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Ask the Medical Expert Archives 2000-2004

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"Waiting" vs. Biopsy
July 2000

Q. How accurate is "waiting" as opposed to a biopsy? My doctor told me to wait and see if my lump goes away. He feels that if it does, it probably isn't cancerous. "Probably" isn't good enough for me. Is there a danger of a cancerous lump disappearing? Do they ever become undetectable by touch, once you've found one? We have already determined that it is not a fluid mass with a needle.

A. You ask an interesting question, and I assume that you're talking about a breast lump because you mentioned that they stuck a needle in it to see if it was filled with fluid. While this can be done with many different types of lumps, it is most often done with a lump in the breast.

The simple response to your question is that cancers (except in the exceeding rare cases and those reported in the National Enquirer) do not spontaneously disappear. This means that if you wait and watch a lump get smaller and disappear, it is assumed that it is not cancer since cancers (without treatment) only get bigger.

The method that your doctor is proposing (often called "watchful waiting") is very common. That is because cancers are exceedingly slow growing, so that waiting a few weeks is trivial in the life of a cancer. If during this time period the lump decreases in size or disappears entirely, then the lump was not a cancer and you avoided an unnecessary biopsy. If on the other hand the lump persists or increases in size, then a biopsy is warranted. If it turns out that the lump is cancerous, the few week delay is considered to negatively impact on your prognosis.

Of course, a large part of this is your own comfort level. Most physicians try to avoid needless biopsies because of the complications that can occur and because of the scarring that will occur. Some patients, however, feel uncomfortable with this approach. My suggestion is that you discuss your concerns with your doctor and make sure that you are comfortable with the approach that is decided upon. If you are not, you can consider getting a second opinion.

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