Impact of a same-day breast biopsy program on disparities in time to biopsy.

Abstract

6508 Background: While screening rates have improved among minorities, racial/ethnic disparities in diagnosis and treatment persist. Many steps in the diagnostic pathway can delay tissue diagnosis, and in usual practice breast biopsies are performed days to weeks after biopsy recommendation. The purpose of this study was to identify if racial/ethnic disparities exist in time from biopsy recommendation to biopsy, and if a same-day biopsy program (biopsy on the same day as the recommendation) eliminates these disparities. Methods: After IRB approval, we identified all diagnostic mammogram and ultrasound exams leading to biopsy pre- (September 2016-March 2017) and post- (September 2017-March 2018) implementation of our same-day biopsy program. We compared the distribution of age, race, language, insurance type, days to biopsy and proportion of same-day biopsies in pre- vs. post-implementation groups using the Wilcoxon test (for continuous variables) and the Pearson’s chi-squared test (for categorical variables). Multivariable linear and logistic models were estimated in pre and post periods to assess if days from biopsy recommendation to biopsy (linear) and having a same-day biopsy (logistic) were associated with age, race, language, and insurance type. Results: 663 and 482 patients underwent biopsy during pre- and post-implementation, respectively. Age, race, language, and insurance type were similar between time periods. For all patients, the same-day biopsy program decreased mean time from diagnostic examination to biopsy from 8 (IQR: 4-13) to 0 (IQR: 0-4) days (p < 0.001). During the pre time period, non-white patients and having government insurance were significantly associated with longer days to biopsy (non-white aCoef: 2.30 (95% CI: 0.58-4.03); insurance aCoef: 1.67 (95% CI: 0.02-3.32); p < 0.05), and increasing age and having government insurance were significantly associated with decreased odds of having a same-day biopsy (age aOR: 0.97 (95% CI 0.95-0.99); insurance aOR: 0.35 (95% CI 0.14-0.88); p < 0.05), after adjustment. During the post time period there was no evidence of these disparities. Conclusions: A same-day biopsy program eliminated racial/ethnic disparities in time from breast biopsy recommendation to biopsy.