Impact of a Same-Day Breast Biopsy Program on Disparities in Time to Biopsy

Brian N Dontchos,Anand K Narayan,Matthew Seidler,Sarah F Mercaldo,Randy C Miles,Emily Ebert,Constance D Lehman

doi:10.1016/j.jacr.2019.05.011

Brian N Dontchos, Anand K Narayan + Show 5 more

Open Access

https://doi.org/10.1016/j.jacr.2019.05.011

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Abstract

BackgroundDisparities in breast cancer diagnosis are established. In usual practice, biopsies are performed days or weeks after recommendation. Our aim was to measure the impact of a same-day biopsy program on disparities in time from biopsy recommendation to performance. MethodsAfter Institutional Review Board approval, we identified all diagnostic examinations leading to biopsy pre- (September 2016 to March 2017) and post- (September 2017 to March 2018) implementation of our same-day biopsy program. We compared demographic characteristics (age, race, language, and insurance) and biopsy information (days from biopsy recommendation to biopsy, and proportion of same-day biopsies in all biopsies) in pre- versus postimplementation groups. Multivariable linear and logistic models in pre- and postimplementation groups assessed if days from biopsy recommendation to biopsy and having a same-day biopsy were associated with patient subgroups. ResultsIn all, 663 and 482 patients underwent biopsy during pre- and postimplementation periods, respectively. Patient subgroups were similar between periods. For all patients, the same-day biopsy program decreased median time from diagnostic examination to biopsy from 8 (interquartile range: 4-13) to 0 (interquartile range: 0-4) days (P < .001). During the pre-implementation period, nonwhite patients and having Medicare insurance were associated with longer days to biopsy (nonwhite Adjusted Coefficient: 2.31, 95% confidence interval [CI]: 0.58-4.03; insurance Adjusted Coefficient: 2.47, 95% CI: 0.58-4.37; P < .05), after adjustment. During the postimplementation period, the previously seen disparities did not persist (nonwhite Adjusted Coefficient: −0.416, 95% CI: −2.16-1.33; insurance Adjusted Coefficient: 0.812, 95% CI: −1.18-2.80; P > .05). ConclusionThere was no evidence of racial/ethnic or insurance disparities in time from biopsy recommendation to performance after implementation of a same-day biopsy program.

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