Regional variation in breast cancer treatment throughout the United States

BACKGROUND: It has been proposed that initial treatment for breast cancer varies greatly across the United States. However, one question that has not been answered completely is whether or not geographic location itself is an independent variable with regard to treatment. METHODS: The American College of Surgeons National Cancer Database Benchmark Reports (NCDB) were used to examine initial breast cancer treatment performed throughout the United States during the study period 1999-2003. These data were then stratified with regard to geographic region in accordance with the US Census Bureau classifications. RESULTS: There was a statistically significant relationship between geographic region and initial treatment of breast cancer. Although there were statistically significant relationships between race and geographic region and stage and geographic region, when the data were controlled for stage and race, the regional differences persisted. Stage-for-stage and within each racial cohort, the geographic differences in treatment were still statistically significant. DISCUSSION: This review suggests that geographic location within the United States is an independent variable with regard to breast cancer treatment.