Using tobacco dollars wisely

March 12, 2000|By Georges C. Benjamin

I REMEMBER her. She was an elderly African-American lady who arrived at my emergency department for evaluation of chest pain. I performed the standard emergency medical exam. The pain was not a result of any emergency causes I had been trained to recognize.

But, one look at her right breast gave the diagnosis. She had a large mass -- hard, ulcerating and clearly cancerous. Further physical examination showed evidence that it had spread. Why had she not come in earlier? When I asked her about the mass, she said, "What mass?" She was in denial and, like too many others, did not have health insurance.

Unfortunately, this is not an unusual story in Maryland. Too many people have obvious signs of cancer, and either will not or cannot seek help early. As Governor Parris N. Glendening's plan to spend our state's dollars from the tobacco settlement is reviewed, we should remember the reasons behind his decision to focus on reducing cancer and tobacco use in Maryland.

High incidence

Maryland ranks seventh among states in cancer mortality. It is the second leading cause of death for Marylanders, with more than 10,000 premature deaths each year. The leading cancers in Maryland -- lung, breast, colon and prostate -- constitute 68 percent of all new cancer cases. Melanoma, a form of skin cancer, is the fastest growing cancer in our state.

There is a disparity between Maryland's African-American citizens and caucasians in both the incidence and death rates for cancer. This is probably a result of differences in the incidence of tobacco use, poor access to health care, lack of culturally sensitive anti-tobacco and anti-cancer messages and inadequate screening of minority populations.

Opportunities exist to beat this disease in lifesaving clinical research programs, but less than five percent of Maryland citizens participate and the African-American community and women are especially left out.

Each year, more than 7,500 Marylanders die of tobacco-related diseases. By reducing tobacco use, we attack a major risk factor for cancer. We also decrease the incidence of many tobacco-related problems such as cardiovascular disease, chronic lung disease and asthma, ear infections, sudden infant death syndrome, pulmonary infections and burns.

The facts are alarming; the trend undeniable. Most smokers take up the habit as teen-agers, with more than 90 percent of them beginning before their 18th birthdays and 12 percent starting as early as the sixth grade. Another five percent use smokeless tobacco. To make matters worse, tobacco use often is a gateway to other risky behaviors such as alcohol and marijuana use.

The situation is unacceptable and must be addressed. We must make significant improvements in our public health efforts to reduce smoking and to prevent, identify and treat cancer.

There are many other noble and good uses for these dollars, but none will achieve the level of public health improvement that reducing tobacco use and focusing on cancer will do.

Last week, I saw a tobacco advertisement in a leading African-American publication that featured an attractive black woman. The advertisement relayed an uplifting message of freedom and opportunity. There was also the required surgeon general's warning that "cigarette smoking is harmful to your health." What a complex message.

A strong foe

The same day I read an article in a newspaper that told of the tobacco industry's influence in preventing the newly formed Legacy Foundation from airing anti-tobacco advertisements that the industry found objectionable. I thought about all of the people who will continue to smoke unless we do something.

We have a unique opportunity and the resources to make substantial improvements in the health of our community.

We cannot delay our efforts.

Each day, 60 Maryland children become addicted to tobacco. Each year, 24,000 people are diagnosed with cancer. It is too late for my patient with terminal cancer, but it is not too late for others.

Dr. Georges C. Benjamin is state health secretary.

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