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Same-day breast biopsy program eradicates racial, ethnic disparities
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CHICAGO — Racial and ethnic disparities in time to breast biopsy disappeared after implementation of a same-day biopsy program, according to a study presented at ASCO Annual Meeting.
“We knew that offering same-day procedures would reduce the delay to tissue diagnosis for all patients, but we were very interested in the impact that the program would have on vulnerable sub-populations,” Brian N. Dontchos, MD, diagnostic radiology specialist at Massachusetts General Hospital and faculty advisor to the study, told HemOnc Today. “Given our findings, we believe that a similar impact on disparities could be seen by implementing same-day care models in other subspecialties.”
In the study, Dontchos and colleagues evaluated all diagnostic mammogram and ultrasound exams resulting in biopsy both before (September 2016-March 2017) and after (September 2017-March 2018) introduction of a same-day biopsy program.
The researchers compared age, race, language, insurance type, days to biopsy and percentage of same-day biopsies among patients in pre-implementation (n = 663) vs. post-implementation (n = 482) groups. They also used multivariable linear and logistic models to determine whether time from biopsy recommendation to biopsy (linear) and same-day biopsy (logistic) correlated with age, race, language and type of insurance, all of which were similar between time periods.
Results showed the same-day biopsy program reduced mean time from biopsy recommendation to biopsy among all patients from 8 days (interquartile range [IQR] = 4-13) to 0 days (IQR = 0-4; P < .001).
For the time period before the program, researchers observed a significant association between higher number of days to biopsy and nonwhite race (adjusted coefficient = 2.3, 95% CI, 0.58-4.03) and government insurance (adjusted coefficient = 1.67, 95% CI, 0.02-3.32; P < .05 for both).
After adjustment, increasing age and government insurance appeared significantly linked to reduced likelihood of having a same-day biopsy (age-adjusted OR = 0.97; 95% CI, 0.95-0.99; government insurance-adjusted OR: 0.35 = 95% CI, 0.14-0.88; P < .05). No indication of these disparities existed after implementation of the same-day program.
According to Dontchos, racial disparities in time to biopsy cannot be ignored.
“We believe this is multifactorial, but could be related to financial, insurance, geographic and transportation factors leading to certain patients having challenges in returning to our breast imaging center for a separate breast biopsy appointment,” Dontchos told HemOnc Today. “Certainly, institutional biases may be present, but through our same-day biopsy program we obviate the need for a separate appointment and as a result eliminated a racial/ethnic disparity in the time to biopsy.” – by Jennifer Byrne
Reference: Seidler M, et al. Abstract 6508. Presented at: ASCO Annual Meeting, May 31-June 4, Chicago.
Disclosures: Dontchos reports no relevant financial disclosures. One author repots a consultant/advisory role with and research funding, honoraria and travel expenses from GE Healthcare.