Maryland cancer specialists and health officials trying to organize the state's first cancer control plan think they have discovered their biggest handicap -- they need a "boss." And they are encouraging Gov. William Donald Schaefer to appoint one.
Now, there is no group with the authority to direct various public and private organizations with a role in battling cancer. And the state has already fallen behind schedule in implementing a key part of its recently announced anti-cancer plan -- its effort to curb smoking statewide.
No one disputes the need for quick action. Maryland has ranked first among states in its cancer death rate for the last two years in a row.
"We need a leader with some sort of vision," said Dr. Albert Owens, director of the Johns Hopkins Oncology Center.
That leader, Dr. Owens and other cancer specialists say, should take the form of a cancer commission or a state cancer advisory board established by the governor. It would need the clout to hold accountable everybody with a role in pursuing the state cancer plan, say Dr. Owens and Dr. Joseph Aisner, director of the University of Maryland Cancer Center.
The state's first Maryland Cancer Control Implementation Plan, dated March 1991, has a timetable for establishing programs in three areas -- reduction and prevention of tobacco use, early detection and treatment of breast cancer and early detection and treatment of cervical cancer.
Breast cancer and uterine cancer coalitions have been organized and have begun meeting on schedule. But the tobacco coalition has yet to get off the ground, state officials admit.
The tobacco plan's schedule said that by March 31, agencies such as the American Cancer Society would all meet to discuss the tobacco implementation plan. By April 30, they were supposed to agree on recommendations to be presented at the first statewide coalition meeting.
But as of the end of last week, an official with the American Cancer Society in Maryland said, the agency had not yet been contacted.
The state cancer plan was created to satisfy a federal grant that the state health department received and that the National Cancer Institute approved two months ago, said Robert Eastridge, deputy health secretary. He suggested that if the plan had been approved earlier, the anti-tobacco effort would likely be on track.
The fact the current cancer plan is tied to a federal grant is one of its limitations and another reason for establishing a permanent oversight group, Dr. Aisner said.
Grants have "a beginning and an end," he said. "When it ends, we have a potential for this [state cancer control plan] dying. Al [Dr. Owens] and I don't want it to die."
The oversight "boss" or commission should have a structure that would give it the ear of the governor and the legislature and would have the authority to revamp the cancer plan from year to year, making changes as needed, Dr. Aisner said.
Dr. Owens chairs the Maryland Cancer Consortium, a federation of 42 organizations involved in some aspect of cancer care or prevention. He describes the group, which formed last year, as "a lot of arms and legs" with no leadership.
Nelson J. Sabatini, newly appointed secretary of health, said Friday that he and Robert Perciasepe, secretary of the Department of the Environment, agree with Dr. Owens and Dr. Aisner.
Ten days ago, the four key state figures in Maryland's cancer control effort -- Mr. Sabatini, Mr. Perciasepe, Dr. Owens and Dr. Aisner -- met with Governor Schaefer to discuss a new cancer panel. They said the governor seemed enthusiastic, though no specific plan was formed.
"He is terribly concerned over the fact that there are people in the state of Maryland that are dying of cancer that don't need to be dying of cancer," Mr. Sabatini said. "I would rank cancer control and the high infant mortality rate as top priorities we'll be facing in the health arena."
Paul E. Schurick, an assistant to the governor, said Mr. Schaefer would announce a new anti-cancer effort "stressing the prevention and the access [to health care] themes" in the next three weeks. He said details of the effort are being worked out.
In the recent General Assembly session, the governor successfully sponsored a bill creating a much stronger cancer registry than the state had before -- something that is expected to improve prevention and treatment programs.
The bill requires hospitals and laboratories to report all new cancer cases to one state registry that will provide, for the first time, information on the incidence of cancer in the state.
It is also expected to be used to identify what types of cancer occur more in one part of the state than another, compare numbers of cases that occur with death rates and examine how far advanced the cancer cases were when diagnosed.
Dr. Aisner said the registry is something that an oversight group needs to keep an eye on.
One beneficiary of the state's efforts might be its chief health official, Mr. Sabatini. He smokes but is trying to quit.
Even after taking smoking cessation classes and other measures, the health secretary still takes a smoke from time to time in his office -- despite a smoking ban in the health department office building.
When he lights up, the human and the chief health official clash. It's an addiction he shares with many Maryland citizens, he admits.