Despite programs, cancer deaths high State’s prevention measures tops

Maine leads the nation in ensuring its citizens have access to cancer prevention and early detection measures, according to a report released Wednesday by the American Cancer Society. But despite strong legislative and bureaucratic support, a regional cancer society official claims Maine residents aren’t getting the full benefit of these life-saving options.

And, according to the state’s chief medical officer, it doesn’t explain why Maine’s overall cancer death rate is higher than the national average or why the death rate from colon cancer in Maine is the highest in the country.

In the report titled “How Do You Measure Up?” the ACS compared legislative support in all 50 states and the District of Columbia for each of five key cancer-busting measures:

. Mandating insurance coverage for certain routine cancer screenings, including mammography, prostate exams, and Pap smear tests;

. Adding colonoscopy and other colorectal screening procedures to health insurance mandates;

. Ensuring Medicaid coverage for smoking cessation programs and products;

. Providing consistent funding for public smoking cessation campaigns;

. Increasing the excise tax on cigarettes to discourage teen smoking and to fund anti-smoking programs.

States scored a “green light” for fullest support, a “yellow light” for partial or pending support, and a “red light” for unacceptable levels of support. No state scored the same color in all areas. Maine was the only state to score four green lights, falling short only in its support for colorectal screening, where it scored a red light. Thirty-four other states also red-lighted on this measure.

In Maine, as in the nation, cancer is second only to heart disease as a leading cause of death. Colon cancer is the second most deadly type, following lung cancer. According to national statistics, 91 percent of colon cancer patients will die within five years of being diagnosed if the cancer is not found and treated early. But when the cancer is diagnosed early on and has not spread, the mortality rate is only about 10 percent.

That’s why the cancer society and other health experts recommend a colonoscopy for just about everyone at age 50 and every 10 years thereafter. People with a family history of cancer or other risk factors may need to be screened more often.

According to Megan Hannan of the New England Division of the ACS, an estimated 800 new cases of colon cancer will be diagnosed in Maine this year, and 310 Mainers will die of the disease.

While insurers in Maine offer coverage for colorectal screening, it is not a required benefit like mammography, according to Hannan – hence the red light. But even if it were mandated, she said, Mainers, like other Americans, are staying away in droves from the invasive procedure.

Unlike a mammogram or a blood test for prostate cancer, colon exams require an aggressive preparation to empty and cleanse the lower bowel, Hannan noted, and the exam itself is not especially pleasant either.

Hannan said Maine primary care physicians may not be assertive enough in scheduling their patients for colonoscopy, or squeamish patients may elect to not keep their appointments. Either way, she said, the state should find ways to increase the number of Mainers who get the lifesaving procedure.

Insurance Superintendent Alessandro Iuppa said another insurance mandate may not be the answer. While evidence shows that mandated coverage does increase consumer use of a service, it doesn’t ensure appropriate use, he said. Maine is already mandate-heavy, Iuppa added, and insurance companies say this ups their costs and contributes to the high price of health care coverage.

Most insurers already cover colorectal screens, Iuppa noted, and some even remind their customers to make an appointment. “They recognize the value of the procedure,” he said.

Dr. Dora Ann Mills, director of Maine’s Bureau of Health, said Maine’s colon cancer screening rates are actually higher than the national average – 51 percent of people over 50 in Maine have had some form of screening compared to 35 percent nationally. But for reasons that aren’t clear, she said, the death rate here due to colon cancer is the highest in the nation. Since 1990, she said, Maine’s mortality figures have run 3 to 5 percentage points higher than the national average.

In fact, Mills said, mortality from all cancers is higher in Maine than it is nationally, despite good public health interventions.

“The screening rate is higher [than the national average], the incidence of diagnosis is the same and the stage at which the cancer is found is the same,” Mills said. “And yet the mortality rate is higher.” Health officials are examining whether Mainers have less access to appropriate treatment, or whether more deadly forms of cancer are striking here, she said.

In addition to its good marks, the ACS study cites Maine’s investment in a “comprehensive tobacco use prevention program” as an example of effective use of cancer prevention dollars. But Mainers should be taking better advantage of anti-tobacco programs, according to the ACS’s Hannan. Maine’s teen smoking rate has come down dramatically in the past 10 years, she noted, in large part due to intensive funding by the state’s share of a 1996 settlement with the tobacco industry. But adults here have among the highest smoking rates in the country, and Hannan said only 3 or 4 percent of smokers have contacted the state’s tobacco “quit line” for help in kicking their habit.

The American Cancer Society report “How Do You Measure Up?” can be read on line at www.cancer.org/takeaction.