Surgeon Influence on Use of Needle Biopsy in Patients With Breast Cancer: A National Medicare Study
Menée à partir des données 2003-2007 de la base Medicare portant sur 89 712 patientes atteintes d'un cancer du sein et sur 12 405 chirurgiens, cette étude américaine évalue le taux d'utilisation de la biopsie à l'aiguille, identifie les facteurs associés à sa non utilisation et analyse les conséquences de cette dernière sur le dépistage et le traitement de la maladie
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.
Journal of Clinical Oncology , résumé, 2014