Yes, biopsies are necessary for diagnosing cancer

A video on Facebook and Instagram misleadingly claims that biopsies are unnecessary for cancer diagnosis, and that they spread cancer. The speaker in the video says: “You don’t need [a] biopsy to tell whether it's cancer or not. You can be 99% sure just by doing an ultrasound with a technician who knows what she’s doing.”

The speaker also says “never do a biopsy for prostate cancer or breast cancer”, and claims that there aren’t studies showing the safety of biopsies. He alludes to knowledge of 50 studies that show that biopsies spread cancer.

However, this is misleading because while imaging plays a role in cancer diagnosis, it is not usually sufficient in isolation as claimed, and a biopsy is the only way to be certain whether something is cancerous or not. According to the American Cancer Society, “Ultrasound cannot tell whether a tumor [sic] is cancer.”

Additionally, the risks of spreading cancer from biopsies, also known as ‘seeding’, have been studied and are considered to be rare complications.

Inaccurate information about health may encourage people to take dangerous risks with their personal health and of those they care for, which can have significant consequences.

What does the speaker in the video claim?

The video features Dr Adiel Tel-Oren, also known as Dr T, whose expertise in this area is unclear based on the qualifications listed on his website. He has a background as a chiropractor and voluntarily surrendered his license after concerns were raised about his management of several patients.

We have contacted Mr Tel-Oren and the accounts that posted the video, but have not heard back at the time of writing.

What is the role of biopsies?

A biopsy is a procedure where a sample of tissue is taken and examined under the microscope. This is useful for investigating abnormalities and can help diagnose conditions, and also assess the severity and aggressiveness of a condition. Contrary to the claim made in the video, it is the only way to be certain whether something is cancerous or not.

Tissue can be sampled from different areas of the body, and this can be done in several ways, including using a needle or excising larger samples to investigate further. The type of biopsy taken depends on the location and can be done with the assistance of imaging.

Although imaging is important in the diagnostic process, it is widely accepted that biopsies provide crucial information that may not be possible with imaging alone. Often, a combination of techniques is used to improve accuracy, as without this, abnormal areas can sometimes be missed. Biopsy results may sometimes be falsely negative, and this is due to various factors such as poor technique and abnormal areas that are difficult to access.

Despite the claims made in the video, ultrasounds in isolation are not usually sufficient to diagnose cancer.

Do biopsies spread cancer?

The most common risks of having a biopsy include bleeding, infection and pain.

While it is technically possible for a biopsy to spread cancer—a process known as ‘seeding’, it is considered to be extremely rare and its likelihood is influenced by the technique used and the cancer type.

Seeding refers to cancer cells spreading from one location to another, typically during a procedure. It can also occur during surgery, and some research has also described ‘self seeding’, which is where tumour cells break off, circulate and later implant back near the original tumour. Cancer cells might spread when cells travel along the path of a needle or along a surgical incision, for example.

The evidence for seeding after prostate biopsy was found to be less than 1% and occurred more with one particular technique over others. Similarly, there were differences in the incidence of seeding after biopsy of head and neck cancers depending on the technique used, but both were less than 1%.

A review of several observational studies for needle tract seeding after liver biopsy found an incidence of 2.7% of cancer (hepatocellular carcinoma), whereas biopsies for pancreatic tumours showed no increased risk of seeding.

A recent review of the available evidence found that whilst displacement of cancer cells during needle biopsy of breast tumours is a common occurrence, it does not impact long term survival or cancer recurrence in the surrounding area. Other research found no seeding up to two years after biopsy for urinary tract cancer.

By contrast, having a biopsy can lead to a better outcome and longer survival from cancer, according to a study by the Mayo Clinic. This is likely due to diagnoses being identified definitively, which allows treatments to be tailored based on the cancer type.

The study's senior investigator and gastroenterologist, Dr Michael Wallace, said at the time:

“This study shows that physicians and patients should feel reassured that a biopsy is very safe. We do millions of biopsies of cancer a year in the US, but one or two case studies have led to this common myth that biopsies spread cancer.”

Biopsies offer “very valuable information that allow [sic] us to tailor treatment. In some cases, we can offer chemotherapy and radiation before surgery for a better outcome, and in other cases, we can avoid surgery and other therapy altogether,” he continued.