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Residents of the largely rural region of the eastern United States called Appalachia carry a heavy burden for certain cancers, a new study shows.



"We've found that the occurrence, or the incidence, of new cancer of the lung, colon, rectum and cervix were significantly increased in residents of the large portion of Appalachia in Kentucky, Pennsylvania, and West Virginia," said Eugene Lengerich, V.M.D., M.S., principal investigator of the study, and associate professor, Department of Health Evaluation Sciences, and with Penn State Cancer Institute, Penn State Milton S. Hershey Medical Center. "These findings support the National Cancer Institute's designation of residents of Appalachia as a population experiencing an excessive cancer burden."

This study titled, "Cancer incidence in Kentucky, Pennsylvania, and West Virginia: Disparities in Appalachia," was presented today (Nov. 18, 2003) at the American Public Health Association (APHA) 131st Annual Meeting and Exposition held Nov. 15-19 in San Francisco.

Previously, Lengerich, who is research director of the Appalachia Cancer Network (ACN), and colleagues from the ACN reported in a Centers for Disease Control and Prevention report that cancer death rates for residents of Appalachia were higher than national rates. (Report, map of Appalachia, http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5124a3.htm)

"Mortality data is well-accepted as a valid measure of disease burden," Lengerich said. "However, our country is really just developing a comprehensive national system to monitor incidence of cancer. We analyzed data from Kentucky, West Virginia and Pennsylvania because these Appalachian states have high-quality, complete data."

For the incidence study, Lengerich compared data from the cancer registries of the three states to the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) registry, established by the National Cancer Institute to track cancer incidence and survival in parts of the U.S. The SEER database, the only federal data available, includes only 14 percent of the U.S. population and overrepresents urban areas.

While Lengerich's analysis showed that the incidence rate for all cancers was the same for residents of Appalachia and the SEER population, the incidence of cancer of the lung, colon, rectum and cervix were 22 percent, 13 percent, 19 percent and 12 percent higher than the SEER average, respectively. Among rural residents, cancers of the lung and cervix were even higher - 34 percent and 29 percent higher than the SEER rates, respectively.

In addition, incidence of unstaged disease, which means that the stage of disease at diagnosis is unknown, was 6 percent higher for all cancer sites in Appalachia and 28 percent higher for rural residents of Appalachia. Patients whose tumors are "unstaged" tend to have lower survival rates, suggesting incomplete diagnose and treatment.

"Combining this new information with our previous findings on mortality, we can clearly see that residents of Appalachia suffer from excess cancer occurrence and death," Lengerich said. "We believe this is due to certain unhealthy lifestyles, like tobacco use, and a lack of health care access. If patients in Appalachia had the same access to health care as other patients, they would have the same rate of unstaged cancer."

"The increased incidence of lung cancer may be attributed to larger numbers of smokers in Appalachia and higher rates of colon, rectum and cervical cancer can be attributed to lack of colonoscopy and gynecological screenings," Lengerich said. The ACN also presented information Nov. 17 at APHA about the efforts of their community coalitions to improve education and access to healthcare for residents of Appalachia.

"It's research like this that gives Penn State Cancer Institute and organizations like Appalachia Cancer Network critical information to design effective programs to reduce the risks of cancer and cancer death in our country's diverse populations," said Thomas Loughran, M.D., director, Penn State Cancer Institute. "Community programs like ACN's identify those in need and play a critical role in helping health care providers to better serve people in rural areas."

In addition to Lengerich, the research team included: Thomas Tucker, Ph.D., M.P.H., Raymond K. Powell, M.P.H., Pat Colsher, Erik Lehman, M.S., Ann J. Ward, M.S., Jennifer C. Siedlecki, B.S., Stephen W. Wyatt, D.M.D., M.P.H.

Led by the University of Kentucky and in partnership with West Virginia University and Penn State University, the ACN directs cancer research and research-based interventions toward rural areas and medically underserved people of Appalachia. Both the College of Medicine and the College of Agricultural Sciences at Penn State are actively involved in ACN.

Penn State Cancer Institute is a partnership of institutions dedicated to enhancing cancer services throughout central Pennsylvania. Through this partnership, the benefits of cancer research and education at Penn State College of Medicine reach not only patients at Penn State Hershey Medical Center, but also at the Institute's other members; the Lehigh Valley Hospital and Health Network in Allentown and Centre Community Hospital in State College. Services are also provided at Lewistown Hospital, a Cancer Institute associate member. Each year, more than 4,300 new cancer patients seek treatment at one of the Cancer Institute's partner facilities.

By Penn State.