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Needle biopsy underused in breast cancer diagnosis, negatively impacting diagnosis and care
Date:6/9/2014

(61,353) underwent a needle biopsy, with the rate of those undergoing the procedure increasing from 60.8 percent in 2003 to 76.5 percent in 2007.

Of the total cohort, 68.4 percent of the patients consulted with a surgeon prior to a biopsy and 31.6 percent saw a surgeon after their biopsy. Of the patients who saw a surgeon upfront: 46.3 percent did not have a needle biopsy; 38.4 percent underwent the procedure, but performed by their surgeon; and 15.4 percent had the needle biopsy performed by a radiologist. In contrast, all patients who saw a surgeon post-biopsy underwent the needle biopsy.

The researchers found that surgeon characteristics associated with excisional biopsy included: lack of board certification; training outside the U.S.; medical school graduation before 1980 and low case volume. Also, patient characteristics most associated with surgeon consultation before biopsy, and thus a lower rate of needle biopsy, were: older age; black race; Medicaid coverage; co-morbid illness; earlier year of diagnosis and rural residence.

Geographical discrepancies in the rate of needle biopsies performed were noted -- the researchers contrast the low rate of 24.1 percent in Bismarck, North Dakota to a high of 97.2 percent in Lynchburg, Virginia. Yet, Smith notes that access issues were far less of a factor for the decision than that of the surgeon's influence.

"The real question is the role of the surgeon and to understand that influence. With our study, we set up a statistical model that allowed us to compare the impact of patient-to-surgeon factors. While there are access issues that should be addressed, it's clear that the surgeon's role is very important for the patients' care," explains Smith.

Excisional biopsies were negatively associated with multiple breast cancer surgeries, 69.6 percent, compared to 33.7 percent of those who did not undergo the surgery.

For patients, says Smith, it's important to know that
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Contact: Laura Sussman
lsussman@mdanderson.org
713-745-2457
University of Texas M. D. Anderson Cancer Center
Source:Eurekalert  

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