REGIONAL VARIATION IN SURVIVAL FOLLOWING THE DIAGNOSIS OF CANCER

Recent studies have documented substantial geographical variation in p atterns of treatment of cancer and other diseases. Because cancer trea tment is not uniform nationwide, survival following the diagnosis of c ancer might also be expected to vary geographically. Survival data fro m the nine population-based registries in the National Cancer Institut e's Surveillance, Epidemiology, and End Results (SEER) Program were an alyzed for cancers of the stomach, colon, rectum, lung, breast, uterus , ovary, prostate, and bladder (n = 401,861). The patients included al l non Hispanic white patients diagnosed with cancer of one of the sele cted sites during 1983-1991. Regional variation in crude five-year sur vival rates across the nine SEER areas was most marked for cancers of the uterus and prostate. For uterine cancer, for example, five-year su rvival ranged from 73.2% in Connecticut to 84.0% in Hawaii. Less marke d variation was observed for cancers of the colon, rectum, and breast. For cancers of the bladder, ovary, stomach, and lung, survival rates five years after diagnosis were relatively invariant across the SEER a reas. Observed differences in survival rates, although statistically s ignificant, were relatively modest from the standpoint of the practici ng physician. Nonetheless, the general pattern of regional variation w as unchanged after adjustment for sex, age, stage, and surgical treatm ent and when analysis was limited to patients younger than 70 years, w ho would be anticipated to have the least comorbidity.