Biopsy: One step or two

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 schedule.

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.