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Multilevel predictors of guideline concordant needle biopsy use for non-metastatic breast cancer

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

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.

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Data availability

The data that support the findings of this study are available from ACS’ NCDB, but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available.

Code availability

Code remains proprietary since it includes information from the ACS’ NCDB, which not a publicly available dataset.

Abbreviations

ACS:

American College of Surgeons

AJCC:

American Joint Committee on Cancer

CI:

Confidence interval

CoC:

Commission on Cancer

HO:

Higher odds

LO:

Lower odds

NCDB:

National Cancer Database

NQF:

National Quality Forum

NQFM:

National Quality Forum Measures

OR:

Odds ratio

PUF:

Participant Use File

RUCC:

Rural–Urban Continuum Codes

U.S.:

United States

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Acknowledgements

The National Cancer Data Base (NCDB) is a joint project of the CoC of the ACS and the American Cancer Society. The CoC’s NCDB and the hospitals participating in the CoC NCDB are the source of the de-identified data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors. This study was supported by the Prisma Health Seed Grant for Cancer Care Delivery Research.

Funding

This study was supported by the Prisma Health Seed Grant for Cancer Care Delivery Research.

Author information

Authors and Affiliations

  1. Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA

    Anja Zgodic, Jan M. Eberth & Swann A. Adams

  2. Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA

    Anja Zgodic, Jan M. Eberth, Whitney E. Zahnd & Swann A. Adams

  3. Departments of Radiation Oncology and Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Benjamin D. Smith

  4. Cancer Survivorship Center, College of Nursing, University of South Carolina, Columbia, SC, USA

    Swann A. Adams

  5. Division of Breast Surgery, Department of Surgery, Prisma Health, Greenville, SC, USA

    Brian P. McKinley

  6. Department of Health Service Research and Administration, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA

    Ronnie D. Horner

  7. Prisma Health Upstate Cancer Institute, Greenville, SC, USA

    Mark A. O’Rourke

  8. School of Medicine, University of South Carolina, Greenville, SC, USA

    Mark A. O’Rourke

  9. Cancer Care Delivery Research, Prisma Health, 900 W. Faris Road, Greenville, SC, 29605, USA

    Dawn W. Blackhurst & Matthew F. Hudson

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  1. Anja Zgodic
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Corresponding author

Correspondence to Matthew F. Hudson.

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Conflict of interest

Dr Benjamin D Smith has equity and royalty interest in Oncora Medical and prior research funding from Varian Medical Systems. Remaining authors declare no personal, commercial, political, governmental, academic, or financial conflicts of interest.

Ethical approval

This research study was conducted retrospectively from data obtained for clinical purposes. We consulted extensively with the Prisma Health’s Institutional Review Board (IRB) who determined that our study did not need ethical approval. An IRB official waiver of ethical approval was granted from the IRB of Prisma Health.

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Zgodic, A., Eberth, J.M., Smith, B.D. et al. Multilevel predictors of guideline concordant needle biopsy use for non-metastatic breast cancer. Breast Cancer Res Treat 190, 143–153 (2021). https://doi.org/10.1007/s10549-021-06352-y

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  • DOI: https://doi.org/10.1007/s10549-021-06352-y

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