N.C. Congressional districts: All cancers, males and females, rates compared to surrounding states. Data and map courtesy ACS.
N.C. Congressional districts: All cancers, males and females, rates compared to surrounding states. Data and map courtesy ACS.

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New American Cancer Society maps of cancer incidence tabulated by Congressional districts found, in particular, men in Southeastern states, including North Carolina, had above average rates of cancer deaths.

By Rose Hoban

People living in the Southeastern U.S. have, in general, higher rates of death from lung, colorectal, breast and prostate cancer than in most of the rest of the country, according to a new analysis from the American Cancer Society. And those death rates are increased for black men, in particular, who have higher rates of death from all those cancers, and for black women, who have higher breast and colorectal cancer death rates.

But the twist to this new analysis, done by Rebecca Siegel, an epidemiologist with the ACS, is that the breakdown for cancer rates was calculated using Congressional districts.

N.C. Congressional districts: Death rates for all cancers, males and females, per 100,000, comparing only N.C. rates. Data and map courtesy ACS

“It’s easy to look at death rates by state, but states are not homogeneous entities,” Siegel said in an interview with N.C. Health News. “This analysis allowed us to see the heterogeneity that’s going on in states. You can look at death rates by county, and those are sometimes really small numbers. This analysis is a happy medium, actually.”

In her article, published in CA: A Cancer Journal for Clinicians, Siegel notes that the economic costs of cancer are “sobering.”

“National expenditures for cancer care are projected to reach $158 billion US by 2020, with state costs predicted to increase by an average of 72 percent from 2010 to 2020,” she wrote in her article. “Investment in cancer prevention and treatment can help curtail this cost explosion.”

More smoking, more cancer

Siegel performed the analysis this summer, using cancer rates from 2002 to 2011 and the Congressional district drawings from that time period. In many states, North Carolina included, Congressional districts have been redrawn in the wake of the 2010 elections, but the geographical boundaries remain roughly similar.

Seigel said there are wide differences between cancer rates in states such as Utah and the states of the Southeast. “That means there are things we can do to lower the risk of dying from cancer in areas like the South that have higher rates,” she said.

Primary among those risk factors that can be changed is the rate of smoking.

“Southern states (with the highest overall cancer mortality rates) have also lagged behind in funding and implementing tobacco control programs and policies and have the lowest cigarette excise taxes in the nation,” Siegel wrote.

Excise tax rates for cigarettes roughly parallel the incidence of lung and other cancers: the lower the tax, the higher the rates.

N.C. Congressional districts: Death rates for all cancers, males and females, per 100,000; rates compared to the rest of the U.S. Data and map courtesy ACS

Siegel told N.C. Health News that “tobacco states currently and historically have the highest death rates for not just lung cancer but 11 other cancers that we’ve established are influenced by smoking.”

“For some sites in the body, about half the cancer deaths are attributable to smoking,” she said. “For example, the oral cavity cancers are due to smoking: urinary or bladder cancers, esophagus. People only think about lung cancer, because it’s the big one.”

She called the variation in excise taxes between states “shocking.” Missouri has the lowest tax rate, imposing a 17 cent tax per pack (with additional city and county taxes), while in contrast New York has a $4.35 tax rate, the nation’s highest.

North Carolina’s cigarette excise tax currently stands at 45 cents.

Siegel said the cigarette taxes have a profound influence on people’s smoking habits, especially people who have less money to spend.

“People in lower socioeconomic levels are more price sensitive,” she said. “They have the highest smoking rates. So when you increase excise taxes, you’re going to lower smoking.… And, of course, kids; they don’t have a lot of money, so they’re price sensitive too.”

Poverty factors

Another factor driving higher cancer rates, Siegel said, is the poverty level in many Congressional districts.

The North Carolina map shows districts in the eastern part of the state with the highest levels of poverty have the state’s highest cancer rates. That finding parallels years of research showing that people with lower socioeconomic status have disproportionately higher cancer death rates than those who are more well-to-do, regardless of demographic factors such as race/ethnicity.

Prior research has shown that educational level is one of the best predictors for health outcomes. For example, college graduates live, on average, five years longer than people who have not graduated from high school.

Siegel said that’s part of the cancer picture, as people with lower educational levels have higher cancer incidence rates because they tend to engage in behaviors that increase cancer risk, such as using tobacco, not being physically active and having an unhealthy diet.

Insurance plays a part too. Research shows poorer patients are less likely to survive after a cancer diagnosis because the disease is often detected at an advanced stage and because they are less likely to receive standard treatment, either because they lack insurance or have more hurdles to treatment if their insurance is not comprehensive.

For example, stage II colorectal cancer patients with private insurance have better survival rates than stage I patients who are uninsured.

One emerging trend though is that rates of lung cancer among blacks is dropping, in part because smoking rates among black teens have been falling since the ’70s, while smoking rates for whites stayed steady.

“It takes 20-plus years for these figures to be seen in the lung cancer prevalence,” Siegel said.

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