Cancer data point to Massachusetts

The Bay State led the nation in the number of women with breast cancer and Hodgkin's lymphoma, according to a landmark study released yesterday. Massachusetts was also in the top five states for 10 other cancer categories and above the national average in 22 more.
But why and what to do about it are questions the report issued by the Centers for Disease Control leaves up to researchers and policy makers.
The study of 1999 data is the first of its kind - a nationwide comparison of cancer rates broken down by region and state.
``This is a larger population than has ever been surveyed before,'' said Hannah Weir, a CDC cancer expert. ``It will help us to describe the underlying factors that contribute to the incidences of cancer.''
Cancer is the second-leading cause of death among Americans. In the United States, one of every four deaths is due to cancer. This year, about 1.3 million people will be diagnosed with the disease, according to the American Cancer Society, and about 555,500 will die because of it.
Until now, researchers have had broad information about cancer among only 14 percent of the population. This expands the reach to 78 percent.
``With this new data, we can better identify, understand and address differences in cancer rates across the country,'' said Tommy Thompson, U.S. Health and Human Services secretary. ``The state and regional data will prove invaluable to public health officials as they plan and evaluate cancer control programs and conduct research.''
In Massachusetts, the age-adjusted rate of non-invasive breast cancer was 47 per 100,000 compared to a national rate of 28.8. The rate for Hodgkin's lymphoma among women in the Bay State was 3.2 compared to a national rate of 2.5.
Compared to the national averages, Bay State women had higher incidences of several cancers including lung, colon, melanoma, pancreas, thyroid, larynx, and brain. Bay State men had higher rates of stomach, brain and thyroid cancers.
The rate of cancer among Bay State men was 588.6 per 100,000 compared to a national rate of 552.3. The District of Columbia had the highest rate at 667.1. Rhode Island was second-highest at 644.7
The rate for Bay State women was 451.5 per 100,000 compared to a national rate of 420.1. Rhode Island was the highest with 487 followed by Connecticut with 458.
The study also found that prostate cancer was the leading category in men, regardless of race, followed by lung and colon cancers.
Among women, the leading cancer was of the breast, followed by that of the lung and colon.
The current report examines data from 37 states that met uniform reporting requirements. But future reports will include all 50 states.
``We begin now to get a sense of the geographic variation of cancer incidences,'' Weir said.
The existing data, though paltry by comparison to the new report, has already spurred large amounts of planning and research, said Dr. Judy Garber, director of risk and prevention at Dana-Farber Cancer Institute.
``It's been quite good, but this is larger so it should be better,'' she said. ``There are subtle variations that might become more apparent.''
It could help determine what cancers should be targeted in certain areas for screening and preventive efforts. Areas with high incidences of lung cancers might be prime areas for anti-smoking campaigns. Areas with high incidences of breast cancer might need more mobile mammogram units.
``It's a great source for research projects and for policy makers who really have to figure out how to use the increasingly limited resources they have to fight cancer,'' Garber said.
Overall, the annual amount the country will spend to deal with cancer will be about $171.6 billion this year, according to the National Institutes of Health. That includes direct medical costs of $60.9 billion. Those costs are expected to increase as the population grows.
``To reduce the nation's cancer burden, we must reduce the prevalence of behavioral and environmental factors that increase cancer risk, and we must ensure that high-quality screening services and evidence-based treatment protocols are available and accessible, particularly to medically underserved populations,'' the CDC wrote in the report.
Eventually, the report could be used to identify cancer clusters - areas in which there are certain types of cancers caused by geographic specific factors. But this report is limited to discovering such trends because it is only one year, Weir said.
The report was produced jointly by the CDC and the National Cancer Institute in collaboration with the North American Association of Central Cancer Registries.
In all, the report contains details about 66 primary cancers for men and 70 for women. Unlike other studies, it shows regional as well as state-specific data.
Source Boston Herald 11/19/02

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