By MIKE DUNNE
Advocate staff writer

While a recent report said cancer incidence and mortality rates are falling across the country, Louisiana’s cancer death rates continue to hover above the national average, according to two local experts.

Dr. David S. Hanson, a medical oncologist with Louisiana Hematology Oncology Associates, and Lori McCallum of Mary Bird Perkins Cancer Center and the Louisiana Tumor Registry, said a lack of early detection means less chance for successful recovery and smoking plays a large part in why the death rates are not falling.

Other than lung cancer for white men and some cases of breast cancer, the incidence of cancer in Louisiana is about the same as the national average, both experts said.

But when cancer deaths — rather than cases of cancer — are factored in, Louisiana has 252 deaths per 100,000 in men and 151 deaths per 100,000 in women. Nationally, the rates are 209 per 100,000 for men and 139 for per 100,000 for women.

In terms of incidence, Louisiana had 500 cancer cases per 100,000 men compared to 475 per 100,000 nationally. For women, the state had 320 cases of cancer per 100,000, compared to 347 per 100,000 nationally.

So, the number of cancer cases is slightly higher for men and below the national rate for women during 1993-1997, according to the American Cancer Society.

In early June, the National Cancer Institute released a report saying the incidence of cancer and deaths caused by the disease were both showing a downward trend.

But that’s not the case when it comes to cancer deaths in Louisiana, Hanson and McCallum said.

The state’s statistics also show some areas of the industrial corridor have slightly higher rates for some cancers compared to the national rates.

A state report said that in the "River Parishes" between East and West Baton Rouge parishes down to St. Charles Parish, white men had 537 cancers per 100,000 compared to 483 per 100,000 nationally. But the rates for all cancers for white men, black men and black women were all below the national incidence rate.

The cause of that increased rate in white men is unknown and both Hanson and McCallum are quick to say it cannot automatically be attributed to the industrial environment.

Hanson said answers to the cause of cancer are just not clear cut.

"We can’t say what it means to be an employee of a certain kind of industry, who smokes in a certain kind of industry, has genes and smokes and works in a certain kind of industry," Hanson said.

But since smoking is so connected to lung cancer, and Louisiana has a higher-than-average rate for white men, "let’s not go to work at the plant and be stupid and keep smoking," Hanson said.

McCallum said the statistics can also be confounding.

For example, the incidence of breast cancer among black women in Louisiana is lower than the national average but the mortality rate is higher, McCallum.

Hanson said too often in Louisiana, cancer is not caught by screening techniques, such as PSA tests for prostate cancer or mammograms for breast cancer. Often it is diagnosed when patients come in complaining of a symptom, and that is often too late for successful treatment.

Hanson said, "We are playing catch-up on screening. We still have an (access and use of) mammography problem."

The mortality rates are trending downward except for lung cancer in women, Hanson and McCallum said.

While access to medical screening and care are more limited in Louisiana, lifestyles also factor into the statistics, Hanson and McCallum said.

"We still have a fairly high proportion of our population that tends to smoke," McCallum said.

Hanson predicted that since lung cancer often does not appear for 20 or more years, "we will see a similar pattern" of increased incidence and mortality of lung cancer in women, who have been smoking at the same rate as men for the past two decades.

Louisiana is in the top 10 percent for lung cancers for white men. Black men are about the national average — another curious aspect of the statistics, McCallum said,

But that could change, Hanson said, as more black men smoke than white men because tobacco companies have done a "great job of working that niche," marketing to black men to make their product "seem like it is part of masculinity."

Prevention is so important in lung cancer, he said. Eighty-five percent to 90 percent or more of lung cancer cases are attributable to cigarette use. "We could significantly reduce it through a preventative health program," Hanson said.

Hanson is also concerned that "teen-age smoking is on the rise. One in three (teen-agers) will keep smoking," and some will develop cancer.

"If we had all the money in the world and we could fix this, we would somehow ban cigarette smoking and screen everyone for the cancers that are easily detected — such as breast, cervical, prostate, colorectal and skin cancers," Hanson said.

Both researchers said they also wonder if the money from the state’s share of the tobacco case settlement will end up paying for either better health screening or education.

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