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New Maryland plan targets cancer deaths

State health officials released an ambitious plan Tuesday to reduce cancer deaths, using the latest strategies to prevent, detect and treat the disease — and save the lives of an additional 1,200 Marylanders a year.

"Our goal in Maryland is to have to lowest incidence of cancer of any state," said Dr. Joshua M. Sharfstein, secretary of the state Department of Health and Mental Hygiene, in announcing the Maryland Comprehensive Cancer Control Plan. "This is our road map."


The plan, which includes the reduction of racial disparities and an increase in screening, is designed to maintain Maryland's progress in battling cancer. In the last couple of decades, Maryland has gone from having the nation's third highest cancer death rate to the 21st, and health officials are aiming for further improvement.

Maryland's plan, the first since 2004, is particularly wide-ranging and ambitious, said Sharfstein and Frances Phillips, the health department's deputy secretary of public health services.


Cancer is no longer thought of as "a tragic and random thing that happened to individuals," said Phillips, though she noted that it is still responsible for one in four deaths, or 10,000 people, a year in the state.

State data shows lung, breast, prostate, colon and ovarian cancers remaining particularly menacing. In addition to the human cost, the toll nationally from cancer was more than $206 billion in 2006, according to the CDC. It was estimated at $3.9 billion in Maryland.

The overall goal is to decrease cancer mortality to160 deaths per 100,000 Marylanders from 187 deaths per 100,000 recorded in 2006, according to the plan.

Officials from the public and private sectors who contributed to the report provided detailed steps that should be taken by public health officials, health care providers, communities and individuals. Areas of focus include monitoring so officials know what they're up against, reduction of disparities among racial and ethnic groups, and attention to patient issues that include access to care and mental health services.

The focus also is on a reduction in tobacco use, the most preventable cause of disease; diet and exercise that can prevent at least a quarter of all cancers, and skin protection. Skin cancer is the most commonly diagnosed cancer in the United States.

Also on the list are reducing occupational and environmental hazards and identifying risk factors and improving screening for some of the cancers that benefit from early detection, including colorectal, breast, prostate, oral and cervical cancer. Pain management and palliative care also are addressed.

Hundreds of people contributed to the report, overseen by the health department and facilitated by the Maryland State Council on Cancer Control.

But the effort will take more than a plan on paper, those involved say. The next step will be working with public and private groups to determine how to reach the plan's goals, said Dr. Kathy Helzlsouer, chair of the council on cancer control. She said there is limited funding available as part of the $250,000 annual CDC grant that helped pay for plans in each state and will fund an educational conference in the fall.


She and others involved say getting the messages to individuals may be the toughest challenge.

Tamika Felder wishes she had received the message about cervical cancer prevention. She was diagnosed at 25.

Having finished school, she was dropped from her mother's health care plan and neglected her annual exam — something she deeply regrets. By the time she got a job and health insurance, and saw a doctor, she had the disease.

A decade after she was successfully treated at Johns Hopkins, the 36-year-old television producer is happy to be alive, though she still needs monitoring and can't bear children. Felder, who lives in Upper Marlboro, now volunteers with an awareness group she founded called Tamika & Friends.

She helped officials in Washington craft their cancer plan and decided to get involved with Maryland's as well because she wanted to make sure "the patients weren't forgotten" during the process.

"I realized that I survived and a lot don't, and I needed to be a voice for myself and others," she said. "I didn't want the clinicians to go through the steps and not think about patients. They are real people with pain and fears."


In her case, the cancer was completely preventable. Now, getting others to get an exam or make lifestyle changes will be key, said Dr. Kevin J. Cullen. He is director of the University of Maryland Marlene and Stewart Greenebaum Cancer Center, one of two National Cancer Institute-designated cancer centers in the city; the other is Johns Hopkins' Sidney Kimmel Comprehensive Cancer Center.

Cullen said research done at Maryland, Hopkins and elsewhere can help bolster the messages about prevention before people reach 50, when the disease is more likely to manifest.

And the research is cutting-edge, says Dr. William G. Nelson, director of the Hopkins center, who pointed to work with the human genome that allows scientists to identify cancer risk and possibly individualize treatments based on a patient's genetic makeup.

Cullen noted new therapies that can not only effectively treat cancer but prevent it, including a vaccine that can help protect women from the types of the human papilloma virus that cause most cervical cancers. He said scientists have also linked the virus to oral cancer, perhaps leading to new prevention methods. And Cullen noted that women at high risk of some kinds of breast cancer may be able to lower their risk by two-thirds by taking an aromatase inhibitor.

New drugs alone are not the full answer, however. Cullen said people might not realize how important their daily activities are. Smoking contributes to at least 10 types of cancer, including the most deadly cancer in the state, lung cancer. Obesity may be a contributor in up to 20 percent of cancer deaths.

"Many cancers are preventable, probably the majority of them; if people did the simple things of not smoking and keeping their body weight in recommended range the overall burden of cancer would probably drop by at least half," Cullen said.


Others involved in the plan said simply going to the doctor on a schedule for age-appropriate screening would help lower the cancer incidence by catching potential problems before they start, or at least early.

In all, the new cancer plan serves as a "call to action," Nelson said. "It also lets everyone know we're keeping score."

The Morning Sun

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Cancer Control Plan


•Aims to control cancer by reducing risk, detecting cancer early, improving treatment and enhancing survivorship.

•Includes goals in the areas of: monitoring; addressing disparities; tobacco use cessation and prevention; nutrition and physical activity; prevention and early detection of skin, colorectal, breast, prostate, oral and cervical cancers; environmental and occupational issues; patient issues and survivorship; pain management; and palliative and hospice care.

•Serves as a resource for health care providers and researchers, policy makers, groups and individuals, and a basis for specific action plans.

•For more information or to see the full plan, go to the Department of Health and Mental Hygiene website.