Public Health Challenge

For years Maryland has ranked among the top states in cancer mortality. However, as a result of programs such as the Maryland Cigarette Restitution Fund, which has provided education, prevention and screening for early detection, Maryland has seen a downward trend in cancer mortality. Maryland now ranks 19th among the states and DC, a change from 2nd two decades ago. It’s likely that the Maryland CRF has had a significant impact on this reduction. Evaluating Maryland’s ranking on cancer incidence, or new cases of cancer diagnosed, has been limited by lack of data availability. Maryland incidence data for 2004-2006 have recently been released.

Research Findings

Surveillance Findings: Although cancer mortality rates are declining in the U.S. as a whole, Maryland’s are declining at a faster pace. Further evidence that the downward trend is due to public health programs resides in the fact that cancers targeted by the Maryland Cigarette Restitution Fund and other state and national programs (Breast and Cervical Cancer screening programs, smoking cessation programs, colorectal cancer screening promotion) are among those declining more quickly. The Maryland Cancer Registry was established to count the number of cancer cases diagnosed in Maryland residents. In Maryland if a person is diagnosed with a reportable cancer, state law requires hospitals, labs, and physicians to report cases to the Maryland Cancer Registry. It is through this reporting that Maryland can monitor the occurrence of new cancers among its residents and the trends with time. Assessment of behavioral risk factors and various health services correlated with increased or decreased risk of cancer enables Maryland to evaluate cancer prevention. Maryland’s colorectal cancer rates have declined as screening has increased; lung cancer has declined as smoking rates have decreased. Assessment of stage at diagnosis in addition to the age-adjusted rates may enable Maryland to evaluate the effectiveness of prevention and screening programs: Maryland has seen an increase in early stage colorectal cancer and a decrease in regional cancer diagnoses at a time when screening increased. Another indicator of progress is the elimination of racial disparities in cancer incidence. Cancer incidence among African Americans was higher than whites in the Maryland. This disparities gap is closing in Maryland and rates have been about equal for the past three years (2004-2006). As to the gender gap, during the period 2002 to 2006, females have a higher rate of cancer incidence from ages 35—55; after age 55, men have the higher age-specific cancer incidence rates. However, because women live longer than men, the absolute number of cancer cases in women is higher than in men although their rate is lower.

Possible Directions

The Maryland Cancer Registry will continue to monitor cancer incidence over time for all cancer sites, population subgroups, including geographic areas of the state, and will examine changes in cancer stage at the time of diagnosis. In the future Maryland’s progress to reduce cancer deaths may depend on primary prevention, lowered incidence, and effective treatment.

Future Research Opportunities

Future Evaluation Opportunities: The Maryland Cancer Registry will continue to monitor Maryland’s standing among other states. Its cancer prevention programs will seek to continue monitor their effectiveness by looking at rates and racial disparities in cancer incidence and mortality.