Dr. Terry Fontham, dean of the Louisiana State University School of Public Health, discusses the area's cancer rates and incidence of the disease and mortality rates in the Caucasian compared to the African-American communities.
Q: How does Louisiana compare with other areas in the country in terms of cancer rates in general, and racial breakdowns of those rates?
A: When we look at the state as a whole for all cancers combined, white men in Louisiana have significantly higher rates than white men in seer areas (other parts of the United States where the best tumor registries are kept). Compared to their counterparts, black men in Louisiana have significantly lower rates than black men in other areas. That's also true for white women and black women. When we look at black men vs. white men, whether we're talking Louisiana or other areas, black men have significantly higher rates than white men. We don't see the same racial difference between white women and black women; white women are a tiny bit higher.
Q: Where do you see the highest rate?
A: The most commonly diagnosed cancer in men is prostate, and black men have significantly higher rates than white men. That's true here and it's true nationally. Rates go dramatically higher with increasing age. Why African-American men have higher rates nobody knows. It's a subject of great study now. Not only do African-American men have a higher risk of getting the cancer, but they have a higher rate of dying from it. That is the biggest discrepancy (between the races). Prostate cancer is the No. 1 diagnosed cancer in men.
Q: Where else do you see high rates?
A: The second most common cancer that is bigger in black men than white is lung cancer. It's the second most commonly diagnosed cancer in men, but the No. 1 cause of cancer death in men. Prostate cancer is the most commonly diagnosed, but it is more treatable. For lung cancer, unfortunately, that is not true. Among women, lung cancer is more common in white women than in black women. [African-American women] have about 20 percent lower rates, and that is heavily driven by smoking rates. Tobacco smoking is a risk factor for a number of cancers. But an interesting thing is that if a black man and a white man smoke the same amount, the African-American man is more likely to develop lung cancer at a given rate of smoking, and a white man is much more likely to develop bladder cancer at that same rate of smoking.
Q: Is Louisiana generally above the national average in cancers in general?
A: We are higher in cancer death rates. We are not higher in incidence rates, except for white men. We are at or below the national average for most of the major cancers in terms of incidence. An exception is lung cancer. We seem to be higher across the state for that. We just smoke a lot in Louisiana, among other things. There remain things we don't understand, but we know if we took away smoking, lung cancer would virtually disappear.
Q: What accounts for the cancer numbers? Is it environmental, socio-economic or genetic?
A: Undoubtedly it's a combination of all three. In terms of mortality, the rate can be from more aggressive tumors in some parts of the population. The biggest factor for most cancers is the time that it is diagnosed and the receipt of the most appropriate therapy. When a cancer is diagnosed at stages 3 and 4, even for cancers that are less aggressive, that's a bad thing. Some segments of our population tend to have their cancers diagnosed at a much later stage. When that happens, the treatment options are different.
Q: Because of the advanced stage of cancer or economic reasons?
A: For children with cancer, probably 85 percent are in clinical protocols with promising treatments. With the adult population in this country with cancer, it's probably 10 percent.
A: It could be physicians wanting to put their patients on the known, proven treatment and do it quickly, which is certainly reasonable. But having access to some of these newer therapies (in clinical trials) is important and helps to drive the field in terms of research and discovery. There is a push to get more people involved in clinical trials. It will offer a unique opportunity for somebody, particularly with the later-stage cancers. Often many of the clinical trials are directed at the worst cases where we know standard treatments don't work.
Q: Are there other cancers in which there are disparities among races?
A: Pancreatic cancer. Cigarette smoking is a component, but there probably is a genetic component as well; the real key genes have not been identified. There is a very strong family history-driving risk, and pancreatic cancer is even worse than lung cancer in survival rates because it has hardly any symptoms before stages 3 and 4. Pancreatic is another cancer this is more common in African Americans than whites, in both men and women. Why the extra risk and what is driving it? Lots of people are doing research, but we don't have the answers.
Q: What circumstances go across all racial lines?
A: Modifiable risk factors. We can't change our ethnic or racial lines, whether we're male or female, age we can't change. Tobacco use we can do something about. Obesity and physical activity are two extremely strong risk factors for cancer as a whole, and overall mortality from all causes. Obesity is a risk factor for prostate cancer, breast cancer, colorectal cancer, esophageal cancer. Obesity is something we can do something about, and physical activity. Even if you are overweight, people who are physically active have a lower risk than those who are physically inactive.
Q: What is being done to bring cancer rates down?
A: Cervical cancer, for example, there are large black-white differences. Black women are at much higher risk than white women. It is a type of cancer that shouldn't occur in any woman, because a PAP smear can detect cervical cancer before it's cancer. If you have a PAP smear and it [shows abnormal cells], it can be removed before it becomes cancer. This is a screening test that can not only reduce mortality, but incidence. Another is the screening procedure for colorectal cancer. Almost all colorectal cancers arise from polyps, and they can be removed before any cancer arises. Obviously mammography is extremely effective for breast cancer. Right now, screening is the answer, along with increasing physical activity to decrease risk and keeping your weight at a healthy stage to decrease risk.
Q: What advancements can the next generation look forward to?
A: We're already seeing new screening tests being tested, so I think early detection will be easier and more affordable.