When 33-year-old Gnalen Kouruma had a suspicious spot on her mammogram, she feared the worst.
"I thought I was going to die," she said.
Her doctor ordered a needle biopsy, the recommended first step in testing for breast cancer. But a study that has experts asking "where's the outrage?" finds 36 percent of women who need breast biopsies are getting invasive surgery, costing three times as much as the recommended procedure.
Why are surgeons ignoring their own guidelines?
"It's something they've been doing for the past 25 years; they're comfortable with the diagnostic accuracy," said Dr. I Michael Leitman, chief of general surgery at Beth Israel Medical Center and co-author of the study. "And they're somewhat hesitant to make a change."
A needle biopsy is done under local anesthesia, leaves a tiny scar and costs about $1,000 to $2,000. It rarely misses lesions.
A surgical biopsy requires sedation and stitches, and costs about $5,000 to $6,000. And it leaves a bigger scar.
"Some women even find they need to have further work to repair the breast biopsy they had, to show they didn't have cancer! That's really crazy," said Dr. Susan Love of the Dr. Susan Love Research Foundation.
For Kouruma, it was the best of all worlds - a minor procedure that found no cancer.
"I said, 'Oh, my God. Thank God,'" she said. "So I can live long to see my kids."
With about 90 percent of abnormal mammograms turning out to be benign, the most minimally invasive approach makes the most sense.