Biased Comparisons of Lung Cancer Survival across Geographic Areas

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Abstract
This report illustrates bias that may affect comparative analyses of cancer survival across geographic areas and describes how it limits the conclusions that can be drawn from such data. Despite the application of a standardized procedure for assigning tumor stage, patients from different areas who are assigned the same stage category may not be homogeneous with respect to extent of disease, if staging is accomplished more aggressively in one group than in another. Stage-specific comparisons of survival may be biased as a result. Cancer sites for which a large majority of patients are treated surgically may be less susceptible to stage bias.

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