Time trends and geographic variation in use of minimally invasive breast biopsy

Christopher J. Zimmermann, Kristin M. Sheffield, Casey B. Duncan, Yimei Han, Catherine D. Cooksley, Courtney Townsend, Taylor S. Riall

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background: Current guidelines recommend minimally invasive breast biopsy (MIBB) as the gold standard for the diagnosis of breast lesions. The purpose of this study was to describe geographic patterns and time trends in the use of MIBB in Texas. Methods: We used 100% Texas Medicare claims data (2000-2008) to identify women older than 66 years of age who underwent breast biopsy. Biopsies were classified as open or MIBB. Time trends, racial/ethnic variation, and geographic variation in the use of biopsy techniques were examined. Results: A total of 87,165 breast biopsies were performed on 75,518 breast masses in 67,582 women; 65.8% of the initial biopsies were MIBB. Radiologists performed 70.3% and surgeons performed 26.2% of MIBB. Surgeons performed 94.2% of open biopsies. Hispanic women were less likely to undergo MIBB (55.9%) compared with white (66.6%) and black (68.9%) women (p < 0.0001). Women undergoing MIBB were also more likely to live in metropolitan areas and have higher income and educational levels (p < 0.0001). The rate of MIBB increased from 44.4% in 2001 to 79.1% in 2008 (p < 0.0001). There are clear geographic patterns in MIBB use, with highest use near major cities. Although rates are increasing overall, rates of improvement in the use of MIBB vary considerably across geographic regions and remain persistently low in more rural areas. Conclusions: Despite an increase in the use of MIBB over time, MIBB use was consistently lower than recommended. We must identify specific barriers in rural areas to effectively change practice and achieve the statewide goal of 90% MIBB.

Original languageEnglish (US)
Pages (from-to)814-827
Number of pages14
JournalJournal of the American College of Surgeons
Volume216
Issue number4
DOIs
StatePublished - Apr 2013

Fingerprint

Breast
Biopsy
Medicare
Hispanic Americans

ASJC Scopus subject areas

  • Surgery

Cite this

Time trends and geographic variation in use of minimally invasive breast biopsy. / Zimmermann, Christopher J.; Sheffield, Kristin M.; Duncan, Casey B.; Han, Yimei; Cooksley, Catherine D.; Townsend, Courtney; Riall, Taylor S.

In: Journal of the American College of Surgeons, Vol. 216, No. 4, 04.2013, p. 814-827.

Research output: Contribution to journalArticle

Zimmermann, Christopher J. ; Sheffield, Kristin M. ; Duncan, Casey B. ; Han, Yimei ; Cooksley, Catherine D. ; Townsend, Courtney ; Riall, Taylor S. / Time trends and geographic variation in use of minimally invasive breast biopsy. In: Journal of the American College of Surgeons. 2013 ; Vol. 216, No. 4. pp. 814-827.
@article{6e0303951e4c45ab9a32ab0a108a4fcd,
title = "Time trends and geographic variation in use of minimally invasive breast biopsy",
abstract = "Background: Current guidelines recommend minimally invasive breast biopsy (MIBB) as the gold standard for the diagnosis of breast lesions. The purpose of this study was to describe geographic patterns and time trends in the use of MIBB in Texas. Methods: We used 100{\%} Texas Medicare claims data (2000-2008) to identify women older than 66 years of age who underwent breast biopsy. Biopsies were classified as open or MIBB. Time trends, racial/ethnic variation, and geographic variation in the use of biopsy techniques were examined. Results: A total of 87,165 breast biopsies were performed on 75,518 breast masses in 67,582 women; 65.8{\%} of the initial biopsies were MIBB. Radiologists performed 70.3{\%} and surgeons performed 26.2{\%} of MIBB. Surgeons performed 94.2{\%} of open biopsies. Hispanic women were less likely to undergo MIBB (55.9{\%}) compared with white (66.6{\%}) and black (68.9{\%}) women (p < 0.0001). Women undergoing MIBB were also more likely to live in metropolitan areas and have higher income and educational levels (p < 0.0001). The rate of MIBB increased from 44.4{\%} in 2001 to 79.1{\%} in 2008 (p < 0.0001). There are clear geographic patterns in MIBB use, with highest use near major cities. Although rates are increasing overall, rates of improvement in the use of MIBB vary considerably across geographic regions and remain persistently low in more rural areas. Conclusions: Despite an increase in the use of MIBB over time, MIBB use was consistently lower than recommended. We must identify specific barriers in rural areas to effectively change practice and achieve the statewide goal of 90{\%} MIBB.",
author = "Zimmermann, {Christopher J.} and Sheffield, {Kristin M.} and Duncan, {Casey B.} and Yimei Han and Cooksley, {Catherine D.} and Courtney Townsend and Riall, {Taylor S.}",
year = "2013",
month = "4",
doi = "10.1016/j.jamcollsurg.2012.12.007",
language = "English (US)",
volume = "216",
pages = "814--827",
journal = "Journal of the American College of Surgeons",
issn = "1072-7515",
publisher = "Elsevier Inc.",
number = "4",

}

TY - JOUR

T1 - Time trends and geographic variation in use of minimally invasive breast biopsy

AU - Zimmermann, Christopher J.

AU - Sheffield, Kristin M.

AU - Duncan, Casey B.

AU - Han, Yimei

AU - Cooksley, Catherine D.

AU - Townsend, Courtney

AU - Riall, Taylor S.

PY - 2013/4

Y1 - 2013/4

N2 - Background: Current guidelines recommend minimally invasive breast biopsy (MIBB) as the gold standard for the diagnosis of breast lesions. The purpose of this study was to describe geographic patterns and time trends in the use of MIBB in Texas. Methods: We used 100% Texas Medicare claims data (2000-2008) to identify women older than 66 years of age who underwent breast biopsy. Biopsies were classified as open or MIBB. Time trends, racial/ethnic variation, and geographic variation in the use of biopsy techniques were examined. Results: A total of 87,165 breast biopsies were performed on 75,518 breast masses in 67,582 women; 65.8% of the initial biopsies were MIBB. Radiologists performed 70.3% and surgeons performed 26.2% of MIBB. Surgeons performed 94.2% of open biopsies. Hispanic women were less likely to undergo MIBB (55.9%) compared with white (66.6%) and black (68.9%) women (p < 0.0001). Women undergoing MIBB were also more likely to live in metropolitan areas and have higher income and educational levels (p < 0.0001). The rate of MIBB increased from 44.4% in 2001 to 79.1% in 2008 (p < 0.0001). There are clear geographic patterns in MIBB use, with highest use near major cities. Although rates are increasing overall, rates of improvement in the use of MIBB vary considerably across geographic regions and remain persistently low in more rural areas. Conclusions: Despite an increase in the use of MIBB over time, MIBB use was consistently lower than recommended. We must identify specific barriers in rural areas to effectively change practice and achieve the statewide goal of 90% MIBB.

AB - Background: Current guidelines recommend minimally invasive breast biopsy (MIBB) as the gold standard for the diagnosis of breast lesions. The purpose of this study was to describe geographic patterns and time trends in the use of MIBB in Texas. Methods: We used 100% Texas Medicare claims data (2000-2008) to identify women older than 66 years of age who underwent breast biopsy. Biopsies were classified as open or MIBB. Time trends, racial/ethnic variation, and geographic variation in the use of biopsy techniques were examined. Results: A total of 87,165 breast biopsies were performed on 75,518 breast masses in 67,582 women; 65.8% of the initial biopsies were MIBB. Radiologists performed 70.3% and surgeons performed 26.2% of MIBB. Surgeons performed 94.2% of open biopsies. Hispanic women were less likely to undergo MIBB (55.9%) compared with white (66.6%) and black (68.9%) women (p < 0.0001). Women undergoing MIBB were also more likely to live in metropolitan areas and have higher income and educational levels (p < 0.0001). The rate of MIBB increased from 44.4% in 2001 to 79.1% in 2008 (p < 0.0001). There are clear geographic patterns in MIBB use, with highest use near major cities. Although rates are increasing overall, rates of improvement in the use of MIBB vary considerably across geographic regions and remain persistently low in more rural areas. Conclusions: Despite an increase in the use of MIBB over time, MIBB use was consistently lower than recommended. We must identify specific barriers in rural areas to effectively change practice and achieve the statewide goal of 90% MIBB.

UR - http://www.scopus.com/inward/record.url?scp=84875370702&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84875370702&partnerID=8YFLogxK

U2 - 10.1016/j.jamcollsurg.2012.12.007

DO - 10.1016/j.jamcollsurg.2012.12.007

M3 - Article

VL - 216

SP - 814

EP - 827

JO - Journal of the American College of Surgeons

JF - Journal of the American College of Surgeons

SN - 1072-7515

IS - 4

ER -