A study in Florida found that 30% of breast biopsies there between 2003 to 2008 were surgical, even though medical guidelines say the rate should be 10% or less. Some observers are questioning what's motivating surgeons to perform so many open biopsies instead of referring patients to radiologists for less-invasive, less-expensive needle biopsies. Are surgeons unaware of the guidelines, they ask, or unwilling to forfeit biopsy fees?

"Open biopsy is incredibly over-utilized," says University of Florida surgeon Luke Gutwin, MD, co-author of a study published by the American Journal of Surgery that looked at 172,342 biopsies, the largest examination of open biopsy rates in the United States.

If the patterns in Florida hold true for the rest of the country, more than 300,000 women a year are having unnecessary surgery, according to a report in the New York Times. Besides being more expensive, open biopsies often require general anesthesia and can affect the type of treatment that the patient receives later if she does have cancer. "It often will mean that patients, where they could have had 1 operation, end up with more than 1 operation," says Stephen Grobmyer, MD, a co-author and colleague of Dr. Gutwein, in a statement.

Hospital charges and doctors' fees amount to twice as much for an open biopsy as for a needle biopsy, with hospitals charging $5,000 to $6,000 for a needle biopsy and $10,000 to $12,000 for an open biopsy, says Dr. Grobmyer, and doctors receiving an average $2,000 for an open biopsy or $1,100 for a needle biopsy.

About 80% of breast biopsies are benign. Of the 1.6 million breast biopsies performed last year, only about 261,000 found cancer.

Kent Steinriede