Rural Somerset County is full of folks like Joe Reading, who used to dip his bare hands in DDT, still uses other chemicals on his farm and bathes his dinner greens in bacon grease. And Lewis W. Jones, a medical clinic director who smoked two packs of cigarettes a day until recently. And Weltonia Engram, who avoided getting Pap smears because she was afraid she might learn she had cancer.
Smoking, diets loaded with fat and salt, exposure to cancer-causing chemicals and poor access to health care may be clues to why one in 321 Somerset residents dies of cancer every year. Cancer statistics developed for The Sun show that the Eastern Shore's Somerset County has the second-highest cancer death rate among Maryland's 24 jurisdictions.
This year Maryland moved into first place with the highest cancer death rate of any state in the United States, and projections from the National Cancer Institute in Bethesda show that Maryland will retain first place next year.
Urban areas have long been known to be unhealthy, presumably because city dwellers are exposed to more industrial pollution. But the cancer risks to rural residents like those of Somerset only become clear when death rates for counties are compiled and examined.
To find out more about the types of cancers affecting Marylanders,The Sun asked the National Cancer Institute to rank states for different types of cancer and total cancer deaths for the last five years that data are available, 1983-1987. Then the state health department was asked to compute cancer deaths for the same five years for Baltimore and the state's 23 counties.
This picture emerged:
* Maryland's No. 1 ranking is propelled not only by high rates in Baltimore but also in the poor rural counties of the Eastern Shore, the midsize bedroom communities of Anne Arundel and Charles counties, and Western Maryland.
* Maryland ranks among the top six states for deaths from all the major cancers -- lung, colon, breast and prostate -- and is in the top four for esophagus; pharynx, the canal between the base of the skull and the esophagus; larynx, the voice box; liver; bladder; and multiple myeloma, cancer of blood plasma cells in bone marrow.
* The highest death rates for cervical cancer occurred in the poorest sections of Maryland -- the Lower Eastern Shore, Western Maryland, Baltimore and Southern Maryland -- a probable alarm that health education and access to care are deficient. Altogether, 406 Maryland women died of a cancer that health officials say need kill virtually no woman, because a Pap smear can detect cervical cancer while it is curable.
And the death rate for non-whites was three times that of whites.
* The highest cancer death rates for whites are in Baltimore and in Anne Arundel County.
* The racial differences in the rates for some cancers are so vast that state authorities should dig deeper for answers, said the National Cancer Institute official who directs the national system of collecting and reporting cancer incidence and deaths.
For example, the high lung cancer death rates for non-whites in Somerset County -- twice the rate for whites and nearly twice the state average for non-whites -- should be investigated, said Ben Hankey, director of the institutes's Surveillance, Epidemiology and End Results program.
A Somerset profile
Somerset is poised at the intersection of several risk factors.
In Somerset County, the southern tip of the Lower Eastern Shore, the seasonal landscape of fields chnages from cornstalks to soybean plants to golden fields of barley, wheat and rye. Roadside stands display the summer and fall harvest from truck crops.
But while Somerset produces a bounty from the land, it is the second-poorest county in Maryland.
Poverty and lack of education usually go together, said Dr. Ignatius L. DiNardo, medical director of the Somerset Medical and Dental Center in Princess Anne. "With an uneducated population, the corollary to that is a population that doesn't understand basic health care. Many of these people probably don't even know that smoking is bad for them."
Among Maryland's 24 subdivisions, Somerset has the worst death rates for lung, bladder and cervical cancers.
Smoking is the major cause of lung cancer and is blamed in about 40 percent of male bladder cancers and some cervical cancers. The state health department ranks Somerset second only to Baltimore in prevalence of smoking, and it is second to Baltimore in cancer deaths overall.
Seeing people smoking in public places is common in Somerset, even among some who know better.
Mr. Jones, 39, the medical clinic's executive director, took a last drag on his cigarette outdoors before stepping into his office to talk about cancer.