In Arizona this year, it will kill the equivalent of Winslow’s population — nearly 10,000 — and will be the diagnosis for nearly 24,000 more people, the population of Marana.

Its cost to the healthcare system last year was $1.36 billion, equivalent to 16 percent of this year’s General Fund spending. Total spending in the state on this killer last year was approximately $3.8 billion.

It’s cancer.

These stunning estimates and statistics are contained in the recently completed Arizona Comprehensive Cancer Control Plan — strategies to reduce the incidence and mortality of the disease that ranks second only to cardiovascular deaths and illness in the state. The plan was developed over the past two years under the Department of Health Services by a coalition of more than 50 public and private organizations, headed by a steering committee of cancer experts.

But implementing the plan will be a challenge, a cancer official said.

Funded by a $150,000 grant from the U.S. Centers for Disease Control and Prevention, it sets five-year goals to reduce cancer risks, increase diagnostic screening, improve access for diagnosis and treatment and enhance the quality of life for those affected by cancer.

There’s a long way to go in the cancer battle, said John Craft of the American Cancer Society, Phoenix office, but progress is being made.

“We’re already seeing a downward trend in mortality,” in part, because cancer treatments have improved, and many people have kicked the tobacco habit, he said.

But, Mr. Craft added, “We are an aging society, and cancer is a disease of aging.”

The Plan

The cancer control plan calls for private and public funding for more and better-coordinated research and implementation of myriad activities, ranging from better nutrition to increased use of sun blocks. It also aims to reduce disparities in cancer screening and treatment in minority populations.

“Some race/ethnicities are disproportionately affected by certain cancers and also experience higher mortality rates,” the plan states.” African Americans suffer from the highest overall cancer mortality rates in Arizona.”

The 202-page plan also deals with what it calls “the burden of cancer among Native Americans due to the complex geographic, financial and healthcare access challenges they face”

Mr. Craft said, “Arizona clearly has a unique mix of culture that affects access to care.”

From its cancer registry, DHS has met a 1988 legislative mandate to produce maps showing cancer rates and other statistics in 126 geographic areas of the state to identify places and populations that need investigation. (The maps are available at www.adhs.gov.)

Adjusted for age, Arizona’s overall cancer rate in 2001 was 423.5 per 100,000 population. Mohave County had the highest incidence of cancer — 445.3 per 100,000 population — and Apache County had the lowest rate — 187.4 per 100,000.

Although Maricopa County has the highest number of cancer deaths, Gila County has the highest cancer death rate per 100,000 population — 209.8. La Paz County had the lowest death rate — 103.5 per 100,000.

Prevention Called ‘Daunting Challenge’

An English judge, Henry de Bracton, is credited with the adage: “An ounce of prevention is worth a pound of cure,” and the cancer plan lists preventive strategies as its top priority.

“Primary prevention represents the most beneficial population-based public health approach to reducing morbidity (the rate of incidence of a disease) and mortality from cancer,” it states. “However, preventing cancer from occurring in the first place within our diverse communities continues to be a daunting challenge in this century…”

The plan states nutrition, physical activity and body weight have been linked to almost one-third of all cancer deaths, and tobacco use accounts for at least 30 percent of all cancer deaths, including 87 percent of all lung cancer deaths.

Lung and bronchial cancers are the leading causes of cancer deaths in Arizona among both men and women, DHS reported.

The plan calls for a reduction of tobacco use among all Arizonans to 16 percent from 20.8 percent (in 2003) and reduction of exposure to secondhand smoke for all Arizonans by 2010.

Among objectives regarding physical activity, the plan sets 2010 as a target to have 52 percent of adults exercising regularly for at least 30 minutes and 70 percent of adolescents routinely doing vigorous exercise. The percentages compare with a 2003 report that 47.9 percent of adults engaged in moderate physical activity, and 66.9 percent of teens exercised vigorously.

Healthy eating and a reduction in obesity rates will lower cancer risks, the plan said.

It calls for an increase by 2010 in the proportion of people two years old and up who consume at least two daily servings of fruit, at least three daily servings of vegetables and an average of 30 grams of fiber daily.

The plan calls for a reduction by 2015 of 20 percent in the number of people who are overweight or obese. It stated that 20.1 percent of Arizona adults were obese in 2003, and 10.8 percent of high school students were considered overweight.

“Arizona experiences a significantly higher skin cancer burden compared to other parts of the United States and Canada,” the plan reports. Between 1985 and 1996, 1,308 males and 647 females per 100,000 population were diagnosed with skin cancers, and the average annual incidence of melanoma between 1999-2001 was 17.8 per 100,000.

The state’s strategies to reduce skin cancer include work site, school-based and media education programs, reduction of use of tanning booths and creation of more shade areas.

Rounding out its clean living agenda to reduce cancer risks, the plan calls for a reduction by 2010 in the number of youth and adults who exceed national dietary guidelines for alcohol consumption (one drink per day for women, two for men and none for children and adolescents).

Plan Strategies

Following is a summary of other strategies in the plan:

• Early detection/screening: Increase to 70 percent by 2010 the proportion of women 40 and older who have received a mammogram and clinical breast exam within the past year; and to 50 percent the proportion of the population screened for colorectal cancer.

• Diagnosis and Treatment: By 2007, utilize telemedicine to increase access to state-of-the-art diagnosis and treatment.

• Quality of Life: Increase access to comprehensive management of acute, chronic and delayed effects of cancer and its treatments.

• Research: Establish a clearinghouse and database for cancer researchers; promote participation in clinical trials, specifically for underserved and minority populations.

• Cancer disparities: By this fall, create a health disparities work group to identify existing barriers to receiving care and draft strategies to reduce inequalities in cancer care.

Group To Seek Grants To Implement Plan

Arizona is one of the last states to have a cancer control plan, Mr. Craft of the American Cancer Society said. “The plan is the easiest part. Implementing it is the hard part.”

He said the Arizona Comprehensive Cancer Control Coalition, which formulated the plan, will be seeking private and government grants to carry it out.

Among the coalition are DHS, AHCCCS, numerous cancer organizations and hospitals, various foundations and county health service departments, University of Arizona College of Public Health and the Translational Genomics Research Institute (TGen).

“The cancer prevention and control activities in this state are paving the way to a healthier A
rizona,” wrote Governor Napolitano and DHS Director Susan Gerard in a statement accompanying the cancer control plan. Ms. Napolitano is a breast cancer survivor. —