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Non-Specialized Surgeons Associated with Underused Needle Biopsies for Breast Cancer

Among women who must undergo a breast biopsy, those who see a surgeon prior to biopsy tend to have lower rates of a needle biopsy. Additionally, specific surgeon and patient factors are associated with reduced rates of a needle biopsy. These results were recently published in the Journal of Clinical Oncology.

A needle biopsy is a biopsy in which a needle is inserted into the mass in question and cells are drawn from the area. A needle biopsy requires a radiologist and radiology facility, so the needle may be guided precisely to the area in question through radioimaging techniques. Pathologists can then analyze the cells to determine if cancer, or a benign condition is present.

A needle biopsy is an improvement over previous types of biopsies in which the entire mass was removed in a type of surgical procedure, typically performed by a surgeon.

Researchers recently sought to determine what possible factors might contribute to the use of needle biopsy versus the older type of biopsies among women with a suspicious mass in their breast. They reviewed nationwide Medicare data from 2003-2007.

Needle biopsy was utilized in 68.4% of all patients.
If patients were seen by a surgeon prior to a biopsy, only 53.7% underwent a needle biopsy.
Patient factors associated with being seen by a surgeon prior to biopsy consisted of “Medicaid coverage, rural residence, residence more than 8.1 miles from a radiologic facility performing a needle biopsy, and no mammogram within 60 days before consultation.”
Among surgeons seen prior to the biopsy, factors that were associated with a lower rate of needle biopsies included “absence of board certification, training outside of the United States, low case volume, earlier decade of medical school graduation, and lack of specialization in surgical oncology.”
Among breast cancer patients who had undergone an initial needle biopsy, the risk of multiple cancer surgeries was 33.7% compared with 69.6% for those who did not undergo a needle biopsy.
These data indicate that women who are to undergo a breast biopsy have significantly lower rates of having a needle biopsy if they see a surgeon prior to a biopsy. Furthermore, several surgeon factors are associated with lower rates of needle biopsies. Multiple surgeries for cancer were also significantly affected by whether a woman had undergone an initial needle biopsy.

Women who are to undergo a biopsy should speak with their healthcare provider regarding referrals to a radiology facility where needle biopsies are routinely performed.

Reference: Eberth J, Xu Y, Smith G, et al. Surgeon influence on use of needle biopsy in patients with breast cancer: a National Medicare Study. Journal of Clinical Oncology. 2014;32(21):2206-2216.