Research was done on whether risk was associated with these factors:
Treatment centre location
Risk of death was higher in patients treated in inner regional centres in Australia compared with major city centres and more remote areas. It would be expected that treatment centres outside major cities would have less access to specialist services and to decision-making teams which include members from different healthcare professions; however, this does not explain why risk of death was higher in inner regional centres but not in more remote areas.
Surgeon case load
The patients of surgeons who treat a higher number of patients per year (more than 20) had a lower risk of death from breast cancer. However, the results suggest that much of this effect may have been due to treatment centre location.
Health insurance status
The study provided clear evidence that risk of death was not related to a patient having private health insurance. Although lack of private health insurance may prevent patients from receiving appropriate breast and other cancer care in the United States, this inequality may not be present in Australia due to universal public insurance.
More research is needed to find out why survivals are lower in Australia when treatment is provided in inner regional centres or by a surgeon with a low case load. Meanwhile, it would be appropriate to introduce quality improvement programs to these settings.