Cancers detected late leading to unnecessary deaths: Report

By Dr. Ananya Mandal, MDNov 24 2010

A new report released Wednesday by the U.S. Centers for Disease Control and Prevention (CDC) says that in spite of the widely available screening tests many cancers are not diagnosed until the disease is well-advanced and, therefore, less treatable and more fatal. The report says that half of colorectal cancers and cervical cancers and one-third of breast cancers in the United States are detected at a late stage.

Report co-author Dr. Lisa Richardson, associate director for science in CDC's Division of Cancer Prevention and Control said, “People need to be aware of what they need to have done medically and follow-up with their providers.” The researchers looked at data collected from 2004 to 2006 from the CDC’s National Program of Cancer Registries; the U.S. National Cancer Institute’s Surveillance, Epidemiology, and End Results Program; and the CDC’s Behavioral Risk Factor Surveillance System.

Some of the findings include the facts that the rates of late-stage colorectal cancer increase with age and are highest among black men and women. Many women aged 70 to 79 and black women were most likely to have breast cancer detected at a late stage. Rates of late-stage cervical cancer were highest among women aged 50 to 79 and Hispanic women. Highest rates of late-stage colorectal cancer are seen in Connecticut, Delaware, Illinois, Iowa, Kentucky, Louisiana, Maine, Nebraska, New Jersey and Pennsylvania. Highest rates of breast cancer incidence were seen in Alabama, the District of Columbia, Kansas, Louisiana, Mississippi, New Jersey, Oklahoma, Pennsylvania, Tennessee and Washington. Highest rates of late stage cervical cancer were seen in Arkansas, the District of Columbia, Illinois, Kentucky, Louisiana, Mississippi, Nevada, New Mexico and Oklahoma.

Dr. Marc Lippman, chair of the department of medicine at the University of Miami Miller School of Medicine and deputy director of the university’s Sylvester Comprehensive Cancer Center, who was an independent observer said, “For me, the most important point is to look at how different the rates of advanced-stage cancer are in different parts of the country… What this tells you is that a lot of cancer deaths are preventable, and those skill-sets to prevent deaths are being applied unequally across the country.” For example Louisiana, Mississippi and Oklahoma had higher rates of late-stage cancers than many other states. He added that there were only a handful of insurance companies that pay for preventive care. He noted that many people are afraid of screening and some doctors don’t even discuss cancer screening with their patients. He said, “Many people have a fatalistic view of cancer, which is unfortunate, because many cancers, if detected early, have dramatically better survival with dramatically less treatment.”

Dr. Marcus Plescia, director of CDC’s Division of Cancer Prevention and Control, said in a statement Wednesday, “This report causes concern because so many preventable cancers are not being diagnosed when treatment is most effective… More work is needed to widely implement evidence-based cancer screening tests, which may lead to early detection and, ultimately, an increase in the number of lives saved.”

Recommendations include regular screening for colon cancer after 50 with foecal occult blood test every year, a flexible sigmoidoscopy every five years, or a colonoscopy every 10 years. All women 50 to 74 years old should be screened for breast cancer with mammography every two years. Pap smears to screen for cervical cancer should begin within three years of becoming sexual active or at age 21, whichever comes first. Initial screening should be annual, and after three consecutive normal tests at least every three years up to age 64.

The CDC said the new health reform law signed by President Barack Obama in March, covers recommended cancer screening tests and this would eliminate cost barriers that might keep people from getting screening tests.