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Comment by makmanalp | Hacker News Reader

I have two questions:

1) From the POV of the patient, how bad / invasive is getting a biopsy? Wouldn't you always want the low-risk biopsy over having discovered a problem too late? From a public health / insurance perspective, I get that you're trying to lower costs and time wasted, which are sadly conflicting goals :-(

2) It's always been so shocking to me that the reaction to "we get false positives" is not "we need to pour money for research into much better diagnostic techniques yesterday" and instead it's "well I guess we'll just not look then".

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These are interesting questions. If biopsy was totally benign you'd be right. But there are complications and rarely serious complications of breast biopsy.

"How bad / invasive is getting a biopsy?" perhaps you are willing to accept those risks, but you have to also accept the risk that you are getting treated for cancer you don't have. Pathology isn't perfect [0].

Should we invest more in getting better results? Yes, and we are. But, we also have to come up with a risk/benefits strategy for the technology we have now for the patients we have now.

Everything in medicine is risk/benefit because our data and our interpretation of that data isn't perfect.

0: https://jamanetwork.com/journals/jama/fullarticle/2203798

Considering that this was funded by the Patient-Centered Outcomes Research Institute[1], which was started as part of the Affordable Care Act, my guess is that this was indeed done to help reduce overall health care costs from unneeded procedures.

[1] https://www.pcori.org

> how bad / invasive is getting a biopsy?

About the same as getting a prostate biopsy, except you can lie on your back instead of on your side while they shove several large hollow needles into your flesh to cut out pieces of a very sensitive gland.

I don't think comparing it to prostate biopsy helps most people. I assume they anesthetize you so you don't actually feel pain just really weird, possibly upsetting tugging right? Afterwards you take some regular pain killers for a few days. This doesn't feel like a big deal to me but I'm likely wrong. Maybe it is only a big deal for some people like how how people who are claustrophobic freak out in the MRI.

Prostate biopsies are usually done without any anaethesia, just a bug gun up the bung that fires multiple needles and retracts.

Breast biopsies maybe use sedation and maybe a local bit of lidocaine, maybe not, depending.

It doesn't make a lot of sense to stick a needle in so you don't feel a needle sticking in, but they're different gauge needles.

Depends on where, I have had kidney biopsys its painless but does take a team of 3 and you spend most of a day flat on your back (taking up a hospital bed) being monitored every 15 mins

> It's always been so shocking to me that the reaction to "we get false positives" is not "we need to pour money for research into much better diagnostic techniques yesterday" and instead it's "well I guess we'll just not look then".

I think it is both. I think we tell people not to get bad diagnostics while also putting a lot of research into making the diagnostics better so we can tell them to get the diagnostics again.

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