WILMINGTON, Del. -- Inside the white cinder-block-and-clapboard church with a red door, nearly 300 parishioners and visitors from this city's black community crowded into the blond oak pews and overflowed into the aisles, singing, shouting, clapping, stomping feet and shaking tambourines.
It was Saturday evening at New Galilee Baptist Church, and the crowd had gathered for a service billed as "Gospelizing for Cancer Awareness."
Clad in black tuxedo, orange tie, and orange cummerbund, with an orange handkerchief in his pocket, the Rev. William Wilmore Jr. pulled out all the stops at the organ. And the Rock of Ages Mass Choir, the Celestial Gospel Singers and the emotional audience overtook the brief words from a public health nurse and a doctor about fighting cancer.
Associate Pastor Ethel Cooper, 62, told of her own bouts with two gynecological cancers, one cured and the other now in remission, and advised the crowd that some cancers can be cured if they are detected early enough.
Preventing cancer or finding it early is particularly relevant in this small state, where black men and women die of cancer at higher rates than anywhere else in the nation.
But while Delaware has high death rates for blacks and for whites in some cancers, the state also has better tools to fight cancer than many other states. In Delaware, a state law requires all hospitals and laboratories to report all cancer cases to a statewide cancer registry.
This record, continually updated, shows incidence, progress of the cancer at time of diagnosis and information on treatment.
And its striking comparisons of incidence and deaths, and rates for blacks and whites, is helping Delaware health officials put together some clear reasons for the high death rates.
Although the death rate for cancer among black women is the highest in the nation, the number of new cases diagnosed each year is lower than average, according to the cancer registry.
"That very quickly told us either they're getting diagnosed late or their treatment is not as good as it should be, or both," said Peter Andersen, director of chronic disease programs for the Delaware Department of Health and Social Services.
The registry's statistics for 1980-1985 provide some telling information about diagnosis. Nearly a third of black women in Delaware were diagnosed with breast cancer while it was still contained in the breast, when the cure rate is the highest. That compares with 43 percent of white women.
Diagnosis was delayed more often for blacks, according to a 1986 study that looked at the time lapsed between first $l detection of a suspicious breast lump and date of the biopsy to determine if it was malignant. Again, for 43 percent of white women, the biopsy was done in less than two months, while only 33 percent of blacks got a biopsy within that time.
There was a similar difference between detection of prostate cancer in black men and white men. Only 42 percent of black men had prostate cancer diagnosed in its earliest stage, compared with 54 percent of white men. And 37 percent of black men had prostate cancer diagnosed after it had spread to other parts of the body, while 26 percent of white men were diagnosed at the latest stage.
Lack of education and lower income reduce the tendency to use preventive health care, Mr. Andersen said. "This translates into hypertension, diabetes, cancer. So that finally when symptoms of disease become so severe, they go to a hospital emergency room. Then gaps in medical care services [occur].
"We estimate there are 100,000 people in Delaware who don't have health insurance," he said. "That's a lot of people when you realize Delaware only has 650,000 people."
The state has bought a $225,000 van to perform mammograms in blue-collar workplaces and neighborhoods where women are more at risk for breast cancer.
Now, Allan Topham, director of the Delaware Tumor Registry, has begun a study to try to determine what's causing high rates of some of the major cancers, mapping high cancer incidence by census tracts, which are areas of about 4,000 population. "Then we'll see if there's any pattern -- industrial exposure, income, etc.," he said.