This Illinois study shows that rural patients who were postmenopausal and node negative were more likely than urban patients to have a modified radical mastectomy (P=.03) and less likely to have had an oncology consultation (P=.01). Postmenopausal rural patients with positive nodes were more likely than comparable CCOP patients to receive radiation therapy (P=.0001), regardless of surgical choice, and were less likely to get hormone therapy than urban patients with an estrogen receptor-positive tumor (P=.007). After adjustment for confounders, rural patients were less likely than those in either comparison group to have limited surgery (odds ratio [OR] = 2.8, 95% confidence interval [CI] 1.4, 5.6 for urban patients, and OR = 2.9, 95% CI 1.5, 5.7 for CCOP patients) and more likely than CCOP patients to undergo radiation (OR = 0.2, 95% CI 0.1, 0.4). These data can be used to assess the impact that dissemination of state-of-the-art treatment strategies has on breast cancer mortality.