Chasing Cancer: Arizona has lowest rates but people aren’t getting screened soon enough

by Richard Tackett – Arizona Capitol Times

Brent Uffelman, who has colon cancer, sits in his backyard in Mesa. By the time he was diagnosed, Uffelman, like many other Arizonans, was already at stage 4, meaning the disease had spread to other areas of his body. (Photo by Ryan Cook/RJ Cook Photography)

Right before Brent Uffelman was diagnosed with stage 4 colon cancer, he wasn’t noticing any extreme symptoms. Sure, he felt tired at times, but that could have been the result of a long day at work, he told himself. It wasn’t until he met a friend for breakfast before starting his day’s shift at Alliance Beverage Distributing Co. that he began to see and feel indisputable signs that something was really wrong. He was passing blood, but felt well enough to finish the workday.

“I guess I was being macho or whatever,” Uffelman says.

That night he passed out from fatigue. It was then he decided to see a doctor. The doctor administered a colonoscopy the next day and found Uffelman’s tumors. The main tumor was in his colon, he says, and the cancer had already spread to his liver and lungs.

“One of the things my main doctor told me is that unfortunately, with colon cancer, unless it’s caught in screening, most people come to him really far along,” Uffelman says. “It’s one of those things that get caught after it’s too far along.”

Findings released this year by the National Cancer Institute and the Centers for Disease Control and Prevention rank Arizona lowest for incidences of cancer among the 50 states and Washington, D.C. And for cancer deaths, Arizona has fewer than all states besides Utah and Hawaii.

At first glance, the news seems positive. The Arizona Department of Health Services even sent out a press release March 29 with a large headline stating: “Arizona Has the Lowest Cancer Rates in the U.S.” However, directly beneath that headline revealed an important caveat: “But Many People are Diagnosed Too Late to Survive.”

Uffelman, like many Arizonans, found out about his cancer after it had already spread to other parts of his body, which restricted his treatment options. He didn’t have any specific reason for not getting screened, and was under the impression that at age 50 was when he should start to be concerned with medical problems like cancer. He was in his mid-thirties when he was officially diagnosed and undergoes chemotherapy a couple of times each month.

“The late diagnoses (in Arizona) aren’t worse than in other states, but they’re bad compared to where we should be,” says Wayne Tormala, chief of the Department of Health Services Bureau of Tobacco and Chronic Disease. “About half of colorectal cancers are getting detected late stage, and so are about 30 percent of breast cancers.”

Tormala says the state’s famous weather, which encourages a healthy lifestyle, and the state’s low tobacco use contribute to Arizona’s low cancer-incidence ranking.

Dr. David Alberts, director of the Arizona Cancer Center at the University of Arizona, says population demographics play a big part in the ranking as well.

“Almost 60 percent of our population is Hispanic, Native American and African American,” Alberts says. “The general Hispanic population, for example, has a lower cancer incidence rate compared to the white, non-Hispanic population.”

But, Alberts cautions, the numbers are getting worse for all Arizonans.

“The Hispanic population is taking on the Western lifestyle,” he says. “The cancer rates in Arizona will rise when that happens. Though our incidence rates are lowest in the country, they’re still sky high. Forty percent of all Arizonans will experience a non-skin invasive cancer. That’s a very upsetting figure and the figure is getting worse, not better.”

Fewer tests mean more late-stage cancers

According to the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System, 60 percent of women in Arizona in 2010 didn’t get their recommended mammogram for breast cancer. Forty-two percent of Arizona adults over 50, the age when screening is recommended, said they’ve never had a colonoscopy, and 44 percent of men in the state haven’t gotten their Prostate-Specific Antigen (PSA) test for prostate cancer risk in the past two years.

Uffelman, who was 36 years old when he was diagnosed, says the general recommendation that people get a colonoscopy beginning at age 50 is too late.

“People think they don’t need a colonoscopy until they’re 50,” he says. “I think that’s the big problem, putting age limits on the screening. Doctors will tell you not to worry about it, even if you might have symptoms. Even if you wanted to go get an early screening just to be safe, your insurance won’t cover it if you don’t have some kind of symptom.”

Uffelman says the reason he hadn’t received a prior screening was because he had no idea about the kinds of symptoms he was supposed to be looking for.

“I don’t know what can be done to push along the screening,” he says. “Up until near the end, when my body gave out, I didn’t have other symptoms. I wish I did.”

Tormala, of DHS, agrees with Uffelman’s observations, but adds that economic factors also play a role.

“Part of it’s simply not going to the doctor,” he says. “Another part of it is, in this economy, with job loss, people are uninsured and making hard financial decisions. With rent, mortgages, car payments and groceries, people tend to put off the doctor and dentist.”

‘Laser-focused’ education program

Tormala says the solution to getting people to get screened sooner is education using a “laser-focused” message. They’ve had less luck with general information campaigns.

“We want to lead people to take control of their own health and take responsibility,” he says. “It’s all about detection. Know what’s going on. Just because you don’t feel anything doesn’t mean something’s not brewing inside.”

Sharlene Bozack, chief government relations officer for the American Cancer Society Cancer Action Network’s Great West Division, says that doctor education is another big part of the solution to late screenings.

“You go in for a visit, and a lot of doctors don’t ask when the last time was that you had a colonoscopy,” Bozack says. “It’s about educating the physicians on early prevention and detection.”

Uffelman says if his doctors had asked about cancer screenings unprompted, it would have pushed him to action sooner, knowing that he could be at risk for colon cancer even without family history or major symptoms.

“I’m not sure whether it’s the people or the regular physician that need to be aware that (cancer is) something they need to look for at all ages,” he says.

Screenings save lives

Uffelman’s experience in getting diagnosed with cancer may have helped save the lives of some of his friends and family. After his diagnosis, all of his family members got screened. They were fine, but Uffelman put the word out to his co-workers about early screenings and prevention, too.

“We put the challenge out at work and said, ‘Hey, this could be you too.’” he says. “There were actually a number of people who were on the verge of having colon cancer, and they caught it in time.”

Tormala says that’s exactly the reason his department publicizes these statistics. The worst thing Arizonans can do, he says, is become complacent because the state ranks lowest for cancer incidences. The danger of late-stage diagnoses, he says, overshadows that positive statistic.

“What we’ve found is that when you take your foot of the accelerator, the rates go back up,” he says. “You don’t want to get a false sense of victory.”

Recommendations

Cancer screening guidelines from the American Cancer Society:
• Women should have yearly mammogram starting at age 40.
• Men over 45 should have a prostate exam (PSA) every 1-2 years. Frequency should depend upon personal risk factors.
• Men and women over 50 should have a colonoscopy every 10 years

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