Five years after surgery for prostate cancer, for instance, 72 percent of men treated at leading hospitals are alive, compared with 62 percent of those treated elsewhere.
Scrutinizing data from specific cancer centers reveals even greater gaps.
Five-year survival for stage IV prostate cancer is 71 percent at Fox Chase, for instance, but 38 percent nationally.
For stage IV breast cancer, the respective figures are 28 percent and 19 percent—an almost 50 percent edge.
For stage IV cervical cancer, five-year survival is 33 percent at the Cleveland Clinic vs. 16 percent nationally.
Remarkably, the quality-of-care gap between elite centers and community settings doesn't reflect who has the newest, coolest multimillion-dollar machine, in which case one could forgive small community hospitals for lagging behind. Instead, it comes down to such basics as experience; to getting the diagnosis right; to whether doctors address diet, exercise, and psychological health; to whether doctors routinely test tumors for molecular markers that can guide therapy; to whether care is coordinated or haphazard; to how well doctors monitor patients—after surgery, radiation, or chemo "got it all"—in order to minimize the chance that the cancer will recur. And it reflects a knowledge gap. Because so many doctors don't seem to know that breast MRIs are influenced by the menstrual cycle, says oncologistJulie Gralow of the Fred Hutchinson Cancer Research Center in Seattle, about 15 percent of the diagnoses for which she provides a second opinion are wrong.