Commission on Cancer

View all recommendations from this society

Released September 4, 2013

Don’t perform surgery to remove a breast lump for suspicious findings unless needle biopsy cannot be done.

  • Needle biopsy is large bore core biopsy or vacuum-assisted large bore needle for histology or fine needle aspiration for cytology.
  • Needle biopsy may be directed by breast imaging (ultrasound, mammographic, magnetic resonance imaging) or by direct palpation.
  • Studies show that confirmation of breast cancer diagnosis prior to any surgery allows for complete multidisciplinary treatment counseling, reduces the overall number of surgical procedures needed for treatment, improves the cosmetic results of surgery and avoids mastectomy resulting from multiple surgical procedures.
  • Use of needle biopsy also makes surgery altogether unnecessary for the majority of image detected breast lesions that require biopsy but prove to be benign.
  • Needle biopsy is generally less costly than open surgical biopsy.
  • Some breast lesions require surgical biopsy because of a location in the breast that precludes image localization. This may apply to 10–15% of breast lesions. Surgeons performing surgical breast biopsy without preceding needle biopsy should document the reason for no needle biopsy.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The American College of Surgeons concluded in its review of this opportunity that it was optimal to submit a separate list of interventions related to cancer from the American College of Surgeons Commission on Cancer. The Commission on Cancer appointed a multidisciplinary task force that met in person in September, 2012 and subsequently by conference call and electronic communications.

Recommendations for candidate interventions were solicited from panel members and other leaders from the Commission on Cancer. These panel members were provided a written charge to identify measures that would support the Commission’s standards for accreditation in use in more than 1,500 cancer programs across the U.S. In addition, panel members were provided with a full description of the Choosing Wisely®campaign and the interventions previously recommended by other organizations both for cancer and all other disorders.

Following initial submission of the candidate interventions, the panel discussed each intervention specifically evaluating the significance of the intervention, the potential scope of variation in care affected by the intervention, and the potential numbers of persons affected by this. The group also discussed the impact on short-term and long-term cost to be gained by implementation of each intervention. The panel voted on each intervention to select the final list of recommended interventions. The panel members then reviewed and refined the wording of each intervention and completed the bulleted supporting documentation and literature citations. The final list of interventions was then approved by the panel and submitted to the leadership of the American College of Surgeons for final approval. The Commission on Cancer’s disclosure and conflict of interest policy can be found at

Commission on Cancer Panel Members

  • Stephen Edge, MD, FACS, Chair, Roswell Park Cancer Institute, Buffalo, NY
  • David Bentrem, MD, FACS, Northwestern Memorial Hospital, Chicago, IL
  • Daniel Kollmorgen, MD, FACS, University of Iowa, Des Moines, IA
  • Daniel McKellar, MD, FACS, Wayne Healthcare, Greenville, OH
  • Christopher Pezzi, MD, FACS, Abington Memorial Hospital, Abington, PA
  • Lee Wilke, MD, FACS, University of Wisconsin Health System, Madison, WI
  • David Winchester, MD, FACS, Medical Director, Cancer Programs, American College of Surgeons


Friese CR, Neville BA, Edge SB, Hassett MJ, Earle CC. Breast biopsy patterns and outcomes in Surveillance, Epidemiology and End Results Medicare data. Cancer. 2009 Feb 15;115(4):716-24.

Williams RT, Yao K, Stewart AD, Winchester DJ, Turk M, Gorchow A, Jaskowiak N, Winchester DP. Needle versus excisional biopsy for noninvasive and invasive breast cancer: report from the National Cancer Data Base, 2003 – 2008. Ann Surg Oncol. 2011 Dec;18(13):3802-10.

James TA, Mace JL, Virnig BA, Geller BM. Preoperative needle biopsy improves the quality of breast cancer surgery. J Am Coll Surg. 2012;215(4):562-68.

Burkhardt JH, Sunshine JH. Core-Needle and surgical breast biopsy: comparison of three methods of assessing cost. Radiology. 1999;212,181-8.