Maryland will once again have the highest cancer death rate among the 50 states in 1992, according to the American Cancer Society.
Only the District of Columbia is likely to fare worse, according to estimates in the society's publication, "Cancer Facts & Figures" for 1992, which analyzes trends in the District and Puerto Rico as well as the 50 states.
Nearby Delaware ranks right behind Maryland in the places where the highest death rates are expected.
Led by malignancies of the lungs, colon and rectum, breast, prostate and pancreas, cancer is expected to kill 9,900 people in Maryland in 1992, according to the society.
Within Maryland, the highest cancer death rates are found in Baltimore City and in Somerset, Charles and Anne Arundel counties.
"Maryland is high in a few of the very prevalent cancers, so all of those combined bring us to be Number 1," said Norma Kanarek, planning director for the Local and Family Health Administration in the state Department of Health and Mental Hygiene.
In lung cancer, the leading cause of cancer deaths, Maryland ranked fifth among the 50 states from 1983 to 1987. The state ranked seventh in breast and colon and rectal cancers, 10th in pancreatic cancer and fifth in prostate cancer during the same period, the most recent for which state breakdowns are available.
Maryland's high cancer mortality has been known for decades, health experts say, but it began to receive increased public and media scrutiny two years ago when the state moved into first place.
Just why cancer death rates are so high in Maryland has not been established. Among the potential explanations that experts have ventured in recent years:
* Relatively high rates of smoking and drinking among some groups of Marylanders.
* Diets high in fats, smoked and salt-cured food, particularly in rural areas.
* Poverty, low levels of education and a resulting lack of access to information about basic health care, to quality medical services and to preventive and early-detection programs.
* Exposure to industrial pollutants, and to pesticides and herbicides used heavily in some Maryland farm fields.
"We like to look to external issues to blame," said Dr. Joseph Aisner, director of the University of Maryland Hospital Cancer Center. "It's nice to blame the gas station on the corner because they smell bad. But in point of fact . . . most of it has to do with what we do to ourselves."
The presence of two major cancer centers -- University of Maryland and the Johns Hopkins hospitals -- isn't a factor because the statistics are based on cancer patients' place of residence, not where they die, Dr. Aisner said.
The high rates in neighboring Washington, D.C., and Delaware suggest that whatever is responsible is regional. "And that fits," he said, "because whether you want to explain it by environment or personal habits, those tend to be regional rather than follow state boundaries."
Virginia has the 10th highest death rate among the states, while Pennsylvania ranks 12th, according to the society.
The society said about 30 percent of all cancers in the United States are directly related to the use of tobacco. Another 35 percent are linked to diet.
In an effort to find ways to attack Maryland's high cancer death rates, health agencies in the state formed the Maryland Cancer Consortium in 1989 and launched an 18-month study to analyze statewide patterns.
"I am very concerned that Maryland ranks No. 1 for cancer," Gov. Schaefer said at a news conference yesterday. "I just can't tell you how hard we are going to push for that [cigarette] tax. It will save lives," he said.
The governor's bill would add 25 cents per pack to the tax on cigarettes. It would bring in about $100 million a year in revenue, he said.
That money could be used to pay for anti-smoking campaigns and cover some of the Medicaid costs for treating health problems that state officials say are caused by smoking cigarettes, Mr. Schaefer said.
The federally funded study also gathered data on Marylanders' tobacco use, diet, environmental and occupational exposures, health care costs and treatment.
In January 1991, the consortium published a Cancer Control Plan with recommended strategies for addressing the high death rates.
Initial efforts have focused on early screening for treatable cancers. The state's Health Services Cost Review Commission is now encouraging hospitals to open or expand screening programs for breast and cervical cancers, Ms. Kanarek said.
"Hospitals can apply for money to offset the costs of prevention activities," she said. The programs are intended to "target women with no insurance, or low income." Smoking cessation programs are also encouraged.
If there is a bright spot in Maryland's cancer picture, Ms. Kanarek said, it may be in a recent statistical "leveling" in the death rates for lung cancer among white males in Maryland, after decades of increases.
Among Maryland men, lung cancer death rates peaked in the early 1980s, then began to flatten and drift lower in the mid-1980s, according to American Cancer Society data.
Among Maryland women, the rates have continued to climb, more than doubling in the last 20 years.
Lung cancer accounts for 27 percent of all cancer deaths in Maryland, more than any other form of cancer, and 80 percent to 90 percent can be traced to cigarette smoking, Ms. Kanarek said.
The society estimates that lung cancer will kill 2,900 people in Maryland this year. Another 3,300 new cases will be diagnosed.
"So our message on cigarettes is that no one needs them," Ms. Kanarek said. "But more attention needs to be drawn to those population groups that haven't gotten the message."
National rankings based on cancer death rates
Deaths per 100,000 population estimated in 1992
HIGHEST DEATH RATES
1. District of Columbia.. .. .. .. .. 223
2. Maryland.. .. .. .. .. .. .. .. .. 192
3. Delaware.. .. .. .. .. .. .. .. .. 191
4. Nevada.. .. .. .. .. .. .. .. .. ..189
5. Louisiana.. .. .. .. .. .. .. .. ..187
National average.. .. .. .. .. .. .. .171
LOWEST DEATH RATES
1. Utah.. .. .. .. .. .. .. .. .. .. .125
2. Puerto Rico.. .. .. .. .. .. .. .. 130
3. Hawaii.. .. .. .. .. .. .. .. .. . 138
4. Colorado.. .. .. .. .. .. .. .. .. 145
5. Idaho.. .. .. .. .. .. .. .. .. .. 149
Cancer deaths in Maryland estimated in 1992
Lung.. .. .. .. .. .. .. .. .. 125
Colon & rectal.. .. .. .. .. 1,100
Female breast.. .. .. .. .. .. 900
Prostate.. .. .. .. .. .. .. . 600
Pancreas.. .. .. .. .. .. .. . 500
2& All types of cancer.. .. .. .9,900