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I have access to the NCR & SEER Incidence State RAD file for 1999-2013 via SEER*Stat. For the most recent 5 years of data (2009-2013), I see that the age-adjusted rates for in situ colorectal cancer range from a high of 4.0 per 100,000 in PA to a low of 0.4 in WA, an order of magnitude as you point out. The number of cases in WA is relatively small (111) compared to PA (2,582). Even though the population of PA is about twice that of WA, the number of cases in WA seems unusually low. My own state of AK is at 1.8, which is just below the national rate is 2.0. So it may very well be a reporting issue as Jim Hofferkamp suggests in his response to your question. And interesting thing to note is that the national rate has fallen by about half (4.1 to 1.9) from 1999 to 2013, and the number of cases have dropped significantly (10,445 to 6,908).