- Cancer mortality rates have decreased nationally by more than 20 percent since 1980, yet local “hotspots” of disparities remain in certain communities, says an article published in JAMA this month.
After reviewing more than 19.5 million records of cancer deaths, researchers from the University of Washington’s Institute for Health Metrics and Evaluation (IHME) found increases in specific cancer rates in certain US counties, indicating local differences in access to care, preventive treatment, and population health management investments.
"Most previous reports on geographic differences in cancer mortality have focused on variation by state, with less information available at the county level,” said the research team. “There is a value for data at the county level because public health programs and policies are mainly designed and implemented at the local level.”
“Moreover, local information can also be useful for health care clinicians to understand community needs for care and aid in identifying cancer hot spots that need more investigation to understand the root causes."
Notable examples include disparities in mortality for lung, colorectal, and breast cancers.
The Southwest saw the lowest rates of mortality from lung cancer. Patients in Arizona, northern New Mexico, Utah, and parts of Southern Idaho were among the most likely to survive. However, regions in Kentucky and West Virginia saw markedly increased lung cancer mortalities in 2014, after experiencing a rise in mortality rates throughout the study period.
Colorectal cancer mortality rates dropped by 35 percent nationally, but areas in the Mississippi river region saw increases by 2014. Conversely, Nassau County (New York) and Howard County (Maryland) saw the largest declines in colorectal cancer mortality.
Breast cancer mortalities saw steady declines from 1980 to 2014 in the Northeast, Southern Florida, and the Midwest, while Madison County, Missouri experienced higher mortality rates than other regions of the country in 2014.
"There are several potential explanations for the high rates of cancer mortality in certain counties and regions," the researchers said. "First, cancer incidence could be high due to a combination of risk factor profile and poor prevention and screening programs. Second, cancer detection happens at a late stage because of the interplay of lack of screening, awareness in the population and health care clinicians, and poor access to health care. Third, cancer treatment strategies are poor."
Local health systems that implemented early detection and screening programs were able to lower breast cancer rates despite the rise in risk factors, such as alcohol consumption and postmenopausal obesity. In regions where these plans were not enacted, spikes in breast cancer mortality occurred, the study points out.
"There is a need for comprehensive breast cancer care that includes prevention efforts, awareness building, adequate coverage of breast cancer screening, access to care, effective systems for timely and accurate diagnoses, and availability of surgical services, radiotherapy, medical oncology, genetic counseling, and palliative care," the researchers said.
The researchers found that populations in rural areas of the country are less likely to find the care they needed from a provider. One example includes how rural Hispanic communities bordering Mexico experienced high mortality rates of testicular cancer, even though recorded survival rates of testicular cancer hit 96 percent nationally.
"Several studies have previously reported an increased incidence of testicular cancer among Hispanics, which may be related to a range of risk exposures; nevertheless, with such highly effective treatment available, the high rates in these communities raise questions about access to quality care," the researchers noted.
Communities with lower socioeconomic advantages and higher risks of obesity and smoking, and poor dietary intake had significantly more risk than for cancer mortality than other counties. The researchers concluded that local and state governments, as well as healthcare providers, have to do more in the monitoring and management of these social risk factors.
"The mortality rate from all cancers combined declined in most counties but increased in some,"
the researchers said. "The pattern of changes across counties varied tremendously by type: for some cancers, mortality rates declined in nearly all counties or increased in nearly all counties (liver, mesothelioma); for the remaining cancers, rates increased in some counties and declined in others. The policy response from the public health and medical care communities depends on parsing these trends into component factors.”