Tuesday, November 18, 2003

Cancer rate high in Appalachia

Lung cancer remains the No. 1 cancer killer in the state of Ohio

By Tim Bonfield
The Cincinnati Enquirer

People in seven Southwest Ohio counties are more likely to die from cancer than people living in the rest of the state.

The region's Appalachian heritage is a key factor, say experts.

Click to view Acrobat PDF file (16k) showing a detailed look at Appalachian cancer trends.
(Elizabeth Kane infographic)
| ZOOM |
The statewide cancer report issued Monday by the American Cancer Society breaks down death rates and new cases in all 88 Ohio counties. Twenty-nine Appalachian counties - including Clermont, Adams, Brown and Highland counties - suffer unusually high cancer rates. Significant numbers of Appalachian people also live in Hamilton, Butler and Warren counties.

"Residents of Ohio's Appalachian counties are getting cancer more frequently and dying of cancer more frequently than the rest of Ohio," said Cynthia Blocksom, a community health services specialist for the Cincinnati Health Department.

Overall, though, "The No. 1 cancer killer in Ohio continues to be lung cancer."

Cancer death rates run as high as 252 per 100,000 residents in Adams County - well above the state rate of 216.7, which in turn is notably higher than the U.S. rate of 202.3. Lung cancer rates exceed national averages in all eight counties.

Several factors appear to influence the high cancer rates in Ohio's Appalachian counties, which form a crescent along the state's southeastern border:

• Tobacco use.

• Obesity.

• Older populations.

High smoking rates - and high chewing tobacco use - are common in areas where tobacco farming is still a way of life.

There are other factors as well.

People from self-reliant rural cultures tend to avoid screening tests that can catch cancer at early, more curable stages. High rural unemployment and poverty rates also make it harder to get treatments that can delay or prevent cancer deaths.

"The American Cancer Society is addressing these disparities through targeted outreach within the rural and Appalachian communities," said Jill Raleigh, executive director of the cancer society's southwest Ohio chapter.

For example, a "Student-Athlete Mentor Program" in several rural schools encourages young people to avoid tobacco. And Ohio University is working with the cancer society to develop more effective ways to communicate public health risks in Appalachia, Raleigh said.

In Ripley - home of Brown County's annual Tobacco Festival - Ohio's only tobacco market opens today. People there question whether more public health messages will make any difference.

Every year on Great American Smokeout Day (Nov. 20 this year), Orville Whalen makes a point of lighting up a cigarette. He prefers chewing tobacco over cigarettes, but the floor manager of the Farmer's Warehouse does it to make a statement.

"It's a legal product. Until the government steps in and makes it illegal, (farmers) are going to continue raising it," Whalen said. "The government wants the taxes off it. The government makes more money off tobacco than the farmer does."

Statewide toll

This year in Ohio, about 60,300 people will be diagnosed with cancer. Another 25,200 will die from cancers already diagnosed, according to the cancer society.

Of eight Southwest Ohio counties, only Warren County had a overall cancer death rate lower than state and national averages. Officials speculated Monday that an influx of younger families in the rapidly growing county has diluted the impact of cancer cases suffered by older residents.

While lung cancer rates were consistently high, reported new cases of breast and prostate cancer were below national averages in Butler, Warren, Brown, Adams, and Highland counties.

Experts fear that may be the result of people skipping cancer screening tests.

A national study to be issued today by the National Cancer Institute reports that anti-tobacco programs can be effective. States with strong tobacco control policies experienced larger reductions in smoking than states that were not as aggressive.

However, some wonder what more the health police can really do.

"There've been so many lawsuits. There's warnings on every pack of cigarettes," said David Dugan, a tobacco farmer who also works as an agricultural extension agent for Brown County.

"I don't see how anybody who is breathing could not know about the risks."



E-mail tbonfield@enquirer.com

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