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Frederic W.-B. Deleyiannis, MD, MPhil, MPH; Ernest A. Weymuller, Jr, MD; Isabel Garcia, DDS, MPH; Arnold L. Potosky, PhD

Arch Otolaryngol Head Neck Surg. 1997;123(11):1203-1210.

Abstract
Objective
To determine the extent to which esophagoscopy and bronchoscopy are being used in various regions of the United States in the initial examination of patients with head and neck cancer.

Design
Population-based study derived from Medicare claims data and information from 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 carcinoma of the oral cavity, oropharynx, hypopharynx, or larynx diagnosed between March 1, 1991, and December 31, 1993, in the 5 SEER areas.

Main Outcome Measure
Rates of esophagoscopy and bronchoscopy according to SEER area.

Results
The proportion of patients who underwent esophagoscopy 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) for patients with regional cancer. The proportion of patients who underwent bronchoscopy ranged from 6.9% (San Francisco) to 32.6% (Detroit) for patients with local cancer and from 12.8% (San Francisco) to 50.7% (Detroit) for patients with regional cancer. After controlling for differences 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 substantial geographic variation in the use of esophagoscopy and bronchoscopy as part of the initial examination of patients diagnosed as having head and neck cancer that cannot be explained by differences in patient or tumor characteristics. This variation likely underscores uncertainty and disagreement about the value of endoscopic screening for synchronous tumors. Additional research is required to determine whether routine endoscopic screening increases survival rates or improves quality of life.

Arch Otolaryngol Head Neck Surg. 1997;123:1203-1210

Author Affiliations
From the Department of Otolaryngology—Head and Neck Surgery, University of Washington, Seattle (Drs Deleyiannis and Weymuller); Oral Health Promotion, Risk Factors, and Molecular Epidemiology Branch, National Institute of Dental Research, National Institutes of Health, Bethesda, Md (Dr Garcia); and Applied Research Branch, National Cancer Institute, National Institutes of Health (Dr Potosky).

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