It’s a classic good news bad news story.
Arizona has the lowest reported rate of cancer in the nation, but those who get cancer here, are more likely to die from it.
That’s because people in Arizona wait too long to get checked for cancer, and once diagnosed, the disease overtakes most cures.
“This is a case where being last, means you are doing well,” said Wayne Tormala, Chief, Arizona Department of Health Services Bureau of Tobacco & Chronic Disease, in an ADHS media release.
While many would celebrate this accomplishment, Patricia Thompson, the Director of Cancer Prevention and Control at The University of Arizona Cancer Center, worries that there is an issue of under-reporting cancer occurrences, and a deeper disparity in the research.
“The cancer rates are driven by screening tests done at our sites. The states with higher cancer rates also have higher detection rates. We aren’t detecting as many cases because people aren’t coming forward, so in reality, we may be doing much worse than we hope.”
Thompson is also a professor in cellular and molecular medicine whose role is program leader for the CPC, currently focusing her research on breast and colon cancer prevention. Thompson said that cultural and language barriers, combined with an economic downturn, have been the main contributors to the decline in prevention for southern Arizona. She said that poor people view taking the time to go get a screening as a luxury, having so many other immediate priorities, which leaves the pre-diagnoses options for the educated and wealthy. The socio-economic factors cause disparities for different races, genders, and age ranges, so the numbers reported can become skewed.
“When the resources are down and the poverty level goes up, we start to see an overall apparent drop. We don’t believe Arizona is facing less of a burden, but instead an increase in burden since our registry is under-resourced,” Thompson said.
Nora McDonald works for the American Cancer Society as the Quality of Life Manager. Her job is to recruit and train volunteers for programs and services in southern Arizona. McDonald also works with the cancer resource centers across the state in cities like Yuma, Sierra Vista, Safford and Payson, being present with patients as they undergo treatment in the centers. McDonald said that all of the services offered are free of charge, and the message is spread through doctor referrals and word-of-mouth.
“We don’t have boundaries, we help whoever we can,” McDonald said. “One year, a refugee came in who needed a breast prosthesis, which was too costly for her to afford. When I told her we could get her one for free, she started crying. I will never forget that.”
Some of the programs that McDonald’s office provides are “The Road to Recovery,” a transportation option for patients going to and from treatment, a lodging option for patients who travel large distances, and the “Look Good, Feel Better” program, which is a system of classes on beauty and skin care for women with cancer.
“While we are doing our best to help the cause, we face people who are uninsured and didn’t have the means to get checked sooner. There may be fewer instances, but they are worse cases. The number of people getting cancer is relatively constant, but more people are dying from it,” McDonald said. “The best defense is being proactive and seeking early detection, so the cancer can be removed or treated before it becomes much worse.”
When it comes to getting the information out to rural and native populations, Thompson said that there is a strong partnership between the UA, Northern Arizona University and the Arizona tribal leadership to work collaboratively and increase the capacity for service. However, in the rural areas, it is difficult to provide services that will meet all of the patients’ needs. One of the organizations Thompson works with is the Indian Health Service, an agency within the Department of Health and Human Services, which provides federal health services to American Indians and Alaska Natives.
“There will always be cultural and language barriers,” Thompson said, “We are trying to decide how to provide a non-fearful message about cancer so we don’t face such a resistance. We want the material to be effective without scaring people.”
Another service offered to rural communities is the Well Woman Health Check, which will provide free breast and cervical cancer screenings to qualifying women over the age of 40. However, since funding is low, a woman must be diagnosed during the screening by the program to receive care, otherwise it is not supported, Thompson said.
A challenge that Thompson said affects the way Hispanic patients receive treatment, is that there isn’t an abundance of literature or information in Spanish for the heavy population in the state. She also said that the homeless population goes unaided because no one really wants to talk about the homeless.
“On top of bilingual information, we also need a committed community member in healthcare who everyone trusts. That person will have a significant impact on the population, but without that, we face distrust from many different demographics,” Thompson said.
The reasons for the disparities seem to match up fairly evenly across the state. Nancy Foreman, an oncology nurse at the Flagstaff Medical Center, said that many rural communities in northern Arizona have high cancer statistics because the patients don’t seek treatment early, and they are unaware of the importance of routine health checks.
“Cutbacks in healthcare options, like AHCCCS, are forcing people to only seek out help when they absolutely need it, since treatment options are so costly,” Foreman said. “There is a denial factor involved as well. People don’t think anything bad will ever happen to them, especially when there is no history of disease in the family. Most of the time, the problem isn’t getting people treated, it’s getting people diagnosed.”
Telemedicine programs that are in place are a major way that physicians work with distant sites to provide aid. Telemedicine is the diagnoses and treatment of patients in remote areas using medical information, as x-rays or television pictures, transmitted over long distances. Because of a lack of funding, many physicians will receive initiatives through federal and state support to provide care for rural areas. A caregiver usually handles the process of getting the patients where they need to go.
Thompson said that the target population for screening and pre-treatment should be the elderly. Cancer rates increase with age, but the older demographics aren’t receiving important information that they should be.
“The system is broken. Not only are we over-whelming people with messages at education fares and booths, but we are also not teaching people to understand health literacy. We are not helping them understand what it means to be tested positive and what the risk factor is,” Thompson said.
In Arizona, cancer is the second highest leading cause of death, following closely behind diseases of the heart, according to data collected by the Arizona Cancer Registry. In 2009, statistics show that 10,147 Arizonans died from cancer related diseases, and there are a reported 25, 857 people diagnosed with at least one form of the disease. Nationally, the Centers for Disease Control and Prevention reported an estimated 567,628 cancer deaths for the same year.