GEOGRAPHIC-VARIATION IN THE UTILIZATION OF ESOPHAGOSCOPY AND BRONCHOSCOPY IN HEAD AND NECK-CANCER

Objective: To determine the extent to which esophagoscopy and bronchos copy are being used in various regions of the United States in the ini tial examination of patients with head and neck cancer. Design: Popula tion-based study derived from Medicare claims data and information fro m the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program. Setting: Five SEER areas (San Francisco, Calif ; Connecticut; Seattle, Wash; Iowa; and Detroit, Mich). Participants: The cohort included 1410 Medicare patients with squamous cell carcinom a of the oral cavity, oropharynx, hypopharynx, or larynx diagnosed bet ween March 1, 1991, and December 31, 1993, in the 5 SEER areas. Main O utcome Measure: Rates of esophagoscopy and bronchoscopy according to S EER area. Results: The proportion of patients who underwent esophagosc opy ranged from 12.9% (San Francisco) to 39.8% (Detroit) for patients with local cancer and from 22.2% (San Francisco) to 59.7% (Detroit) fo r patients with regional cancer. The proportion of patients who underw ent bronchoscopy ranged from 6.9% (San Francisco) to 32.6% (Detroit) f or patients with local cancer and from 12.8% (San Francisco) to 50.7% (Detroit) for patients with regional cancer. After controlling for dif ferences in age, sex, race, tumor site, tumor grade, comorbidity, and socioeconomic status, SEER area remained independently associated with esophagoscopy and bronchoscopy (both P<.001). Conclusions: There is s ubstantial geographic variation in the use of esophagoscopy and bronch oscopy as part of the initial examination of patients diagnosed as hav ing head and neck cancer that cannot be explained by differences in pa tient or tumor characteristics. This variation likely underscores unce rtainty and disagreement about the Value of endoscopic screening for s ynchronous tumors. Additional research is required to determine whethe r routine endoscopic screening increases survival rates or improves qu ality of life.