In its zeal to fight cancer, Maryland may be failing to combat two other diseases that, together with cancer, account for the majority of all deaths in the state, a research team contends.
Dr. Stephen Havas, an epidemiologist with the University of Maryland School of Medicine, said in a 15-page report that heart disease, cancer and stroke together account for 60 percent of the state's deaths -- with heart disease far outstripping cancer as the leading killer.
"Deaths from these three diseases are occurring at a higher rate in Maryland than elsewhere in the United States," Dr. Havas said. "We know that premature deaths caused by these diseases are largely preventable by controlling the underlying risk factors such as poor diet, high cholesterol levels, smoking and physical inactivity."
The University of Maryland study, published today in the Southern Medical Journal, followed a $100,000 appropriation that the state legislature made two years ago at Gov. William Donald Schaefer's request. Most of the conclusions were drawn from deaths that occurred during the mid- to late 1980s.
Heart disease accounts for almost 13,000 deaths each year in Maryland -- about 3,500 more people than succumb to cancer. Stroke kills approximately 2,400 annually. More important, he said, death rates for all three diseases are significantly above the national average, suggesting that Marylanders may be plagued with a disproportionate share of risk factors.
While Maryland continues to have the nation's worst cancer mortality rate, he said the state also has higher-than-average death rates for heart disease and stroke.
"Those are also the three leading killers throughout the United States, but people tend to forget about [heart disease and stroke] because of all the publicity in the last year and a half focusing on cancer," he said. "I think it clearly makes sense to go after all three diseases. It's more effective and it's more logical."
The report drew a mixed response from Dr. John Southard, chief of chronic disease prevention for the state Department of Health and Mental Hygiene. He agreed with the assessment of Maryland's cancer and heart problems, but said stroke mortality had been below the national average for decades until it drew even in the past couple of years.
The health department's data may differ because it draws from a different source, he said. But overall, Dr. Southard said he had little quarrel with the report.
"Always, more can be done," he said. "We certainly need to do more, and the department is planning to put additional resources in all three areas."
Other key findings of the report:
* Treatments associated with the three diseases cost $1.4 billion in 1988 -- about one out of every six health care dollars spent in Maryland that year. Indirect costs such as lost wages and lost productivity accounted for another $3 billion.
* More than half of those who die from the three diseases are under 75 years old, the average U.S. life span. Their deaths should be considered premature, Dr. Havas said.
* More than 15 times as many people die from the three diseases combined than die in accidents.
Last year, Maryland began piecing together an anti-cancer strategy following reports in The Sun that the state's cancer death rate is the nation's worst.
In large part, the state is planning public education campaigns aimed at discouraging smoking -- risk factors for lung and cervical cancer -- while encouraging greater use of mammograms to detect breast tumors and Pap smears to flag cervical cancer.
A "cancer summit," to be held next Friday at Martin's West, will pull together some of the nation's top cancer authorities for a discussion of the possible causes and solutions.
Dr. Havas said state government should launch a public education campaign aimed at getting people to avoid risk factors for all three diseases. Also, he said, the state should develop programs to train doctors, nurses, pharmacists and social workers in the detection and treatment of the diseases, and the counseling of patients at risk.
It is true, Dr. Havas said, that an anti-cancer campaign aimed at promoting healthy lifestyles will have the side benefit of reducing heart disease and stroke. Smoking and fatty diets, for instance, are risk factors for all three diseases.
But he said important messages about stroke and heart disease are not getting enough attention.
For years, Maryland spent more to prevent heart disease than cancer. This year, the state is spending $3.4 million on cancer control but only $600,000 for heart disease and stroke.