Cancer is a significant health problem in Georgia. In the twenty-first century there will be an estimated 33,400 newly diagnosed cases of cancer and about 13,900 deaths from cancer annually. Cancer is a disease that affects adults and children of all races, cultures, and educational backgrounds. Though the number of children diagnosed with cancer is not large in comparison with Georgia's population, cancer is the second leading cause of death among adults (after heart disease) and the third leading cause of death among children in the state.
Whether rich or poor, Georgians from urban, suburban, and rural areas alike are at risk for cancer. In fact, one in two men and one in three women in Georgia are expected to be diagnosed with cancer in their lifetimes. Because cancer is so common, it can be assumed that virtually every Georgia family has been touched by the disease. The risk of developing cancer increases as we grow older; therefore, the longer we live, the more likely it becomes that we will be diagnosed with cancer. As Georgia's population ages, it is likely that cancer will become even more prevalent.
At one time cancer was assumed to be fatal. Little was known about its causes, methods of diagnosis, effective treatments, or methods of prevention. Occasionally one heard the term remission (slowing or temporarily halting the growth of cancer) in association with the disease but seldom the word cure. In recent years, however, methods of preventing, diagnosing, and treating cancer have improved significantly. As a result, more advanced cancer-related care and services are available from doctors, nurses, public health clinics, hospitals, and outpatient centers. The general public is exposed to more detailed information about cancer prevention, detection, and treatment. Through awareness and education programs, the public is encouraged to take advantage of screening and treatment, and the fear of being diagnosed with cancer is reduced.
Though cancer can still be fatal, there are many forms of cancer that can be cured and numerous others that can be managed like a chronic illness such as diabetes. Cancer mortality rates declined 6 percent in Georgia between 1993 and 1998. Consequently, people who have cancer live much longer and have a better quality of life than ever before. Many doctors and scientists believe that any form of cancer, if discovered early enough, can be controlled or cured. One key to fulfilling this promise will be to have state-of-the-art methods of detecting and treating cancer available to all Georgians.
Georgia has the ability to take advantage of extraordinary advances in cancer education, screening, and care by building on existing medical, scientific, educational, and public health resources to improve the health of Georgians.
What exactly is cancer? First, it is not one disease or a single condition, even though it is commonly referred to as such. Cancer is characterized by the uncontrolled growth and spread of abnormal cells. These cells may be in blood, tissue, or organs. Cancer cells are not regulated by normal methods of cell division and growth. What may begin as an abnormal cell can multiply rapidly, invade healthy areas of the body, create tumors (a mass of tissue), and aggressively invade other parts of the body. Metastasis is the term for the spread of cancer from one location or form to another.
There are more than 100 different types of cancer—depending on the type of cells, their proliferation, and where they reside. For this reason, identifying and treating cancer requires sophisticated medical training, diagnostic equipment, access to scientific and medical research, and the ability to deliver medications (including chemotherapy), surgery, radiation therapy, and other clinical interventions in the most scientifically and clinically effective manner. Some cancers are more lethal than others, and the most common types of cancer account for more than half of all diagnoses and deaths.
According to the American Cancer Society the most prevalent types of cancer in Georgia in 2003 were: prostate, breast, lung, and colorectal. The cancers with the highest death rates in Georgia in 2003 compared somewhat differently: lung, colorectal, breast, and prostate.
Cancer incidence and mortality rates differ by race; these differences are referred to as disparities. For instance, blacks are 27 percent more likely to die from cancer than whites, and black men are twice as likely to die from prostate cancer as white men. Additionally, lung, colorectal, and pancreatic cancer mortality rates are higher in Georgia (17 percent, 41 percent, and 50 percent respectively) among black males than white males. Breast, colorectal, and pancreatic cancer mortality rates are higher in Georgia (36 percent, 54 percent, and 48 percent respectively) among black females than white females. These statistics are grim evidence of the fact that disparities are associated with worse health outcomes for black Georgians.
Scientific research points increasingly to the fact that these disparities are not caused by race; in other words, cancer disparities are not a result of inherent biological differences between races. Differences in patterns of care on the part of health-care providers and levels of acceptance of care on the part of patients both contribute to uneven treatment patterns. Many studies are testing the principle that "equal treatment yields equal outcomes" in an effort to demonstrate that disparities will be reduced or eliminated when care is delivered in a consistent manner to all Georgians. While this research hypothesis is being tested, it is imperative that providers, administrators, scientists, and educators ensure that cancer care is delivered without bias or prejudice by culturally competent providers and that Georgians who suffer disproportionately from cancer have adequate information and support.
Prevention and Detection
Cancer researchers have made important discoveries about the causes of cancer, and as a result there is now credible information on ways to prevent cancer. While it was once assumed that cancer was inherited, today scientists indicate that only 5 percent of cancer deaths are attributable to family history or genetics. Though certain causes of cancer, such as occupational hazards, viruses, and environmental pollution, may be outside our personal control, the most common causes of cancer are not. In fact, at least two-thirds of cancer deaths are a result of preventable factors.
Tobacco use (smoking, dipping, and chewing) contributes to as much as three-fourths of all cancer. Lung cancer, the leading cause of cancer death among Georgians, is a direct result of tobacco use but also may be contracted by inhaling secondhand smoke. Therefore, those who smoke cigarettes and cigars are putting themselves at risk of developing cancer and are also increasing the likelihood that those around them will develop cancer.
Maintaining a healthy weight, leading an active lifestyle that includes regular exercise, eating fresh fruits and vegetables daily, limiting alcohol intake, and reducing exposure to ultraviolet radiation from the sun are all proven ways of reducing one's risk of developing cancer. In addition, it is important to follow national guidelines and doctor's recommendations for cancer screening tests. Cancers affect men and women at different ages, and cancer can be present in the body without causing symptoms of discomfort or distress. As a result the American Cancer Society has developed guidelines specifying who should receive screening tests and at what age and frequency.
Cancer screening tests provide a mechanism for identifying cancer at an early stage, when treatment is most likely to be effective. Screening tests and guidelines for early detection have been developed for many types of cancer. Breast cancer can be detected through mammography or a clinical breast exam. Several tests, including the fecal occult blood test, flexible sigmoidoscopy, and colonoscopy, are used to detect colorectal cancers. The PSA test and a digital rectal exam are used to identify prostate cancer in men, and Pap tests are used to diagnose cervical cancer in women. Unfortunately, there is no screening test for lung cancer. Therefore, it is usually identified at a late stage, when treatment is less likely to be effective.
The Cancer Burden
Cancer burden is a term that may be used to describe the magnitude of the impact of cancer on a geographic area (a county or state) or a population group (by sex, race, or economic status). Georgia's cancer burden is a combination of multiple variables, the prevalence of the disease and cancer-related deaths being chief among them. Other factors must also be considered when assessing the toll of cancer on the state of Georgia.
The human suffering associated with cancer cannot be overlooked. Tens of thousands of individuals each year undergo treatment and manage the disease and its symptoms, while others provide care and support to friends and family members with cancer, and still others grieve the loss of loved ones to cancer. In addition, many Georgians lack health insurance that provides access to cancer screening and treatment. Georgia has a high percentage of people living in poverty and/or having failed to complete high school; research indicates that these measures of socioeconomic status are highly correlated with incidence of and mortality from cancer.
Georgia also incurs significant cancer costs. An estimated $1 billion annually is spent in medical care costs, $300 million annually for indirect morbidity costs (the cost of lost productivity due to illness), and $1.6 million annually for indirect mortality costs (the cost of lost productivity due to premature death). Five percent of Georgians with cancer are uninsured; that percentage is higher for African Americans and Hispanics.
When these factors are viewed in combination, the state's cancer burden is staggering. In spite of the availability of medical care, public health programs, social services, research, and educational institutions, the state suffers mightily from cancer. Many health, business, government, and civic leaders are motivated to reduce the state's cancer burden through a combination of scientific, clinical, educational, and social programs.
The Georgia Cancer Coalition
In 2000 Georgia became the beneficiary of the Master Settlement Agreement between tobacco companies and state attorneys general. A portion of the resulting revenue from the tobacco settlement was allocated by the General Assembly to the Georgia Cancer Coalition.
The Georgia Cancer Coalition is a public-private partnership dedicated to reducing the number of cancer-related deaths in Georgia. In partnership with public health agencies, government programs, hospitals and health systems, doctors, educational institutions, nonprofit organizations, and civic and survivor groups, the Georgia Cancer Coalition has created a comprehensive statewide initiative focused on a shared mission.
The goals of the Georgia Cancer Coalition are to prevent and detect existing cancer earlier; improve access to care for all Georgians; save more lives; train cancer researchers and caregivers; and realize economic benefits.
The Georgia Cancer Coalition is strengthening the collective impact of its partners in the fight against cancer and creating new initiatives that will accelerate cancer prevention, detection, care, and research. As a result, a higher level of cancer care will be available across the state, and the future of cancer in Georgia will be unlike its past.
Harmon J. Eyre, M.D., Dianne Partie Lange, and Lois B. Morris, Informed Decisions: The Complete Book of Cancer Diagnosis, Treatment, and Recovery, 2d ed. (Atlanta: American Cancer Society, 2002).
Edward H. Laughlin, M.D., Coming to Terms with Cancer: A Glossary of Cancer-Related Terms (Atlanta: American Cancer Society, 2002).
Nancy Paris, Georgia Cancer Coalition
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