Not too many years ago, all women undergoing
surgery for breast symptoms had a "one-step" procedure: If the
surgical biopsy showed cancer, the surgeon proceeded immediately
with mastectomy. The woman went into surgery not knowing if she had
cancer, and woke up not knowing if her breasts were intact.
Today a woman facing biopsy has a broader range of options. In
most cases, biopsy and diagnosis will be separated from any further
treatment by an interval of several days or weeks. Such a
"two-step" procedure does not adversely affect outcome, and it
provides several benefits. It allows time for the tissue sample to
be examined in detail and, if cancer is found, it gives the woman
time to adjust to the diagnosis. She can review her treatment
options, seek a second opinion, receive counseling, and arrange her
Some women nonetheless prefer a one-step procedure. They have
decided beforehand that, if the surgical biopsy and frozen section
show cancer, they want to go ahead with surgery, either mastectomy
or breast-conserving surgery and axillary dissection (removal of
the underarm lymph nodes). If, on the other hand, the lump proves
to be benign, the incision will be closed; the procedure will have
taken less than an hour, and the woman may go home the same day or
the next day.
A one-step procedure avoids the physical and psychological
stress, as well as the costs in time and money, of two rounds of
surgery and anesthesia-a particularly important consideration for
women who are ill or frail. Women who have clinical signs of cancer
can find the wait between biopsy and surgery emotionally draining,
and they may be relieved to have a one-step procedure to take care
of the problem as quickly as possible.
No single solution is right for everyone. Each woman should
consult with her doctors and her family, weigh the alternatives,
and decide what approach is appropriate. Being involved in the
decision-making process gives a woman a sense of control over her
body and her life.