The habitual disease


FOR THE past two years, Maryland has had the highest cancer mortality rate in the United States, followed by neighboring Delaware, according to the American Cancer Society.

Understandably, this has alarmed residents and officials, some of whom have demanded a probe into what they consider the state's greatest health emergency.

Their reaction says a lot about how we perceive cancer and why it continues to be such a killer.

In fact, we know why Maryland's cancer death rate is so high. The data point to behavioral origins -- smoking, drinking, high-fat diets, high-risk sexual activity. People continue to resist the reality that cancer is largely a behavioral disease.

This ignorance, often fueled by media accounts that portray cancer as a "mystery" illness caused by arcane toxins, is heedlessly killing thousands of Americans every year. It is time that health officials, and the media, hammer home the truth.

When Marylanders learned last year of the state's unusually high death rate, they looked outside. They talked about the water and the air, about farm pesticides, industrial pollutants and power lines.

Cancer experts, though, say less than 10 percent of the disease is caused by these things. National Cancer Institute data show that 35 percent of cancer can be attributed to diet, 30 percent to smoking. And experts say education programs could cut some cancer death rates by more than 50 percent.

"It's very clear-cut," says John Southard, director of chronic disease for the state's Department of Health and Mental Hygiene. "People want to look at environmental things, but it's generally not that. It's usually people's own habits."

Another health official, Larry Ward, recalls a meeting of citizens concerned about the location of an incinerator. "They were complaining about the pollution causing cancer, but then you look out in the audience and people are smoking," he said. "Pollution accounts for about 2 percent of cancer, smoking for about 30 percent."

Simple truths such as this are met with resistance because they shift the responsibility to the individual. It's easier to blame outside sources. Similarly, people assume that the way to lower cancer death rates is to pour money into further studies. In fact, say many experts, what's most needed is a comprehensive education program.

Sure, there are stories about people getting cancer who have led healthy lifestyles. But far more common are stories such as this one: A co-worker, who had smoked for most of his life, developed a chronic cough. But because he had no history of cancer in his family, he waited months before going to a doctor. When he finally did, the cancer -- which might have been removed months earlier -- had become inoperable.

In a culture that often sells disease as mystery and that glamorizes high-risk behavior, it's difficult to convince people that simple changes in habit could save their lives. Yet that's the responsibility we are faced with: to tell the truth about cancer, and to do so loudly and convincingly.

Ten years ago, Rhode Island was prodded into the same sort of awareness that Maryland is now coming to, after data showed it had the highest cancer death rate in the country during the 1970s.

In response, the state came up with a long-term plan, the thrust of which was changing people's behavior. According to Robert Marshall of the Rhode Island Health Department, when the 1970s data were released, 50 percent of Rhode Island men smoked. The figure has since dropped to about 30 percent.

"That has probably been the single greatest contributor to our lower mortality rate," Marshall said. "We started an aggressive anti-smoking campaign. We emphasized the link between smoking and lung cancer, the No. 1 killer in the state."

Programs such as this should not be limited to states with a high cancer death rate, though. When you consider how many deaths could be prevented by early diagnosis and education, every state's rate is too high.

The hardest part of the battle is just getting people to accept the truth: Cancer is a disease caused primarily by the habits of those who have it.

James Lilliefors is editor of the Maryland Coast Dispatch in Berlin.

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