Cancer progress slows; racial disparity widens
Wednesday, September 3, 2003
WASHINGTON -- Cancer deaths may be leveling off after several years of decline, and many states are lagging in proven methods to fight the most common tumors, says the nation's annual report on cancer.
Sixteen states spend less than $1 per person on tobacco control -- far less than the $5 to $10 per person recommended -- even though smoking is the leading cause of lung cancer, the nation's top cancer killer. Screening for breast and colorectal cancer varies widely, too.
And there's a widening racial gap as white Americans increasingly survive certain tumors better than blacks, says the report published Tuesday in the Journal of the National Cancer Institute.
"The progress against cancer continues to be mixed," said co-author Dr. Michael Thun of the American Cancer Society.
Instead of awaiting the next anti-cancer discovery, the report shows states how to better target programs already proven to save lives but that are not being offered equally across the country, he said.
"There are substantial opportunities in applying what we already know," Thun said. Yet "because of the state budget crises, programs like tobacco-control programs are being cut at a critical time, when there's terrific opportunity for progress."
The report's overarching finding is somewhat sobering: Death rates for all cancers had been inching down by about 1.4 percent a year through the mid-1990s, but by 2000 that decline seems to have leveled off.
At least part of that is due to a statistical quirk -- a change in how cancer deaths are recorded that mean fewer were being missed in national counts starting in 1999.
An estimated 556,500 Americans will die of cancer this year, and 1.3 million will be diagnosed with it.
Death rates for the four most common cancers -- lung, breast, prostate and colorectal -- still are declining for all but one group, women with lung cancer.
Lung cancer deaths are increasing by just under 1 percent a year among both white and black women.
Most striking are the racial disparities. By 2000, death rates for whites were substantially lower than those for blacks, particularly among breast and colorectal cancer patients, where the gap appeared to have been widening.
Although breast cancer incidence is 16 percent higher in white women, black women are far more likely to die. Indeed, while breast cancer death rates dropped 2.5 percent a year for white women during the 1990s, death rates dropped just 1 percent a year for black women.
Similarly, black men and women are more at risk of getting and dying of colorectal cancer than whites, and white survival improved more than that of black patients through the 1990s.
That "would suggest perhaps the black population is not receiving the same benefit from early detection and treatment as the white population," said CDC epidemiologist Hannah Weir.
While socioeconomic factors play a role, scientists cannot yet fully explain the gap.
Then researchers examined states.
By 2010, the government wants no more than 12 percent of the population to smoke. Utah is closest to that goal, with 13.3 percent of adults who smoke and with the fewest deaths from lung cancer. The worst state for smoking is Kentucky, where 30.9 percent of adults light up, and the lung cancer death rate is the nation's highest.
Kentucky spends just 84 cents a person on tobacco-control programs. Utah, where the predominant Mormon church is a strong anti-tobacco influence, spends $2.46 per person on tobacco control.
Cancer screening varies widely, too. Women aged 40 or older are supposed to have mammograms every year or two. In Indiana, just 30 percent of uninsured women do.
Similarly, the government wants at least half the over-50 population to be getting regular colorectal cancer screening by 2010. In many states, well below 40 percent do.
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