Thank you PJ for acknowledging that these marker clips can cause problems for women. The widespread assumption is that if women were having problems with their clips we would surely have heard about it. The fact is that many doctors have no clue about these clips or why women might be experiencing post-biopsy pain. Women who present with unusual problems like post-biopsy pain or symptoms that they attribute to their clips are often not taken seriously. And it does not seem that anyone working in the medical profession (should I say industry?) is interested in systematically collecting women's reported experiences with these clips.
I myself have been experiencing significant post-biopsy pain for 8 months. I never wanted the clip in the first place and was pressured into accepting it. Any woman who is fortunate enough to find a surgeon who will remove the clip risks worse pain and sensitivity that may never abate, possible disfigurement (unless she finds a very good surgeon), and permanent loss of sensation in her nipple.
You suggest that a breast biopsy is performed only a last resort. I would beg to differ. It is safer, legally, especially in the United States, for a radiologist to perform a biopsy even when it likely that no cancer will be found. Check the medical journals and see what radiologists are advising. If you cannot find any articles, let me know and I will forward you some titles.
In the meantime, I would suggest that women explore their legal options and consider launching a class action suit against any cancer agency or medical organization that 1) pressures women to comply with procedures they don't want and 2) fails to properly inform women about all the risks, both physical and psychological, associated with mammography and related surgical procedures.
Voice of Experience
It would appear that many "needless" biopsies are being performed, since the number of negative ones hover around 85%. But it's a tough call; how do you decide not to biopsy a lump, when all other tests have proved inconclusive? It gets back to the mammogram debate - how much needless pain and suffering do you put X number of women through to identify one cancer - to save one life?
'm sure a lot of biopsies in the U.S. are driven by fear of malpractice suits; it's something I'd love to see better addressed in the current health care reform environment. (And yes, I'd like to see links for those papers, if you could share). And I'd love to see more acknowledgement (well, any acknowledgement) that titanium clips CAN cause issues; and to have possible side effects shared prior to surgery, as you say. Perhaps a class action suit would indeed get the attention of the FDA... Thanks for sharing here. PJH
Here is an informative article on the topic of breast cancer and malpractice litigation. It appeared in a peer reviewed medical journal. I hope many women will read this article and consider its contents carefully.
Berlin, L. (2003). Breast cancer, mammography, and malpractice litigation: The controversies continue. American Journal of Roentgenology, 180, 1229-1237.
- Voice of Experience
Forgot to mention that you mentioned that any woman who has the chip removed risks loss of permanent sensation in the nipple. That wouldn't bother me because the only sensation I have there is numbness in 3/4 of it and pain in the other 1/4 anyway -- certainly not the type of sensation any woman would want.
I had a biospy in my breast 8 yrs. ago it came back negative,placed titanium clip in. and while getting a MRI for calcifications which turned out to be nothing, they found a spot around the clip, biospied and it came back positive for cancer I go in for surgery next week. i am so up set, i do not know if i should pe
perrsue this any further.. PB
PB, I'm sorry to hear about your cancer diagnosis. If you are worried that the clip might have caused the cancer, be sure to discuss that with your doctor. Since the clip was originally placed to be able to find a trouble spot later, I doubt that there is a cause/effect relationship. One of the first things we do when learning we have cancer is try to figure out what might have caused it. Unfortunately, there usually is not an easy answer. I hope that your surgery goes well and wish you well with your treatment.
My opinion is, you'd have a very long row to hoe trying to prove the clip had anything to do with your cancer. I feel strongly, given the body of scientific evidence, that it was a random coincidence. Think what it would cost you, in money, time, and emotional distress, to try to connect the two (via a lawsuit, I'd assume); do you really want to go through that at the same time you're having cancer treatment? You're understandably upset; but why not put all the energy you have towards getting through treatment the best way possible, without voluntarily putting yourself through a lot of self-induced stress?
Could be that you actually did have cancer 8 years ago, when they placed the clip, and it was so infinitesimal that it was missed; breast cancer can be extremely slow-growing. If that's what you were considering pursuing, I think you'd have an equally hard time from that angle. So, all in all, it might be better to just move forward, without looking back - that's my opinion, anyway. Take care, and I hope your treatment goes well. PJH
The medical literature shows that many studies have found an increase in cancer rates in women who undergo screening mammography as compared with those who do not undergo screening. In an article called "Mammography Saves Lives--Or Does It?" (published in the American Journal of Nursing in January 2004, volume 1, number 4), Maryann Napoli draws attention to this and says that Michael Retsky, PhD, and colleagues have suggested that this increase in mortality in screened women is "due to the surgery that often follows an abnormal mammogram. . . They suspect that a surgical procedure, performed during a time of hormonal fluctuations within the premenopausal breast, could trigger the growth of invasive cancers in those with dormant micrometastases."
This connection between screening mammography and breast cancer rates is known within the medical community, but most women are not informed about this increased cancer risk prior to giving their consent to screening or biopsy procedures. One might not get cancer from the clip specifically, but one could certainly get cancer as a result of having a biopsy, especially since they require several x-rays be taken. There is documented medical evidence to show this correlation.
Surely it is negligent to not inform women about all the risks.
These markers hurt terribly! I too have had them put in and many times a day it feels like a terribly painful pinch or tear. In fact they hurt so much that I have not had a mammogram since my operation 3 years ago for fear that I will damage the breast even more from the marker.
I am very angry that they abuse women's bodies in this manner. They should be sued for putting these things in women without their permission.
Furthermore, after hearing that breast implants cause cancer, I am really really angry over these clips. If they are causing constant pain they will certainly bring about cancer down the road and the surgeons will get off scott free while women read in the newspaper that these markers cause cancer.
I don't like having a lot of foreign bodies in my body because I think the more you have, the more the cells learn to disregard fighting off foreign bodies, and they may confuse some cancerous cells with foreign bodies as well.
I have complained and complained about the pain but doctors refuse to listen to women. If big pharma said the markers don't hurt, then the hell with what women say. The men will tell the women they simply don't hurt.
These things are so painful they should be banned and every surgeon who has put them in without the permission of women should be sued!
I am very angry that I will have to have these painful markers in for the rest of my life and I really really hate Big Pharma as well as all cancer organizations for allowing this abuse against women!
I will never ever get a mammogram again with these markers causing so much pain!
I also have had continuing pain following my biopsy and my surgeon is no help She says, it cannot be the clip, and she refuses to remove it. I have to search blindly until I find some surgeon who will take it out.
I was never informed that this clip was optional, that I could have the biopsy without the clip being placed in my breast, and I consider that disgraceful.
My clip was made by a subsidiary of a medical device making company which has had a string of recalls recently. So assurances that this clip is not contaminated do not impress me.
I won't go back for a mammogram either. Besides the inflammation from this clip I was exposed to extra radiation targeted right at my breast where they thought I might have cancer. 2 xrays before the biopsy; radiation during the biopsy; 2 more xrays after the biopsy; and 4 xrays before the biopsy to determine the nature of the calcifications. Then they left this clip in. That's a lot of damage inflicted on my breast and I do not think the medical profession is taking this all into account. I think all of this has raised the probability that I may get cancer in the affected area in the future.
I found out the other day that no markers were put in with that huge knitting sized needle beforehand. They only put in wires. Could it be that part of a wire broke off during removal? For all I know, the pain could even just be caused by nerves. Some days it's not there, and some days there are a few hundred shocks or pricks a day. It's not the type of pain women are familiar with, normally, which is what raised my suspicions about markers in the first place.
They never told me I had markers because they knew that the reason I refused the stereotactic biopsy was because I didn't want them. They were surprised when I discovered from the Internet that these things were put in, in stereotactic biopsies in the first place. At first they denied it but then later admitted it and said I didn't have to have them if I didn't want to. So they booked me for a manual biopsy instead.
I'm still pretty sure markers were put in when I was unconscious during the operation though. Yes, I did have a huge lumpectomy - not a small one.
The trouble is that if there if markers were put in there secretly or even accidentally and they are cuasing the problems, I can't even have them removed - especially not without undergoing more radiation.
Those who operated on me don't have a clue if any were put in there. They (including higher ups now) have been trying to figure it out for nearly two months.
This makes me doubly suspicious since I hadn't realized before this that anyone was allowed to throw any ol' device inside a woman's body without advising her, and without even documenting it, let alone mapping it. (At least it seems that way) For all I know, it could be a microchip.
I wonder how they can refuse to remove it if you hadn't realized it would be left in? It seems they deliberately don't tell women things. They seem to feel they have a right to do anything they like with a woman's body, and what they have done to that woman is none of her business.
I too fear cancer from that thing because I'm allergic to a few things. Also, if they're not required to document it, and especially to map it, how would a woman know if it became dislodged and headed toward her heart or some other important place? And how would any doctor even realize there was a danger? They have been known to move before.
Not only that, but if it moved, they could end up operating in the wrong place next time and taking out either too little cancer or too much because the thing would be marking different borders. And of course if this happened, the woman might die and would never be advised.
Really, I'm beginning to think that women need to form women's rights groups to protect their bodies, and to give them the rights over their own body that they should be entitled to by law.
Yes, like you, I too was exposed to a lot of radiation -- far too much as far as I'm concerned. As a matter of fact, just a few years before I got cancer I was exposed to massive massive amounts on it in the breast, which is another reason I don't want to be forced to get a mammogram "just" to get the answer to something the medical community should already know. My ultrasound turned out fine.
Susan, a doctor might not verbally explain everything to the patient. Some doctors seem to routinely underestimate what patients can understand. Some patients don't really want to know the details. However, the use of a marker should be documented in both the informed consent papers you signed and the surgeon's notes about the operation. Something should be in your medical records. Since the purpose of a marker is to be able to find the biopsied area again, there should be an imaging test that can locate it, so it can be removed.
I'm sorry you have had such a terrible time with doctors. I've had a couple in my time who didn't explain what they were doing to my satisfaction, but generally speaking, I've found that when I tell them upfront that I am the kind of patient who likes lots of detailed explanations, I get them. The next time you need to see a doctor, I'd suggest letting the nurse or appointment clerk know that you have some trust issues because of a bad experience with a doctor and you need one who is good at being upfront with you about what will be done.
I AM A CRITICAL CARE NURSE WHO RECENTLY HAD A TITANIUM CLIP INSERTED IN ONE OF MY BREAST. MY RESULTS WERE NEGATIVE. SINCE I'VE HAD THE PROCEDURE/ BIOPSY AND MARKER PLACED, I HAVE BEEN HAVING PAROXYSMAL SHOOTING AND STABBING PAINS RIGHT AT THE IMMEDIATE SITE. I HAD TOLD MY DOCTOR THAT I WAS CONCERNED ABOUT THE CLIP IN MY BREAST. THIS CONVERSATION WAS JUST BEFORE THE SURGERY. I TOO, WAS TOLD THAT I HAD ABSOLUTELY NOTHING TO WORRY ABOUT. I AM SO SORRY THAT I DIDN'T PUT MY FOOT DOWN AND HAVE HER REMOVE IT. I AM HAVING A LIGHT BURNING PAIN AT THE SITE NOW AS I TYPE. I THINK I AM GOING TO TALK TO A LAWYER. ALL OF THESE WOMEN CAN NOT BE EXPERIENCING THE SAME KIND OF SYMPTOMS AND IT NOT BE THOUGHT TO BE THE "CLIPS".
Since many women are expressing concern about titanium marker clips, and there are women who would like to have their clips removed, I would like to share some information that might be helpful.
In October 2000, the American Journal of Roentgenology published an article called "Percutaneous Extraction of a Biopsy-Site Marker Clip Using a Vacuum-Assisted Biopsy Device." The article was written by Douglas R. Baker, Handel E. Reynolds, and Peter McGraw, all of whom were working in the Department of Radiology at Indiana University School of Medicine at the time.
In the article, Baker, Reyholds, and McGraw tell about "two patients who reported persistent emotional distress related to the presence of this foreign object in the breast. Both patients had benign disease diagnosed at vacuum-assisted biopsy [i.e. there was nothing wrong in the first place with the breasts of either woman] and required no intervention. However, their unease was severe enough that they sought surgical removal of the marker several months after placement. The first patient underwent needle-localized surgical excision [i.e. she had a lumpectomy]. The second was offered the choice of attempted percutaneous removal."
Using a vacuum-assisted core-biopsy device, the authors took several specimens (four), and then located the marker in one of the speciments. They claim that there were "no complications" and say that given the 2-mm size of the tissue marker, this kind of extraction is "not technically challenging." They conclude that their extraction technique provides "a viable alternative to surgery."
My understanding is that for some women a core biopsy can be as painful as a regular excisional biopsy. Also, I did read in another journal article on the topic of biopsy pain that vacuum-assisted core biopsies are reported to be more painful than those that do not involve the use of the vacuum device. And any sort of procedure will be more painful for a woman who has dense breast tissue.
However, if a woman is anxious to have her biopsy clip removed, she might try contacting one of these authors to see if he would use this technique to remove the clip and thus avoid surgery.
These doctors are no longer working at Indiana University School of Medicine. However, I was able to locate Dr. Baker (by phone) in summer 2010 at a clinic in Atlanta. If enough women wanted this procedure, I would think that someone like Dr. Baker would surely step forward to assist.
Thanks so much for this information. It sounds like a viable alternative to traditional core or excisional biopsies. And vacuum-assisted biopsies are becoming more and more common as the technique makes its way into the mainstream. I'd think, rather than to try to locate Dr. Baker in Atlanta, any interested readers should first contact their own doctor; then a Comprehensive Cancer Center, where most of the country's leading-edge surgeries are performed; and only then, if she hasn't received help, seek out Dr. Baker. Thanks again for posting this - PJH
Hi,
I have been researching the topic of screening for several months now and would like to share two sources that I think would benefit all women who are either thinking about being screened or have had a screening mammogram and are now facing further follow-up screening or maybe surgical treatment.
Both sources are very informative and accessible. I wish I had seen these before I went for a screening mammogram. By the way, I have no financial interest in this--I offer these sources as a public service only.
The first is a book: How Patients Should Think: 10 Questions to ask Your Doctor about Drugs, Tests, and Treatment. It's written by Ray Moynihan and Melissa Sweet. Published by Pegasus, in 2009.
The second is a web site that contains links to some CBC (Canadian Broadcasting Corporation) Ideas documentary programs. The program I am recommending is called Are You Prediseased, Part 1 and 2. It's written by Alan Cassels, who is a drug policy researcher at the University of Victoria, in British Columbia. The web address is http://www.alancassels.com/pages/public/audio.cfm
I hope women will check out these two sources. It will be time well invested, I guarantee.
One month ago I had a lumpectomy to remove DCIS on my right breast. ( I had had a biopsy prior to this which included inserting the titanium chip). As I was recovering on the day of surgery in the hospital the surgeon came in to check on me and also said that he believed he had 'got everything'. Apparently though he was "...unable to find the chip. Perhaps it just got vacuumed away".
I seem to be healing okay and had a follow up appointment with the surgeon including mammograms yesterday.
He told me that all the calcite deposits were gone. Good news! However, he needs to go back in to remove the chip that is showing up clearly on the mammogram.
I am baffled. If he couldn't find the clip at the time of surgery, what has changed to ensure he'll find it this time? I asked if it had to be removed. Might it obscure something in the future? No, he said, but it is a good idea to remove it.
I'm just beginning to feel better and heal. I can't believe he wants to do surgery all over again. He says that it will be less of a precedure this time. Well, perhaps it is less involved for him but for the person it is happening to the process is exactly the same - guiding wire beforehand, time off work etc. What if he doesn't see it again? I'm not sure that I can do it again emotionally, physically or finacially.
Does this 'not seeing the chip' seem odd to anyone else?
Confused,
Christine
Christine, I'm not a surgeon, but i would imagine that when a doctor is looking at an open incision with blood, surgical sponges, and so forth, it would be very easy for a little piece of blood-covered metal to blend in with his field of vision. Later, on an imaging test, the marker would show up in contrast to the soft tissue. If you didn't have a reaction to the clip after the first biopsy, I don't understand why it needs to come out now. As you know from your two biopsies, every new incision causes new scar tissue and requires additional healing time. The clip is no longer necessary to guide the doctor to the calcifications seen on the mammogram because those are now gone, but if it hasn't been causing problems, why can't it stay in place? There may be very good answers to that question, but your doctor hasn't explained it to you throughly enough to justify another surgical procedure, however, minor. I would suggest that you ask more questions and/or get a second opinion about whether the clip needs to come out.
Christine, the surgeon was remiss in not removing the titanium clip - since it's implanted at the site of the suspicious tissue, how could he have removed that tissue, but left the clip? This is a key question I'd ask prior to your next surgery. "How could you 'get it all,' yet not get the clip, when the clip should have been directly in the center of what you were trying to remove? Does that mean you DIDN'T remove the DCIS, or...?"
Whatever his answer, I should think he wouldn't charge you for the second surgery, since it was his mistake in not removing the clip first time around. It's your choice whether or not to even have this surgery; as you can see from this thread, some women do have problems with leaving it in, but the vast majority don't.
So, up to you - leave it in, and probably be just fine; or go through another surgery, and be sure. I'm sorry what should have been fairly simple has turned out to be so complicated... if you don't have a good feeling about this surgeon after another discussion about why the clip got missed, then perhaps you should consider a different surgeon, if you decide to go ahead and have the clip removed. Best of luck to you - PJH
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When a mastectomy or lumpectomy is indicated do they remove the titanium marker?
Yes, it comes out with the tumor when you have a mastectomy; but they might leave it in with a lumpectomy, in case they need to go back in for another try at clear margins... PJH