When Kathy Sabadosa was diagnosed with early-stage breast cancer in 2007, she agonized over her options.
"It was a pretty traumatic and devastating weekend at our house," Sabadosa said.
Patients like Sabadosa may not realize the treatment they get is strongly determined by where they live.
"As strange as it can seem, where people live can have more influence on the health care they receive than their medical condition or their own personal preferences," said Dr. Michael Barry.
There's often no standard way of determining treatment.
For example, women with early stage breast cancer in Victoria, Texas were about seven times more likely to have a mastectomy than those in Muncie, Indiana. And surgery for early prostate cancer was twelve times more likely in San Luis Obispo than in Albany, Georgia.
"We think the differences as they stand now probably relate a lot to doctors' preferences for one procedure over another, even when both are pretty reasonable options," Dr. Barry said.
That's why some hospitals are using a process called shared decision making -- a formal way for patients to learn about all their options, including having no procedure.
"We want them to be so informed they get really get what they're signing up for," said Kate Clay, director of Dartmouth-Hitchcock's Center for Shared Decision Making.
Kathy Sabadosa chose to have a mastectomy, a decision she says she felt confident in.
"Having the shared decision making center open to me as a patient really gave me the sense of, wow, I do have choices," she said.
LaPook adds that experts at Dartmouth estimate about twenty to forty percent of elective procedures like back surgery would not be done if patients were properly informed.