TY - JOUR
T1 - Multilevel predictors of guideline concordant needle biopsy use for non-metastatic breast cancer
AU - Zgodic, Anja
AU - Eberth, Jan M.
AU - Smith, Benjamin D.
AU - Zahnd, Whitney E.
AU - Adams, Swann A.
AU - McKinley, Brian P.
AU - Horner, Ronnie D.
AU - O’Rourke, Mark A.
AU - Blackhurst, Dawn W.
AU - Hudson, Matthew F.
N1 - Publisher Copyright:
© 2021, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
PY - 2021/11
Y1 - 2021/11
N2 - Purpose: Persistent breast cancer disparities, particularly geographic disparities, may be explained by diagnostic practice patterns such as utilization of needle biopsy, a National Quality Forum-endorsed quality metric for breast cancer diagnosis. Our objective was to assess the relationship between patient- and facility-level factors and needle biopsy receipt among women with non-metastatic breast cancer in the United States. Methods: We examined characteristics of women diagnosed with breast cancer between 2004 and 2015 in the National Cancer Database. We assessed the relationship between patient- (e.g., race/ethnicity, stage, age, rurality) and facility-level (e.g., facility type, breast cancer case volume) factors with needle biopsy utilization via a mixed effects logistic regression model controlling for clustering by facility. Results: In our cohort of 992,209 patients, 82.96% received needle biopsy. In adjusted models, the odds of needle biopsy receipt were higher for Hispanic (OR 1.04, Confidence Interval 1.01–1.08) and Medicaid patients (OR 1.04, CI 1.02–1.08), and for patients receiving care at Integrated Network Cancer Programs (OR 1.21, CI 1.02–1.43). Odds of needle biopsy receipt were lower for non-metropolitan patients (OR 0.93, CI 0.90–0.96), patients with cancer stage 0 or I (at least OR 0.89, CI 0.86–0.91), patients with comorbidities (OR 0.93, CI 0.91–0.94), and for patients receiving care at Community Cancer Programs (OR 0.84, CI 0.74–0.96). Conclusion: This study suggests a need to account for sociodemographic factors including rurality as predictors of utilization of evidence-based diagnostic testing, such as needle biopsy. Addressing inequities in breast cancer diagnosis quality may help improve breast cancer outcomes in underserved patients.
AB - Purpose: Persistent breast cancer disparities, particularly geographic disparities, may be explained by diagnostic practice patterns such as utilization of needle biopsy, a National Quality Forum-endorsed quality metric for breast cancer diagnosis. Our objective was to assess the relationship between patient- and facility-level factors and needle biopsy receipt among women with non-metastatic breast cancer in the United States. Methods: We examined characteristics of women diagnosed with breast cancer between 2004 and 2015 in the National Cancer Database. We assessed the relationship between patient- (e.g., race/ethnicity, stage, age, rurality) and facility-level (e.g., facility type, breast cancer case volume) factors with needle biopsy utilization via a mixed effects logistic regression model controlling for clustering by facility. Results: In our cohort of 992,209 patients, 82.96% received needle biopsy. In adjusted models, the odds of needle biopsy receipt were higher for Hispanic (OR 1.04, Confidence Interval 1.01–1.08) and Medicaid patients (OR 1.04, CI 1.02–1.08), and for patients receiving care at Integrated Network Cancer Programs (OR 1.21, CI 1.02–1.43). Odds of needle biopsy receipt were lower for non-metropolitan patients (OR 0.93, CI 0.90–0.96), patients with cancer stage 0 or I (at least OR 0.89, CI 0.86–0.91), patients with comorbidities (OR 0.93, CI 0.91–0.94), and for patients receiving care at Community Cancer Programs (OR 0.84, CI 0.74–0.96). Conclusion: This study suggests a need to account for sociodemographic factors including rurality as predictors of utilization of evidence-based diagnostic testing, such as needle biopsy. Addressing inequities in breast cancer diagnosis quality may help improve breast cancer outcomes in underserved patients.
KW - Breast cancer
KW - Female
KW - National cancer database
KW - Needle biopsy
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U2 - 10.1007/s10549-021-06352-y
DO - 10.1007/s10549-021-06352-y
M3 - Article
C2 - 34405292
AN - SCOPUS:85112778568
SN - 0167-6806
VL - 190
SP - 143
EP - 153
JO - Breast Cancer Research and Treatment
JF - Breast Cancer Research and Treatment
IS - 1
ER -