Time, Place and Intention Matter

Some of the most difficult conversations I have with people begin after a lump appears either on themselves or one of their animals, or when a medical professional offers an opinion that suddenly changes everything.

What follows is often a much deeper discussion about biopsies, uncertainty, and how to make sense of decisions when they are placed in front of us under pressure. More often than not, these conversations happen when people are shocked, distressed, and deeply concerned for the wellbeing of themselves or their animal.

In those moments, my first priority is to slow the conversation down, because I believe nothing good ever comes from a state of panic. These discussions are rarely about diagnosis alone. They’re about clarity, context, and making informed, logical decisions in the best interests of the individual, whether it be a person or an animal. What follows are my general thoughts on biopsies, and why I believe time, place, and intention matter.

Biopsies are one of those topics that tend to split opinion straight down the middle. Some people see them as the gold standard of diagnosis. Others feel instinctively uneasy about disturbing a lump, lesion, or mass at all. As with most things in health, my view sits somewhere in the middle.

There is a time and a place for biopsies and there are also situations where they make very little sense. This applies to both humans and dogs.

A Note Before We Go Further

I want to be very clear about something.

This article is not medical advice. I am not diagnosing, treating, or advising anyone on what they should or should not do. What follows is based on my personal experience, the conversations I’ve had over many years, and what has been shared back with me by people navigating these decisions in the real world.

Since entering the natural health industry in late 2010, a recurring topic of conversation is centred on biopsies, with many conversations beginning after people or animals have already gone down the biopsy path. Based purely on those conversations and not clinical data, not published statistics - I genuinely believe that around 8 out of 10 have told me their biopsy results came back inconclusive or unclear. In many of those cases, the result did not provide the certainty they were hoping for and instead created more questions, more stress, and more difficult decisions. It probably doesn't count for much, but I once agreed to a biopsy for a dog in my care because after expressing skepticism, the veterinarian insisted that they would provide a definitive result. Much to my disappointment, the report came back as inconclusive.

This morning, the very first thing that appeared when I opened Facebook was the post you see below. I couldn’t help but notice the irony of being in the final drafting stages of writing about biopsies, uncertainty, and difficult decisions, only to be met with a real-world example unfolding in that exact moment. It felt important to share, because these situations are not theoretical. They are happening to real people, with real animals, and they are stressful.

With all that said, it doesn’t mean biopsies are useless. It does mean they are not always the definitive answer people expect them to be, and that reality deserves to be part of the conversation.

What follows is my perspective which I offer in good faith, on how I think about biopsies, based on lived experience and long-term observation, not promises or guarantees. Again, it is not medical advice and I am certainly not an authority on the topic.

When a Biopsy Can Make Sense

If you are medically minded in the Western sense - meaning you are comfortable with all or some of the conventional diagnostics, pharmaceuticals, surgery, chemotherapy, or radiation, then a biopsy can be a logical and often appropriate next step.

In these cases, a biopsy serves a clear purpose:

To confirm a diagnosis
To help guide a treatment plan
To inform decisions you are genuinely willing to act on

For example:

If a doctor or veterinarian suspects a tumour and you are open to surgery or oncology treatment
If a doctor or veterinarian needs tissue confirmation before initiating chemotherapy
If the outcome of the biopsy will meaningfully influence what you do next

In this context, biopsies are widely used in conventional human and veterinary medicine, and tissue sampling is commonly regarded as a reference standard for diagnosing many types of tumours. When paired with a clear treatment pathway, biopsies are generally considered safe and clinically useful.

If you trust the medical system and intend to follow through with its recommendations, then a biopsy may be the most appropriate option.

When a Biopsy May Not Make Sense

Where things change is when the biopsy result is unlikely to alter your decision-making.

If:

You are not inclined toward Western medical treatment
You would not pursue chemotherapy, radiation, or surgery regardless of the result
Your dog is elderly, frail, or at higher risk from anaesthesia or invasive procedures
You are committed to a comfort-focused or palliative approach only

Then it is reasonable to ask an important question: What is the purpose of the biopsy?

In these scenarios, a biopsy may provide a diagnostic label - such as benign or malignant - without offering a practical outcome that aligns with the animal’s condition, tolerance for intervention, or the owner’s chosen approach.

Diagnosis Does Not Always Equal Benefit

In an ideal world, diagnosis would always be clear and definitive. In reality, uncertainty is often part of the process. One of the most valuable steps before proceeding with a biopsy may simply be an open and honest conversation with the doctor or veterinarian about realistic expectations.

Based on their clinical experience - including the appearance, location, texture, and behaviour of a lump - it can be reasonable to ask how likely a biopsy is to provide a clear and definitive answer, and how often results instead return as uncertain or inconclusive.

These kinds of discussions are not about challenging expertise, but about strengthening informed consent, communication, and trust between people and health professionals. Slowing the conversation down in this way can help ensure that any decision made is deliberate, understood, and aligned with the best interests of the individual animal.

When Surgery Is Not An Option

There are also situations where Western medical options are limited, not by philosophy, but by practicality.

In some animals - particularly those that are very elderly, physically frail, or managing multiple health challenges - surgery may carry significant risk. Anaesthesia alone can be a concern, and the stress of invasive procedures may outweigh potential benefits. In these cases, even when a clear diagnosis exists, surgical intervention may simply not be a realistic or humane option.

When this happens, people are often forced to reassess what support looks like. That may include conservative management, non-invasive supportive approaches (including topical care), or broader lifestyle and nutritional considerations aimed at maintaining comfort and overall wellbeing. This is not about rejecting conventional medicine, but about recognising the limits of what a particular animal can reasonably tolerate at a given stage of life.

These decisions are rarely simple, and they are highly individual. What matters most is that the chosen approach reflects informed decision making, taking into account the animal’s capacity, not just what is theoretically possible.

Lumps Are Rarely The Problem - They’re a Signal

One of the reasons I encourage people to slow down and think carefully when a lump appears is because, in many cases, the lump itself is not the underlying issue. It is a visible signal that something else is happening within the body.

A good and simple example of this is a grass seed that becomes lodged beneath the skin. The body responds with inflammation, swelling, and local immune activity, which are all normal protective processes designed to isolate and deal with a foreign object. In this situation, the lump is not the problem itself, but rather a sign of the body actively responding to something that shouldn’t be there.

A similar biological response can be observed when the body encounters other foreign materials, including medical implants used in human healthcare. Rather than universal rejection, the body typically forms a protective inflammatory or scar-tissue response as it works to isolate and adapt to what it recognises as foreign. In many cases this process is well tolerated, while in others it may contribute to symptoms or complications, reflecting the natural variability of individual biology.

From my perspective, whether a lump is approached through conventional medicine, topical management, surgery, or more conservative means, the more important question is often why it appeared in the first place.

Modern medicine can be very good at identifying, naming, and removing physical structures. In many situations, that is appropriate and necessary. But focusing solely on the lump can sometimes overlook the broader context of the animal’s overall health, resilience, and internal balance.

My own focus has always been on the foundations of health - particularly nutrition and eliminating toxins - because the body’s ability to maintain, repair, and regulate itself is deeply influenced by the raw materials it is given. This does not mean ignoring medical or veterinary care or rejecting conventional options. It means recognising that visible changes on the outside often reflect internal processes that deserve attention as well.

Looking beyond the lump does not guarantee an outcome, and it is not a substitute for diagnosis or treatment. Rather, it is a way of thinking that asks whether the body is being adequately supported at a foundational level, especially in cases where invasive intervention is limited by age, frailty, or circumstance.

For me, the goal is not simply to react to what can be seen, but to consider the broader picture of the animal in front of us - and to support the body in ways that are reasonable, appropriate, and aligned with the individual situation.

Over the years, I’ve also observed that the way a lump is approached can lead to very different visible outcomes. In many cases where lumps have been surgically removed, people later report new changes appearing in the same general area, or elsewhere on the body. In other situations where individuals have chosen more conservative or topical supportive care, they sometimes describe minimal to no visible scarring and no obvious return at the original site. These are personal observations shared with me over time, not controlled scientific findings, and they highlight how individual biology, underlying causes, and different approaches can all influence what happens next. For this reason, I believe it is important to look beyond any single intervention and continue asking why the lump appeared in the first place.

When Timing Means Surgery Is The Only Option

It’s also important to acknowledge the other side of the equation.

In some cases, lumps or abnormal growths are left unaddressed for too long. When this happens, the window for conservative or supportive approaches can close. At that point, natural or non-invasive options may no longer be sufficient, regardless of philosophy or intent.

There are situations where the only realistic way to preserve quality of life - or life itself - is through timely surgical intervention. When surgery is delayed beyond a certain point, opportunities narrow, risks increase, and outcomes become harder to influence.

This is why timing matters so much. Waiting too long can be just as consequential as acting too quickly. The challenge lies in recognising when observation is appropriate, when support is reasonable, and when decisive intervention is necessary.

Mast cell tumours are a good example of why careful monitoring and thoughtful decision-making matter. While some are considered lower grade and may behave in a relatively local or slow-growing way, their biological behaviour can be unpredictable, and changes can occur over time. For this reason, recommendations often involve ongoing assessment, staging, and discussion of management options, rather than simple reassurance alone. In certain cases - particularly in younger animals with a longer life ahead - early and appropriate intervention may offer the best chance of maintaining long-term health. This is not about creating fear, but about recognising that uncertainty is part of cancer biology, and that clear communication between doctors or veterinarians and patients or customers is essential when deciding how to proceed.

Left unaddressed, some mast cell tumours can grow locally and, depending on their biology, may carry a risk of spreading over time, which is why monitoring and clear staging discussions matter.

Can Biopsies Ever Cause Harm?

This is where nuance matters.

Medical and veterinary literature acknowledges that biopsies are invasive procedures and, like all procedures, carry some degree of risk. Documented risks have included:

Needle-tract seeding, where tumour cells implant along the path of a biopsy needle
Local inflammation, bleeding, or tissue disruption, which are recognised procedural effects
Changes to the local tissue environment following mechanical disturbance

In human medicine, needle-tract seeding has been reported in certain cancers, such as liver tumours, although the overall risk is considered low. Similar rare case reports exist in veterinary medicine, particularly in relation to fine-needle aspiration and biopsy techniques.

Some may argue that these outcomes are uncommon, but they are not theoretical.

The “Toxin Jar” Analogy

To explain this concept in simple terms, I sometimes use an analogy.

If you think of a lump or tumour as a contained biological environment, or as Don Tolman calls it - a garbage can, then puncturing it can be likened to disturbing that environment. This disturbance may involve inflammation, immune signalling, and the movement of cellular material - all normal physiological responses to tissue injury.

In a strong body with a clear and active treatment plan, this disturbance is often of little consequence.

In an older, frailer, or compromised animal - particularly where no follow-up treatment is planned - disturbing otherwise stable tissue may offer limited benefit and potential downside, even if that downside is uncommon.

This does not mean biopsies are inherently dangerous. It means they are not always neutral.

Clarifying The Different Diagnostic Options

It’s also worth clarifying that when people talk about “doing a biopsy,” they are often referring to different procedures, each with its own purpose, level of invasiveness, and limitations.

Fine Needle Aspirate

A fine needle aspirate (FNA) is one of the least invasive options. It involves inserting a very thin needle into a lump to withdraw cells for examination. FNAs are commonly used as an initial screening tool because they are quick, relatively low risk, and often do not require heavy sedation or anaesthesia. However, because they collect only individual cells rather than structured tissue, results can sometimes be non-diagnostic or inconclusive.

Incisional Biopsy

An incisional biopsy, in the stricter sense, involves taking a small piece of tissue. This can be done with a needle biopsy or through a small surgical procedure. Because biopsies preserve tissue architecture, they can provide more detailed information than an FNA, but they are also more invasive and may require sedation, anaesthesia, or a recovery period.

Core Needle Biopsy

A core needle biopsy involves using a slightly larger hollow needle to remove a small cylindrical sample of intact tissue from a lump or internal structure. Because this technique preserves tissue architecture, it can provide more detailed diagnostic information than a fine needle aspirate while remaining less invasive than a full surgical biopsy.

Core needle biopsies are often considered when an initial fine needle aspirate is inconclusive, or when a clearer understanding of the tissue structure is needed to guide decision-making. In veterinary medicine, they are used more selectively and are more commonly performed in referral or specialist settings, sometimes with imaging guidance.

Going back to the Toxin Jar analogy

The degree of disturbance can vary depending on the procedure performed. A fine needle aspirate involves only minimal penetration and cellular sampling, whereas a biopsy - particularly one that removes a larger piece of tissue - creates greater local disruption and a more significant healing response, even though both procedures are generally regarded as safe when clinically indicated.

While Core Needle Biopsies are regarded as a relatively safe diagnostic tool, they do create more local disturbance than a fine needle aspirate, reflecting their intermediate position between minimally invasive sampling and surgical tissue removal.

Excisional Biopsy

A surgical excision is another common approach, where the lump is removed entirely and then sent for analysis. This can serve both diagnostic and therapeutic purposes, but it is also the most invasive option and is not always suitable, particularly for older or medically fragile animals.

A General Note About Each Approach

Each of these approaches exists for a reason. They are tools, not guarantees. The choice between them should be guided by the person or animal’s overall health, the likelihood that the result will meaningfully change next steps, and the risks involved in obtaining the sample in the first place.

Diagnosis Should Serve a Purpose

This perspective is not anti-biopsy. It is about avoiding automatic or reflexive biopsies.

Before proceeding, it is worth asking:

What will be done with this information?
Will it change the treatment path?
Is the body likely to tolerate the procedure?
Does this align with the overall philosophy of care?

If the answer to those questions is yes, a biopsy can be entirely appropriate.

If the answer is no, then observation, supportive care, or a conservative approach may sometimes be the more considered option.

Final thoughts

There is no single right approach for every dog or every person. Conventional medicine has saved many lives, and so has careful restraint. Biopsies are powerful tools when used with clear intent. They can also be unnecessary interventions when used without one.

The goal should not be more testing for its own sake, but better, more deliberate decision-making. Time and place matter.

Good medicine is not only about what can be done, but about ensuring that every decision is made with clarity, understanding, and genuine informed consent.

Disclaimer

This article is general information only and is not intended as veterinary or medical advice. It does not diagnose, treat, cure, or prevent any condition. Always seek guidance from a qualified doctor or veterinarian regarding diagnosis and treatment decisions.

For transparency, Phivo is the founder of Augustine Approved, a company that produces whole-food nutritional products for people and animals. This article is educational in nature and is not intended as a promotion or recommendation of any product. No reference to any Augustine Approved product is intended to imply suitability for any medical condition.