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

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.