By Kelly April Tyrrell
For too many years in the last century, Delaware led the nation in the total number of cancer deaths.
Since then, Delaware's overall cancer incidence and mortality rates have declined relative to the rest of the nation.
The latest cancer statistics, released Tuesday by Delaware Health and Social Services, show the state continues to make improvements -- but not in all areas.
Delaware's cancer death rates decreased nearly 19 percent in the five-year rolling measurements recorded between 1995-1999 and 2005-2009, a 50 percent greater decline than the rest of the nation. Delaware now ranks 14th nationwide for cancer mortality.
But Delaware still has work to do, particularly when it comes to lung cancer.
The number of overall cases and deaths from lung cancer in Delaware is statistically higher than the rest of the U.S., and accounted for 15 percent of all cancers in Delaware in the most recent years for which data are available, between 2005 and 2009. It also accounted for nearly a third of all cancer deaths in the state.
And the number of women dying from lung cancer is 20 percent higher in Delaware than the rest of the country, making the state's lung cancer death rate among women fourth-highest in the nation.
"Despite all the efforts and progress lung cancer continues to play an enormous role in Delaware's overall cancer burden," Rita Landgraf, secretary of Delaware Health and Social Services, told an audience of medical professionals, patients, health care workers and more gathered at Christiana Care's Helen F. Graham Cancer Center on Tuesday for the release of the most recent cancer numbers.
Also troubling are the most recent rates for skin cancer.
The incidence of malignant melanoma, a form of skin cancer, is on the rise everywhere in the U.S., but the rate of increase in Delaware is more than triple the national average.
Still, the main topic Tuesday was lung cancer -- and smoking.
According to the Centers for Disease Control and Prevention, lung cancer kills more men and women than breast, prostate and colon cancers combined. More people die from lung cancer than from any other type of cancer, and smoking is the number one risk factor. As many as 90 percent of all lung cancers are known to be caused by smoking cigarettes.
"It takes about 20 years to develop cancer after someone begins smoking," said Dr. Karyl Rattay, director of the Delaware Division of Public Health. "There was a point in time where smoking rates were higher in women than in men, so it's kind of that lag time that we're dealing with. But why lung cancer seems to be more aggressive in women than in men is unclear, and that's the case nationally."
Speakers Tuesday also spoke of progress made in the last decade.
The news was brighter for African-American males, for whom lung cancer deaths are down 40 percent in Delaware over the last decade.
In 2002, with Gov. Ruth Ann Minner"s signing of the Clean Indoor Air Act, the First State became the second state in the nation to ban smoking in indoor workplaces and in public places. Since that time, other proactive and often controversial steps have been taken across the state to reduce smoking and secondhand smoke exposure.
For instance, the University of Delaware became a smoke-free campus late last year, Beebe Medical Center began refusing to hire smokers at the beginning of 2013 and several Delaware beaches have banned smoking or are considering bans.
"What we forget about is there is secondhand smoke and thirdhand smoke and we know that second- and thirdhand smoke is just as dangerous as smoking a cigarette directly," said Dr. Nicholas Petrelli, medical director of the Graham Cancer Center. "So what we're seeing -- we're in a transition period here so it's not only the Clean Indoor Act making an impact, but it's also the smoking cessation programs that we have across the state and the Quit Line ... and the tremendous educational programs."
"I think over the next five, 10 years you're going to going to see a dramatic drop," Petrelli added.
Theresa Young, vice president of the American Cancer Society of Delmarva, echoed Petrelli.
"We are seeing a reduction of smokers in the state of Delaware but the impact on mortality rates is going to take time," Young said.
Earlier this year, the first screening guidelines for lung cancer were published in the American Cancer Society's journal Cancer, but they apply only to heavy smokers. Screening and affordable treatment are known to play a major role in improving incidence and mortality rates of other types of cancer.
Screening has paid off elsewhere.
Last year, Christiana Care oncologist Dr. Steve Grubbs announced the disparity in colorectal cancer incidence between African-Americans and whites had been eliminated in Delaware, thanks to a program in which community navigators helped connect people to free or affordable screening and treatment.
The results of that Delaware Cancer Consortium program were estimated to have saved $8.5 million annually from reduced incidences of cancer and detection of cancers at earlier stages, more than offsetting the $6 million cost of the program.
Other efforts in Delaware are aimed at reducing cancer incidence rates and mortality, initiatives Rep. John Carney has long been a part of. A decade ago, Carney said, Delaware was in the top 10 for cancer death rates, a spot no one in the state wanted to occupy.
"So the government, going back to Mike Castle and a special commission formed by Gov. Minner, decided to put together a working consortium, put real dollars behind it using tobacco settlement funds to fund treatment for cancer for those who can't afford it," Carney said.