Implementing a Same-Day Biopsy Program to Reduce Disparities in Breast Cancer Care

A same-day biopsy program for women helped reduce disparities related to age, race, and insurance type in breast cancer care, according to a single-center retrospective study presented at the 2019 American Society of Clinical Oncology (ASCO) Annual Meeting (abstract 6508). Disparities are known to exist in breast cancer care and can lead to delays in diagnosis and treatment and even adversely affect survival.

“These investigators demonstrated that by shifting their practices to provide same-day services, including diagnostic imaging and biopsy, to patients, that they were better able to serve the needs of these patients,” said Lisa Newman, MD, MPH, chief of breast surgery at Weill Cornell Medicine and NewYork-Presbyterian, during an interview with Cancer Network. “I think it will serve as a very powerful model for other healthcare systems.”

“We can definitely make some significant strides in achieving health equity when the healthcare system adjusts its practices to accommodate patients rather than always expecting patients to accommodate the convenience of the healthcare system,” Newman said.

The same-day biopsy program was implemented in August 2017 and allowed patients to be offered the choice of a core needle biopsy on the same day as the recommendation. After the program was implemented, the study researchers retrospectively selected patients who underwent ultrasound-guided or mammographically guided breast biopsies. Patients who had biopsies between September 2016 and March 2017 were part of the pre-implementation group (n = 663) and patients who had biopsies between September 2017 and March 2018 were part of the post-implementation group (n = 482). Patient age, race, language, insurance type, days to biopsy, and proportion of same-day biopsies were compared between the groups.

The average number of days to biopsy was lower in the post-implementation group compared with the pre-implementation group (3.6 vs 9.6 days; P < .001), and the proportion of patients who received a same-day biopsy was higher in the post-implementation group compared with the pre-implementation group (51% vs 11%; P < .001).

According to a linear regression model, non-white patients waited for 2.3 more days to have a biopsy than white patients (coefficient, 2.307; P = .009), and once the same-day biopsy program was implemented, the disparity disappeared (coefficient, –0.416; P = .640). Medicare patients waited for 2.4 more days to have a biopsy than privately insured or self-paying patients (coefficient, 2.473; P = .011), and this disparity also disappeared when the same-day biopsy program was implemented (coefficient, 0.812; P = .424).

A multivariate analysis showed that the odds of having a same-day biopsy were lower for older patients (adjusted odds ratio [OR], 0.97; P = .002), and this disparity went away when the same-day biopsy program was implemented (adjusted OR, 1.007; P = .348). Medicare patients also had lower odds of having a same-day biopsy than privately insured or self-paying patients (adjusted OR, 0.151; P = .013), and this disparity was eliminated when the same-day biopsy program was implemented (adjusted OR, 0.655; P = .133).

Although the racial disparity was not seen in the multivariate analysis, Newman explained, “Whenever we do these multivariate analyses, it starts to whittle down on the sample sizes and that results in reducing the statistical power of any of your observations. Nonetheless, I think that this study very powerfully demonstrated the importance of accommodating patient needs.”