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More than one third of Texas women still receive unnecessary breast biopsy surgery

Thu, 16 May 2013 16:36:00 GMT

Many women in Texas who are found to have an abnormality on routine mammogram or discover a lump in one of their breasts end up having an old-fashioned surgical biopsy to find out whether the breast abnormality is malignant. Since 2001, national expert panels have recommended that the first course of action for women with breast lumps or masses should be minimally invasive biopsy.

Minimally invasive biopsies are most commonly done under ultrasonographic or X-ray guidance, with either a fine needle or preferably a “core tissue extraction” needle. They do not require surgery or anesthesia and leave little to no scarring. Most importantly, a diagnosis of benign (non-cancerous) or malignant (cancerous) breast mass can be determined before any decisions about treatment are made.

UTMB Director of Breast Imaging Dr. Morton Leonard points to a suspicious mass in a breast mammogram image. Click here to download a high-resolution version of the photo.

In spite of these benefits, new research from the University of Texas Medical Branch published in the Journal of the American College of Surgeons shows that expensive, invasive surgical breast biopsies remained the first diagnostic step for 35 percent of women diagnosed with a breast mass between 2000 and 2008 in Texas. The investigators performed an exhaustive analysis of Texas Medicare data from 2000 to 2008, including more than 87,000 breast biopsies.

The traditional method of removing the mass through surgery to obtain a definitive diagnosis has a number of negative consequences. If the mass is benign, then the woman had surgery unnecessarily; in fact, only 40 percent of the women studied ended up having breast malignancies. Simply put, thousands of women throughout Texas underwent surgery just to find out they did not have cancer.

Jennifer Thomas, UTMB mammographer, shows the core tissue extraction needle used for minimally invasive breast biopsies. Click here to download a high-resolution version of the photo.

On the other hand, if the mass is malignant, more surgery will probably be required to remove more tissue, so the patient will end up having to have multiple surgeries instead of only one. Surgery is far more expensive than needle biopsy, so for the Medicare patients in this study who underwent biopsy surgery, the government had to pay a much steeper tab.

“There is no benefit to the patient in having an expensive, invasive surgical procedure instead of a needle biopsy,” said senior author Dr. Taylor Riall, UTMB associate professor of surgery and a lead investigator for the study. “We need to get the word out to women across the state that surgery is not the procedure of choice for definitive diagnosis of a breast mass.”

The American Society of Breast Surgeons, the American College of Radiology and the National Cancer Center Network have all endorsed minimally invasive breast biopsy as providing results that are as accurate as surgical biopsies.

“At UTMB, minimally invasive biopsies are our diagnostic procedure of choice. We do them more than 98 percent of the time,” said Riall.

The National Cancer Center Network is trying to find out what barriers stand in the way of reaching a 90 percent rate of minimally invasive breast biopsies nationwide. The study is a step in providing crucial information that will help in the national effort.

This research, which was supported by the Comparative Effectiveness Research on Cancer in Texas research project, also examined the time trends, racial/ethnic variation and geographic variation in the use of biopsy techniques. It is the most detailed study of breast biopsy patterns undertaken in the United States and was funded by the National Institutes of Health and the Cancer Prevention Research Institute of Texas.

Co-authors are Christopher Zimmermann, Kristin Sheffield, Dr. Casey Duncan, Yimei Han, Catherine Cooksley and Dr. Courtney Townsend.

What you can do now to help prevent age-related muscle loss

Wed, 15 May 2013 14:58:00 GMT

UTMB’s Douglas Paddon-Jones and Dr. Elena Volpi weigh in on how best to prevent age-related muscle loss. Paddon-Jones advises doing resistance training: “It’s massively important for building muscle — and preventing it from vanishing in the first place.” If you’re deficient in vitamin D (your doctor can do a simple blood test) consider upping your daily intake with a supplement, suggests Volpi.

The surprising connection between your sinuses and stroke

Wed, 15 May 2013 14:55:00 GMT

Many of us already know that sinus conditions can trigger headaches and congestion, but a new study from Taipei Medical University says the inflammation that causes the pain and pressure of a sinus infection also increases the odds of suffering a stroke. UTMB’s Dr. Meera Gupta explains that sinus infections are most commonly caused by the same viruses associated with the common cold. When a virus sets up shop in your sinuses, it produces inflammation that causes the telltale pressure around the nose and eyes.

Can genetic testing determine your arthritis risk?

Wed, 15 May 2013 14:52:00 GMT

“Osteoarthritis has less of a genetic component than rheumatoid arthritis,” says UTMB’s Dr. Emilio Gonzalez. Experts say about 30 percent of the risk of OA is probably genetic. “But even if a [genetic] test revealed that you had an elevated risk, the advice wouldn’t differ from what we tell everyone, regardless of their family history or genes: Keep your weight in check, don’t smoke, and exercise regularly.”

Get in more fruits and veggies by juicing them

Wed, 15 May 2013 14:50:00 GMT

In this week’s column, UTMB’s Dr. Victor S. Sierpina writes about the benefits of juicing. “Drinking your fruits and veggies can easily get you on your way to meeting the minimal of servings we need daily. One good smoothie or juice can give up to 3-4 servings of plant-based antioxidants, fiber, vitamins, in a single easy to prepare, refreshing drink. All you need is a blender or juicer, some simple ingredients, and a little motivation.”

Tips for traveling in airplanes with kids

Wed, 15 May 2013 10:04:00 GMT

In this week’s Keeping Kids Healthy column by UTMB Drs. Sally Robinson and Keith Bly: The American Academy of Pediatrics has tips for traveling by air with children. “Talk to your children before coming to the airport about the security screening process. Let them know that their bags (backpack, dolls, etc.) will be put in the X-ray machine and will come out the other end and be returned to them.”

Keeping Kids Healthy - Tips for traveling in airplanes with kids

Wed, 15 May 2013 09:03:00 GMT

Keeping Kids Healthy
By Sally Robinson and Keith Bly

Traveling with children can be a challenge.

The American Academy of Pediatrics has tips for the entire family. Here are some tips to follow when traveling by airplane:

• Allow yourself and your family extra time to get through security — especially when traveling with younger children.

• Have children wear shoes and outer layers of clothing that are easy to take off for security screening.

• Talk to your children before coming to the airport about the security screening process. Let them know that their bags (backpack, dolls, etc.) will be put in the X-ray machine and will come out the other end and be returned to them.

• Discuss the fact that it’s against the law to make threats such as: “I have a bomb in my bag.” Threats made jokingly (even by a child) can result in the entire family being delayed and could result in fines.

• Similar to travel in motor vehicles, a child is best protected on an airplane when properly restrained in a car safety seat appropriate for the age, weight and height of the child, meeting standards for aircraft until the child weighs more than 40 pounds and can use the aircraft seat belt.

You also can consider using a restraint made only for use on airplanes and approved by the FAA. Belt-positioning booster seats cannot be used on airplanes, but they can be checked as luggage (usually without baggage fees) for use in rental cars and taxis.

• Although the FAA allows children 2 and younger to be held on an adult’s lap, the AAP recommends that families explore options to ensure that each child has his or her own seat. Discounted fares might be available. If it is not feasible to purchase a ticket for a small child, try to select a flight that is likely to have empty seats.

• Pack a bag of toys and snacks to keep your child occupied during the flight.

• In order to decrease ear pain during descent, encourage your infant to nurse or suck on a bottle. Older children can try chewing gum, drinking water or juice through a straw or filling up a glass of water and blowing bubbles through a straw — 4 years of age or older.

• Wash hands frequently; consider bringing hand-washing gel to prevent illnesses during travel.

• Consult your pediatrician before flying with a newborn or infant who has chronic heart or lung problems or with upper or lower respiratory symptoms.

• Consult your pediatrician if flying within two weeks of an episode of an ear infection or ear surgery.

Sally Robinson is a clinical professor of pediatrics at UTMB Children’s Hospital, and Keith Bly is an associate professor of pediatrics and director of the UTMB Pediatric Urgent Care Clinics. This column isn’t intended to replace the advice of your child’s physician.

SARS-like virus vaccine unlikely, experts say

Tue, 14 May 2013 11:48:00 GMT

A virus similar to SARS has spread through hospitals in Europe and the Middle East, prompting fears of human-to-human transmission. But health officials said vaccines were unlikely to play a role in controlling the outbreak, which has sickened 34 people and killed 18. Instead, they've focused on detecting the novel coronavirus, dubbed nCoV, and have quickly isolated patients. UTMB’s Thomas Ksiazek said “mindfulness” is key once again, as a vaccine for nCoV could take years to develop and test. “The thing that really takes time is the regulation aspect of it,” he said, describing the lengthy process of proving safety and efficacy in animal models before even thinking about testing in humans.

Timing is everything for key protein

Tue, 14 May 2013 11:46:00 GMT

The relationship between the processes of RNA reading and protein folding is at the center of paper recently published in the journal Nature on circadian rhythms. UTMB associate professor José Barral played a key role in the project that produced the paper, which was led by a team from the University of Texas Southwestern Medical Center and also involved scientists from Texas A&M University and China’s National Institute of Biological Sciences.

Nonsurgical prostate cancer treatment a first of its kind in Texas

Tue, 14 May 2013 11:44:00 GMT

A new nonsurgical prostate cancer treatment offered at UTMB virtually eliminates the side effects of impotence and incontinence that can occur when patients receive the traditional treatment for prostate cancer — surgical prostate removal. UTMB’s chairman of radiology Dr. Eric Walser is one of only a few physicians in the world and the only physician in Texas who performs this groundbreaking procedure. [Note: This article was written by Molly Dannenmaier of UTMB’s Office of Marketing and Communications. Send your story ideas to public.affairs@utmb.edu.]