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 Overall, the U.S. death rate from cancer has dropped about 20
percent from 1980 to 2014, the study found. Cancer fatalities now
account for about 192 deaths for every 100,000 people in the U.S.,
down from 240 per 100,000 at the start of the study period.
But in some parts of the country where poverty, obesity and smoking
are more common, rates of death from cancer are going up.
"Known cancer risk factors – smoking, diet, and obesity, among
others – combined with poor prevention programs may increase cancer
cases," said senior study author Dr. Christopher Murray of the
Institute for Health Metrics and Evaluation at the University of
Washington in Seattle.
"Unequal access to and quality of care are likely contributors to
cancer mortality disparities, and the lack of early detection for
some cancers and lack of specialized treatment can be deadly,"
Murray added by email.
Cancer is the second leading cause of death in the United States and
globally, after heart disease. Most previous reports on geographic
differences in cancer mortality in the U.S. have focused on
variation by state, the researchers note in JAMA.
For the current study, researchers estimated mortality rates at the
county level for 29 types of cancer using death records from the
National Center for Health Statistics (NCHS) and population counts
from the Census Bureau, the NCHS and the Human Mortality Database.
Nationwide, there were about 19.5 million cancer deaths during the
study period.
This included 7 million deaths from lung, tracheal and bronchus
cancer; 6 million breast cancer fatalities; 5 million deaths from
colon and rectal tumors; 2 million from pancreatic malignancies and
1 million from prostate cancer.
For many types of cancer, there were clusters of counties with
especially high death rates.
Breast cancer fatalities were particularly high in the south and
along the Mississippi River, while liver cancer was prominent along
the Texas border with Mexico. The study also found clusters of
kidney cancer in North and South Dakota as well as parts of West
Virginia, Ohio, Indiana, Louisiana, Oklahoma, Texas, Alaska and
Illinois.
Colorado offered the brightest spot on the map; cancer deaths in
Summit County fell by almost half during the study from 130 for
every 100,000 people in 1980 to just 70 deaths per 100,000
population by the end of the study.
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Kentucky had the worst spots, with cancer deaths surging by up to
about 45 percent in some counties in the eastern part of the state.
One limitation of the study is that the data may not have captured
all cancer deaths, and the analysis might have underestimated
inequalities in death rates in some instances, the authors note.
Still, improvements in screening, prevention and treatment across
many tumor types should make many more deaths preventable,
especially in counties where fatality rates far outpace the national
average, the authors conclude.
"This study shows that we have made huge strides in cancer
prevention and treatment but have not done a good job extending
these benefits to all of our citizens, and the most vulnerable are
paying for this with their lives," said Dr. Ethan Basch, director of
cancer outcomes research at Lineberger Comprehensive Cancer Center
at the University of North Carolina in Chapel Hill.
"Individual citizens should realize that the system isn't
necessarily going to get them the best quality care, so they need to
educate and advocate for themselves by seeking recommended screening
like colonoscopies, finding a good local health provider, and
obtaining health insurance," Basch, author of an accompanying
editorial, added by email.
SOURCE: http://bit.ly/2jtImTG JAMA, online January 24, 2017.
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