The Maryland Cancer Consortium and the state health department have issued the state's first cancer control plan, but the consortium chairman admitted it "only scratches the surface" of a major health problem that has worsened to the point that Maryland now has the highest cancer death rate of any state in the nation.
"It's a start," Dr. Albert H. Owens Jr., director of the Johns Hopkins Oncology Center, said yesterday of the Maryland Cancer Control Plan, which targets prevention or early detection of breast, cervical and tobacco-related cancers such as lung cancer. But "between the covers [of the 154-page document] is not a complete cancer control plan."
What is needed to turn Maryland's cancer problems around, he said, is something not mentioned in the plan: creation of a Maryland Cancer Commission with a full-time staff that has regular access to a detailed registry of Maryland cancer patients or some other surveillance system.
Dr. Owens, a nationally respected cancer specialist, suggests that a state cancer commission could be funded with part of the income realized from a proposed 20-cents-per-pack increase in the cigarette excise tax under consideration by the legislature.
The plan's recommendations include reducing tobacco use among people with low levels of education and income, pregnant women, minorities and teen-agers; and increasing the number of hospitals that provide low-cost mammography to screen for early breast cancer and Pap smear tests to detect early cervical cancer, especially in areas that have poor access to health care.
Gov. William Donald Schaefer said through a spokesman yesterday that he realized the plan was "clearly the first step in a series of steps that will address this problem in Maryland."
Mr. Schaefer wants to name a task force on cancer as "the next step" to prepare a detailed report on how to reduce cancer deaths, saidRay Feldmann, the governor's spokesman.
The governor will direct the new health secretary, who will replace Adele A. Wilzack, to "have this cancer issue as one of his or her priorities," Mr. Feldmann said.
The plan endorses as "a priority" a state cancer registry, a matter that is about to confront the legislature.
"We need to know something about where the people [cancer patients] live, work, their environmental exposures, their family histories -- did they actually get the treatment prescribed, did they do well or didn't they do well," Dr. Owens said.
Such a registry of information about cancer patients would serve as "a documentation of best medical practice," he said. And it could provide the basis for consensus among Maryland physicians on up-to-date diagnosis and treatment for various types of cancer.
But treatment comparisons between hospitals and between different doctors are "loaded with controversy and apprehension" in the medical community, he said.
Administration-sponsored bills requiring hospitals and laboratories to report cancer diagnoses and other information to a Maryland cancer registry, are expected to be voted on in key legislative committees as early as tomorrow.
Many amendments have been proposed by various interest groups. The Maryland Hospital Association has been negotiating with the administration over how much information the registry would require and how much that would cost.
The new Maryland cancer plan does not look at the state on a county-by-county basis, identifying each region's biggest cancer problems.
Dr. Owens said the plan was developed to satisfy requirements of a federal grant the health department received for cancer prevention, which is why it has a narrow focus. Its goals provide "a very justifiable start," he said.
In particular, smoking prevention and cessation, breast cancer screening, and statewide access to state-of-the-art care would yield large returns in cutting the cancer death rate, said Dr. John Southard of the state health department.
The document was titled the "Maryland Cancer Control Plan" in response to Mr. Schaefer's directive last November to come up with a plan for improving Maryland's serious cancer death rate, Dr. Owens said.
Mr. Schaefer said he learned of the state's cancer problem from a story detailing it in The Sun. He ordered an examination of the causes for the high death rates in three geographical areas -- Baltimore, the Eastern Shore and Western Maryland.
Mr. Feldmann said yesterday that the governor still wanted more information on how to reduce cancer area by area in the state.
The plan says that Maryland has had a serious and worsening cancer problem for at least 40 years.
This is the first attempt to deal with the statewide problem through a focused plan, according to Dr. Southard, director of disease prevention for the health department.
About 9,000 people die from cancer each year in Maryland; black people and poor people have higher rates of cancer deaths, the report points out.
It says that various regions of the state will need to be targeted with education and intervention programs appropriate to the particular risk groups who live there.
A separate report with more details on how the state will address
reduction of the three cancer groups will be sent to the National Cancer Institute next week, Dr. Southard said. It was not ready yesterday.
The recently formed Maryland Cancer Consortium, a group of 42 organizations that play some role in cancer care, prevention or rehabilitation, was described by Dr. Owens as "a lot of arms and legs" with no coordinated leadership.
"We need a leader with some sort of vision," he said in urging the establishment of a state cancer commission.