“Doctor, I heard needle biopsies can cause cancer to … spread? I’ve discussed this with my family. I don’t want the needle biopsy.”
Though her tone betrayed fear and uncertainty, she appeared firm in her decision, influenced by her family’s beliefs.
Dahlia*, in her 40s, was recalled after a routine screening mammogram revealed a small cluster of suspicious microcalcifications.
There was no lump. No pain. Nothing she could feel.
I explained that these tiny calcium deposits could represent ductal carcinoma in situ (DCIS), a very early, non-invasive form of breast cancer confined within the milk ducts. A needle biopsy would help us establish the diagnosis and plan appropriate treatment.
Despite my reassurances, she declined the biopsy.
A year later, she returned. This time, with a breast lump.
A biopsy confirmed invasive breast cancer with aggressive features. She now faced chemotherapy as part of her treatment.
“Doctor, would things have been different if I had done the biopsy last year?”
It was a heartbreaking question. I could not tell her with certainty. We could not know whether invasive cancer had already been present a year earlier. But we had missed an opportunity to investigate the original area of concern and establish a diagnosis and treat the disease sooner, partly because of fear stemming from a common misconception that a needle biopsy causes cancer to spread.
What Does Scientific Evidence Show?
A systematic review involving 5,369 patients across 15 studies [1] found that needle biopsies can occasionally cause microscopic cancer cells to be displaced along the needle track. However, there was no demonstrated increase in local cancer recurrence or poorer survival, although survival data were limited. Subsequent reviews [2] [3] reinforce that microscopic cancer cell displacement does not necessarily translate into clinically significant cancer spread or worse long-term outcomes, with evidence suggesting that displaced cells may not remain viable over time.
Clinically significant cancer spread requires more than the displacement of cancer cells; it requires cells to survive, invade surrounding tissues, enter the body’s circulatory system, evade immune defences and establish themselves in distant tissues, where they can grow.
Current evidence supports the use of needle biopsies as an important and generally safe diagnostic procedure. Delaying a recommended biopsy, on the other hand, may delay diagnosis and the opportunity to make timely decisions about treatment.
A Recall Is Not A Diagnosis
Not every suspicious finding on a screening mammogram means cancer. Not every case of DCIS becomes invasive. But without a biopsy, we may not be able to reliably distinguish abnormalities that are harmless from those that require treatment.
Our concern should not be that a biopsy will spread cancer but the delay of an undiagnosed cancer being given more time to progress.
This Breast Cancer Awareness Month, do not let the fear of a needle prevent you from seeking the answers you need. If you have concerns about a recommended biopsy, speak to your breast specialist and understand your options before making a decision.
Article contributed and reviewed by Dr Esther Chuwa, Senior Consultant & Breast Surgeon at Solis Breast Care & Surgery Centre.
*The patient’s name has changed to protect her identity
References
[1] Liebens F, Carly B, Cusumano P, Van Beveren M, Beier B, Fastrez M, Rozenberg S. Breast
cancer seeding associated with core needle biopsies: a systematic review. Maturitas. 2009
Feb 20;62(2):113-23.
[2] Loughran CF, Keeling CR. Seeding of tumour cells following breast biopsy: a literature review.
Br J Radiol. 2011 Oct;84(1006):869-74.
[3] Holmes DR. Reducing the Risk of Needle Tract Seeding or Tumor Cell Dissemination during
Needle Biopsy Procedures. Cancers (Basel). 2024 Jan 11;16(2):317