Evaluating the Need for Biopsies During Follow-up Care in Early Breast Cancer

Key Points

  • The 5- and 10-year overall incidence of breast biopsy was 14.7% and 23.4%, respectively, in the MarketScan cohort, and 11.8% and 14.9%, respectively, in the SEER-Medicare cohort. 
  • Adjuvant chemotherapy use, patient age, and endocrine therapy were independently associated with biopsy in both cohorts.
  • Of the patients who underwent a breast biopsy, 29.8% in the MarketScan cohort and 23.2% in the SEER-Medicare cohort underwent subsequent cancer treatment.

In an analysis of more than 120,000 women diagnosed with and treated for early-stage breast cancer, researchers from The University of Texas MD Anderson Cancer Center determined the rate of additional breast biopsies needed for these patients during their follow-up care.

The findings, reported by van la Parra et al in JAMA Surgery, are the first comprehensive nationwide population-based study regarding the need for breast biopsies performed during follow-up treatment for invasive breast cancer.

Research and data help physicians counsel women about breast cancer recurrence rates. However, in a thorough review of the literature, no data offered clues about how often a patient will require a biopsy after having had breast cancer, explained Henry Kuerer, MD, PhD, the study’s corresponding author.

“This is a genuine concern for patients. Many feel very anxious over the future need for biopsies and the potential of another diagnosis,” said Dr. Kuerer. “Women will often choose a mastectomy rather than have the fear and stress associated with future biopsies or another cancer diagnosis.”

Database Analysis

To gather information that could shed light on the need for follow-up biopsies, the researchers analyzed two national databases. They looked at 41,510 patients with breast cancer in MarketScan (the national database of patients with private insurance, aged 64 years and younger) and 80,369 breast cancer patients in Surveillance, Epidemiology, and End Results (SEER)-Medicare (patients aged 65 years and older).

All patients had stage I to III disease and were diagnosed between 2000 and 2011. Diagnosis and procedural codes were used to identify biopsy rates during follow-up.

Major Findings

The 5- and 10-year overall incidence of breast biopsy was 14.7% and 23.4%, respectively, in the MarketScan cohort, and 11.8% and 14.9%, respectively, in the SEER-Medicare cohort. Adjuvant chemotherapy use, patient age, and endocrine therapy were independently associated with biopsy in both cohorts.

Of note, said the researchers, the 5-year incidence of breast biopsy was higher in women treated with brachytherapy compared to those treated with whole-breast irradiation: 16.7% in the MarketScan cohort and 15.1% in the SEER-Medicare cohort. Also, after a mastectomy in one breast, the estimated 5-year breast biopsy rates for the other breast were 10.4% and 7.8% in the MarketScan and SEER-Medicare cohorts, respectively.

Of the patients who underwent a breast biopsy, 29.8% in the MarketScan cohort and 23.2% in the SEER-Medicare cohort underwent subsequent cancer treatment.

Dr. Kuerer noted the study is not without limitations, including that it is based on claims data. Also, he and his colleagues added that both imaging and targeted therapy for early-stage breast cancer may have improved since 2011, when the study concluded.

Still, he said, the research addresses an important issue that will allow surgeons to have more meaningful conversations with their patients.

“This information is something I can use daily when discussing breast cancer treatment options,” said Dr. Kuerer. “The important message is that the rate of biopsy for patients is relatively low and the overwhelming majority of the biopsy results will be benign and not require further treatment.”

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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