicles and lawn equipment. Consumers should follow the fueling recommendations in their owner’s manuals and carefully read all gasoline pump labels before refueling, he said.

Potential problems with E15 – which is being advanced as a way to help meet volume requirements set out by the Renewable Fuels Standard – were discussed at a hearing on Capitol Hill this week. API President and CEO Jack Gerard criticized EPA’s rush to push E15 into the marketplace:

“EPA should not have proceeded with E15, especially before a thorough evaluation was conducted to assess the full range of short- and long-term impacts of increasing the amount of ethanol in gasoline on the environment, on engine and vehicle performance, and on consumer safety.”

Greco said consumer protection is paramount:

“Our first priority should be protecting consumers and the investments they’ve made in their automobiles. EPA has an obligation to base this decision on science and not on a political agenda.”

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