Surgeon influence on use of needle biopsy in patients with breast cancer: A national medicare study

Jan M. Eberth, Ying Xu, Grace L. Smith, Yu Shen, Jing Jiang, Thomas A. Buchholz, Kelly K. Hunt, Dalliah M. Black, Sharon H. Giordano, Gary J. Whitman, Wei Yang, Chan Shen, Linda Elting, Benjamin D. Smith

Research output: Contribution to journalArticlepeer-review

27 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)2206-2216
Number of pages11
JournalJournal of Clinical Oncology
Issue number21
StatePublished - Jul 20 2014

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research


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