Perhaps during a routine screening, you or your doctor found a lump; perhaps you’re experiencing some kind of pain in your breast. If a mammogram or exam requires a closer look, your doctor may request a biopsy. Leading up to that biopsy, your anxiety might be building, as you wonder whether it’s something benign or not. During the biopsy appointment, you will likely wear a paper gown while your breast is exposed and numbed. A doctor inserts a needle into your breast to remove a tissue sample (maybe more than one), alerts you that you may hear a pop sound and asks you to hold still. Even though you don’t feel any pain, the loud pop startles you. You just want this to end.
This is not an uncommon patient experience, and concern or anxiety about the procedure has caused patients to forego needed biopsies. This is why it’s important for medical technology companies and clinicians to continue to put the patient front and center as they bring innovations to market and determine how to deliver the best care possible. Vanessa Wear, MD, Director of Breast Imaging at Advocate Illinois Masonic Medical Center in Chicago, is proactive in using new technology that offer improvements in functionality, sound, ergonomics and efficiency. We spoke with Dr. Wear about how these innovations have impacted her patients’ experience as well as her own clinical performance.
How willing are patients to be screened and how do they react to learning that they need a biopsy?
We have a very vocal community about breast cancer screening; however, screening rates definitely took a hit this past seven months with COVID-19. Women put off mammograms, because they were scared to come in. Hopefully now that we’re getting a better handle on COVID-19, people will come in for screenings again. Men were hesitant to come in even before the pandemic, so we often end up finding their breast cancer in later stages.
When most women or even men learn that they need a biopsy, they may be in complete denial and will ask: “are you sure I need a biopsy? No, I think I'm fine.” Every once in a while, I have a patient say: “I don't want to do this procedure. I'm not doing it.” That’s when I have to tell them I think the situation is worrisome and that we need to schedule this biopsy. I try to not go down that road if I don't have to, because sometimes the masses can be benign. After talking to the patient and describing the procedure, they usually understand that it's not as traumatic as they think. Most of the time, however, patients want to get it over with and get the results as soon as they can, and my goal is to get in and complete the procedure and get out, so that women aren’t on the bed too long. They're vulnerable, they're nervous. They have their breast exposed. They’re uncomfortable. So I try make sure they know it's going to be okay and then get the biopsy done as quickly and safely as I can. Afterwards, they're frequently like: “Wow, that wasn't bad. That was so fast.” So, they usually leave having had at least a better experience than they had anticipated.
What tools are you using now and what have recent innovations in device technology meant to your practice?
In the past, I'd used different spring-loaded devices. With a spring-loaded device, you have to insert the needle, fire, pull out of the breast, take that sample out, put it back into the breast, and fire again. Going in and out of the breast can be traumatic for the patient, and it takes a little bit longer. With the vacuum device, like the BD EleVation™ Breast Biopsy System, you go in one time, you pop once, and you can take four to eight different samples, so there's not that trauma of going in and out of the breast. The only time they hear a second pop is if I want to move to a different part of the mass. I just tell patients, “You're going to hear the same noise again, we're almost done,” and my perception is that most women aren’t too bothered by the noise. Additionally, I use both the 14-gauge and the 12-gauge needles. I love the 12-gauge needle, because the samples are large, and I only have to take a few samples, which further lessens the time that the device is in the patient's breast.
Do you think newer biopsy technologies can help to improve re-biopsy rates and, if so, how do you think that would impact the patient experience?
I think that technology can help to make a difference in the re-biopsy rate. For example, if you can get a good sample the first time, then that can help to avoid the need to collect another sample. Devices with vacuum-assisted technology have been shown to help physicians retrieve a larger volume of sample per biopsy when compared to core needle devices.
For a patient, that re-biopsy doesn’t necessarily impact their treatment process much, because we try to get them in quickly, but having to come back again can have a possible effect. They may wonder what went wrong last time. It introduces an element of doubt to our abilities as physicians and that confidence is important for patients. Even thinking of myself as a patient, when something hasn’t gone right the first time, I question whether I should have gone to a different surgeon or hospital. I don't want my patients to worry about that. I understand that patients have choice for their provider, and I don’t want to lose them to another hospital. I want to make sure that they trust us and have confidence that we're doing it right the first time and giving them the best care that we can.
Why is it so important that med tech device companies keep innovating and that clinicians adopt these tools?
It can make a difference in both the clinical and patient experience. On average, biopsies I’ve timed that I’ve done with the BD EleVation™ Breast Biopsy System have taken around one minute—so it’s fast enough that I'm literally in there and out of there—whereas other devices may take as long as five minutes. It doesn't sound like much, but for a woman who's nervous, whose breast is exposed, who's staring right at you or right at the screen, those four minutes can make a big difference. Also, having a tetherless device—meaning that there’s no wires—makes it easier and more convenient to work with. It’s easy to manipulate if you need to be moving the device around in the breast, you don't trip over it, and you don't have a big console to control the wires and vacuum.
Most of the doctors I've introduced to the device find it comfortable to use and like it going forward. I don't understand why physicians still biopsy with older methods. Some resist the change for a combination of reasons, including comfort and the “if it’s not broken, don’t fix it” mindset, as well as a concern about potential up-front financial or administrative expenditures. Fortunately, my administrative staff have been very supportive.
At the end of the day, my goal is to provide the best possible care that I can for my patients. They’re usually relieved when the procedure's over. They smile and say: “wow, thank you. That was so much better than I thought it would be.” And I ask: “Did you Google the procedure before coming in?” And they say: “Of course!” And so it's nice to just show them that it's not as bad as they anticipated. That always just makes me smile and feel good. I hope they'll send that message to their friends, so that when their friend or loved one needs a biopsy, there’s hopefully less concern about the procedure.
Learn more about how BD EleVation™ Breast Biopsy System takes the patient experience to the next level at bd.com
The BD EleVation™ Breast Biopsy System is indicated to obtain tissue samples from the breast or axillary lymph nodes for diagnostic analysis of breast abnormalities. The BD EleVation™ Breast Biopsy System is for diagnostic use only, NOT for therapeutic use. The BD EleVation™ Breast Biopsy System is contraindicated for those patients where, in the physician’s judgment, there is an increased risk of complications associated with percutaneous removal of tissue samples. Please consult product labels and inserts for complete indications, contraindications, hazards, warnings, precautions and directions for use.
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