Geographic Variation in the Treatment of Localized Breast Cancer

THERE is substantial geographic variation in the medical and surgical management of disease in the United States. 1 2 3 4 5 6 7 8 To date, however, specific variations in cancer treatment have not been comprehensively examined. Clinical trials published during the 1980s 9 10 11 suggested that for women with localized breast cancer, modified radical mastectomy and breast-conserving surgery followed by radiation offer alternative approaches of comparable efficacy. We used data from the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute to determine the geographic and temporal variation in the use of mastectomy and breast-conserving surgery and radiation in nine areas of the United States . . .