title: Surgeon influence on use of needle biopsy in patients with breast cancer: a national medicare study.
abstract: OBJECTIVE
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Jan M. Eberth, Arnold School of Public Health, University of South Carolina, Columbia, SC; and 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, and Benjamin D. Smith, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Jan M
authors.initials: JM
authors.lastname: Eberth
authors.affiliation: Jan M. Eberth, Arnold School of Public Health, University of South Carolina, Columbia, SC; and 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, and Benjamin D. Smith, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Ying
authors.initials: Y
authors.lastname: Xu
authors.affiliation: Jan M. Eberth, Arnold School of Public Health, University of South Carolina, Columbia, SC; and 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, and Benjamin D. Smith, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Grace L
authors.initials: GL
authors.lastname: Smith
authors.affiliation: Jan M. Eberth, Arnold School of Public Health, University of South Carolina, Columbia, SC; and 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, and Benjamin D. Smith, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Yu
authors.initials: Y
authors.lastname: Shen
authors.affiliation: Jan M. Eberth, Arnold School of Public Health, University of South Carolina, Columbia, SC; and 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, and Benjamin D. Smith, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Jing
authors.initials: J
authors.lastname: Jiang
authors.affiliation: Jan M. Eberth, Arnold School of Public Health, University of South Carolina, Columbia, SC; and 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, and Benjamin D. Smith, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Buchholz
authors.affiliation: Jan M. Eberth, Arnold School of Public Health, University of South Carolina, Columbia, SC; and 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, and Benjamin D. Smith, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Kelly K
authors.initials: KK
authors.lastname: Hunt
authors.affiliation: Jan M. Eberth, Arnold School of Public Health, University of South Carolina, Columbia, SC; and 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, and Benjamin D. Smith, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Dalliah M
authors.initials: DM
authors.lastname: Black
authors.affiliation: Jan M. Eberth, Arnold School of Public Health, University of South Carolina, Columbia, SC; and 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, and Benjamin D. Smith, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Sharon H
authors.initials: SH
authors.lastname: Giordano
authors.affiliation: Jan M. Eberth, Arnold School of Public Health, University of South Carolina, Columbia, SC; and 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, and Benjamin D. Smith, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Gary J
authors.initials: GJ
authors.lastname: Whitman
authors.affiliation: Jan M. Eberth, Arnold School of Public Health, University of South Carolina, Columbia, SC; and 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, and Benjamin D. Smith, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Wei
authors.initials: W
authors.lastname: Yang
authors.affiliation: Jan M. Eberth, Arnold School of Public Health, University of South Carolina, Columbia, SC; and 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, and Benjamin D. Smith, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Chan
authors.initials: C
authors.lastname: Shen
authors.affiliation: Jan M. Eberth, Arnold School of Public Health, University of South Carolina, Columbia, SC; and 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, and Benjamin D. Smith, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Linda
authors.initials: L
authors.lastname: Elting
authors.affiliation: Jan M. Eberth, Arnold School of Public Health, University of South Carolina, Columbia, SC; and 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, and Benjamin D. Smith, The University of Texas MD Anderson Cancer Center, Houston, TX. bsmith3@mdanderson.org.
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Smith
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery*; D002983:Clinical Competence; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006278:Medicare; D009367:Neoplasm Staging; D010818:Practice Patterns, Physicians' / Q000592:standards*; D014481:United States