Time trends and key factors in the choice of one-step or two-step biopsy and surgery for breast cancer.

The relationship between type of biopsy-mastectomy procedure and four sets of independent variables (physician, patient, hospital and tumor characteristics) was examined for 993 locally-staged breast cancer patients diagnosed between 1974 and 1981 in 13 counties of western Washington State. Time trends were also investigated. Cases were selected from records of a population-based cancer registry. The frequency of the two-step procedure, in which biopsy and surgery occur on different days, increased from 28 to 57% during the 8-year study period. Use of the two-step procedure was associated with younger age of the patient, less suspicious symptoms or mammogram results, younger physician cohorts and hospitals with government and health maintenance organization proprietorship. These relationships remained unchanged after controlling for potentially confounding variables. There were also substantial differences between individual hospitals in the frequency of the two-step procedure, suggesting differing schools of thought in different locales.