Journal article
Surgeon Influence on Use of Needle Biopsy in Patients With Breast Cancer: A National Medicare Study
Journal of clinical oncology, v 32(21), pp 2206-2216
20 Jul 2014
PMID: 24934794
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Purpose
Use of needle biopsy is a proposed quality measure in the diagnosis and treatment of breast cancer, yet prior literature documents underuse. Nationally, little is known regarding the contribution of a patient's surgeon to needle biopsy use, and knowledge regarding downstream impact of needle biopsy on breast cancer care is incomplete.
Methods
Using 2003 to 2007 nationwide Medicare data from 89,712 patients with breast cancer and 12,405 surgeons, logistic regression evaluated the following three outcomes: surgeon consultation before versus after biopsy, use of needle biopsy (yes or no), and number of surgeries for cancer treatment. Multilevel analyses were adjusted for physician, patient, and structural covariates.
Results
Needle biopsy was used in 68.4% (n = 61,353) of all patients and only 53.7% of patients seen by a surgeon before biopsy (n = 32,953/61,312). Patient factors associated with surgeon consultation before biopsy included Medicaid coverage, rural residence, residence more than 8.1 miles from a radiologic facility performing needle biopsy, and no mammogram within 60 days before consultation. Among patients with surgeon consultation before biopsy, surgeon factors such as absence of board certification, training outside the United States, low case volume, earlier decade of medical school graduation, and lack of specialization in surgical oncology were negatively correlated with receipt of needle biopsy. Risk of multiple cancer surgeries was 33.7% for patients undergoing needle biopsy compared with 69.6% for those who did not (adjusted relative risk, 2.08; P < .001).
Conclusion
Needle biopsy is underused in the United States, resulting in a negative impact on breast cancer diagnosis and treatment. Surgeon-level interventions may improve needle biopsy rates and, accordingly, quality of care.
Metrics
Details
- Title
- Surgeon Influence on Use of Needle Biopsy in Patients With Breast Cancer: A National Medicare Study
- Creators
- Jan M. Eberth - The University of Texas MD Anderson Cancer CenterYing Xu - The University of Texas MD Anderson Cancer CenterGrace L. Smith - The University of Texas MD Anderson Cancer CenterYu Shen - The University of Texas MD Anderson Cancer CenterJing Jiang - The University of Texas MD Anderson Cancer CenterThomas A. Buchholz - The University of Texas MD Anderson Cancer CenterKelly K. Hunt - The University of Texas MD Anderson Cancer CenterDalliah M. Black - The University of Texas MD Anderson Cancer CenterSharon H. Giordano - The University of Texas MD Anderson Cancer CenterGary J. Whitman - The University of Texas MD Anderson Cancer CenterWei Yang - The University of Texas MD Anderson Cancer CenterChan Shen - The University of Texas MD Anderson Cancer CenterLinda Elting - The University of Texas MD Anderson Cancer CenterBenjamin D. Smith - The University of Texas MD Anderson Cancer Center
- Publication Details
- Journal of clinical oncology, v 32(21), pp 2206-2216
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Health Management and Policy
- Web of Science ID
- WOS:000339995300002
- Scopus ID
- 2-s2.0-84905851594
- Other Identifier
- 991021855183504721
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InCites Highlights
Data related to this publication, from InCites Benchmarking & Analytics tool:
- Web of Science research areas
- Oncology