Breast biopsy patterns and outcomes in Surveillance, Epidemiology, and End Results—Medicare data

BACKGROUND: Despite known benefits to needle biopsy for suspicious breast lesions, variability in the use of this technique has been documented in practice. We sought to study the use of needle biopsy and open surgical biopsy in women with breast cancer, predictors of needle biopsy use, and the effect of biopsy choice on overall number of surgical procedures needed to treat breast cancer. METHODS: We analyzed Surveillance, Epidemiology, and End Results (SEER)-Medicare data for 45,542 women diagnosed between 1991 and 1999 with ductal carcinoma in situ and stage I-II breast cancer. By using diagnosis and procedure codes from 3 months before to 6 months after the SEER diagnosis, we classified the initial biopsy as needle or surgical. By using multivariate logistic regression, we identified patient and tumor characteristics associated with needle biopsy use, and estimated the association between initial biopsy type and likelihood for multiple breast surgeries. RESULTS: Needle biopsy was the initial procedure for 11,073 (24.3%) women. In multivariate analyses, needle biopsy use varied significantly by race, year of diagnosis, and tumor size. After controlling for patient and tumor characteristics, needle biopsy use was associated with a reduced likelihood of multiple breast surgeries (odds ratio, 0.35; 95% confidence interval, 0.34-0.37). CONCLUSIONS: Use of needle biopsy as the initial breast cancer procedure was more common among black women and those with larger tumors, and increased significantly over time. Providers should consider needle biopsy when clinically feasible as the initial breast procedure, because it may reduce the number of surgeries needed to treat breast cancer.