State health officials rolled out a new cancer prevention and treatment plan for North Carolina last week. But there are still many missing pieces.

By Rose Hoban

Forty-three years ago, Richard Nixon declared “war on cancer” with the signing of the National Cancer Act. In that time, the rate of deaths from cancer has dropped from about 83 per 100,000 people under 65 to less than 60 per 100,000.

But despite this progress, cancer still accounts for about one of every four deaths of people under the age of 65.

Meanwhile, in the same time period, deaths from heart disease have seen a much steeper decline, dropping from about 100 per 100,000 people under 65 to less than 40 per 100,000.

Cancer remains a stubborn foe for those who want to reduce the number of people who die too young.

In North Carolina, about 90,000 people will be diagnosed with cancer this coming year and about 19,000 will die from the disease. In 2009, cancer became the leading cause of death in North Carolina for people under 65, surpassing deaths from heart disease.

Now state officials are working on a new plan, unveiled late last week, to reduce the burden of cancer. The plan – which received input from cancer patients, survivors and advocates, as well as legislators – is a broad document that is as yet without a lot of specifics.

“This group is committed to coming up with that,” said Ruth Petersen, chief of the Chronic Disease and Injury Section of the state’s Department of Health and Human Services. “That’s the only way we’ll be able to measure our progress, and it’s the only way we’ll be able to know if we’re falling short to where our vision is.”

“We’re hoping to work with our grassroots partners to get the word out,” said Debi Powell, from DHHS’s Cancer Prevention and Control Branch.

[pullquote_left]NC Health News is part of the IndyWeek’s annual Give!Guide Please consider supporting us this season![/pullquote_left]Petersen admitted that the current political and reimbursement environment makes getting preventive services, treatment and follow-up care to all the people diagnosed with cancer challenging.

About 1.5 million North Carolinians were uninsured in 2013, according to data from the U.S. Census. More than 357,000 people, many of whom had been previously uninsured, signed up for insurance under the Affordable Care Act last year. But the state’s refusal to expand the Medicaid program under the law means that anywhere from 350,000 to 500,000 people will remain ineligible for coverage in the coming year.

“What we’re worried about is the people who don’t have any coverage in any shape,” Petersen said. “We’re hoping to work with partners to make sure those people who don’t have funds for any cancer treatment or screening, once they get that diagnosis, they can make improvements. But it’s an unknown landscape.”

Although the state legislature has designated funds for women to get screened for breast and cervical cancer, those funds are limited to uninsured women who live in households that earn less than 250 percent of the federal poverty level ($29,175 for a single person). And the money for treatment is limited by the fact that women need to be referred to the state’s Breast and Cervical Cancer Control Program before being diagnosed with cancer to be eligible to be covered for treatment.

“Medicaid expansion would cover a lot of those women … who don’t have coverage,” Petersen said.

Breast cancer is the third-leading cause of cancer death in North Carolina women, behind lung and colorectal cancer. For men, the top three causes of cancer death are lung, colorectal and prostate cancers.

Many plans, fewer resources

The new plan emphasizes that people on all levels have a role to play in the fight against cancer, from individuals quitting smoking and maintaining a healthy weight, to businesses supporting non-smoking policies, to legislators funding tobacco-control efforts.

But the realities currently fall short of those lofty goals.

About two-thirds of North Carolina adults are overweight or obese, and the state ranks fifth worst in the country for rates of childhood obesity.  And in the past two legislative sessions, lawmakers have allocated less than $3 million toward the state’s tobacco Quitline and eliminated funding for the state’s youth tobacco-prevention program, despite the fact that North Carolina receives more than $145 million each year from the Tobacco Master Settlement Agreement.

“Certainly, creating a plan to address these issues is laudable, but it’ll be difficult to make serious change without funding a tobacco cessation and prevention program, among other programs that they could fund as well, to improve the health of North Carolinians,” said Pam Seamans, head of the North Carolina Alliance for Health.

“The tie of tobacco use to cancer is real, and we won’t have success in reducing cancer rates unless we keep kids from starting to smoke by funding youth tobacco-prevention programs and increasing the price of tobacco products,” Seamans added.

North Carolina’s current cigarette tax is 45 cents per pack, the fifth-lowest tax in the country.

Seamans said that if North Carolina increased the cigarette tax by a dollar, it would take the state to just under the national average of $1.54 per pack. Research from the National Bureau of Economic Research has shown that raising cigarette taxes prevents kids from starting to smoke and induces young smokers to stop smoking.

According to the Campaign for Tobacco Free Kids, raising North Carolina’s cigarette tax by one dollar would prevent 62,700 teens under 18 from becoming smokers and reduce the rate of teens smoking by 15 percent. The organization also estimates that an increase in the tax would induce an additional 71,300 adult smokers to quit.

Legislators also failed to give final passage to a bill that would have banned use of tanning beds by anyone under the age of 18. Tanning bed use has been implicated in the dramatic rise in skin cancers and malignant melanomas in young people in the past decade.

“We have a legislative committee on the advisory committee,” Petersen said. “They are paying attention to the landscape about how we can work with our policymakers to make sure they understand the decisions they make have ramifications on the plan and on people’s treatment and diagnoses and their ability to receive care.”

State senators Tamara Barringer (R-Raleigh), Jeff Tarte (R- Cornelius) and Don Davis (D-Snow Hill) are on the advisory committee for the plan, as well as state representatives Nelson Dollar (R-Cary), Bert Jones (R-Reidsville) and Susan Martin (R-Wilson).

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Cancer screening, prevention, treatment and support resources in N.C.

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