Study questions value of mammograms, breast cancer screening

(AP Photo/Damian Dovarganes, File)

Delaware continued to make strides in the ongoing fight against cancer, public health officials detailed Tuesday, but there's still quite a bit of work to be done. 

On the heels of the Division of Public Health's release of their annual Cancer Consortium report detailing cancer mortality rates in the First State, division director Dr. Karyl Rattay says the fight isn't anywhere close to being over. 

"Some may remember two decades ago when Delaware had the worst incidence and mortality in the nation. As a state, we've made a tremendous amount of progress," Rattay said. "Our mortality rate is at 15th highest, which is certainly an improvement from when we were number one, but we still have room for improvement. There's a lot of work that we still want to do to improve cancer rates in our state."

Screenings re one of the best tools in the fight against cancer, Rattay said, because early detection means better chances of survival. However, when it comes to compiling statistics, it can be something of a double-edged sword. The more screenings performed results in more incidents of cancer discovered, though it's also likely those incidents are more survivable.  

"There's still a lot of room for improvement, because there are 35 states who have a lower mortality rate than Delaware. But, as one of our cancer...oncologists on the Cancer Consortium pointed out, we're the only state that has been able to get out of the Top 10, and stay out of the Top 10," she said. "We've been out of the Top 10 for a number of years now, and that's largely a reflection of these increased screenings that we've been able to do. We actually have some of the best screening rates in the country in our state. But we also have some of the highest tobacco rates, some of the highest lung cancer rates. And with that comes high mortality so, while, again, there's improvement, there's a lot of work yet to be done."

Lung cancer screenings have been one of the areas where a lot of energy has been focused, Rattay said, as it holds both Delaware's highest incidence rates and highest mortality rates, she said. Which has led to it being screened for most frequently--not just in Delaware, but nationally, according to Rattay. 

"We really want to see more improvement, so that all who are eligible for lung cancer screenings, get those screenings, so that we can detect more cancers at a local state. It makes a big difference with survival," she said. "Breast cancer is another common type of cancer, as it's the most common type of cancer among women. And while our breast cancer mortality decreased during these two time periods about 2%, it decreased about 15% in the nation. While we have high breast cancer screening rates in the states, we really would like to see even higher breast cancer screening rates than we have had in the past, and really seeing all eligible women get their screenings as per the guidance."

Black women are a high priority, Rattay said, as they in particular are less likely to receive a screening, and more likely to have higher mortality rates compared to Caucasian women. Black males also have a higher rate of prostate cancer than their counterparts, she said. The state has initiated a Screening for Life program for the uninsured and underinsured. 

Because Delaware is such a small state, Rattay says the annual report examines data over a five-year period, then compared that data to data over the same stretch of time 10 years ago. It gives them a better view of the overall situation, and allows experts, doctors, and scientists to break out data based on demographic to see the areas where improvement is necessary. 

"It's really important work for us to understand our trends over time, our trends based on race, ethnicity, and gender, as well as our trends and how we compare to the nation," Rattay said. "It's also really important that we're looking at things like how much cancer are we detecting in a local stage, versus a distal stage? That helps us to know how well we're doing with our screenings. Very importantly, also, is looking at certain populations, even geographically, to better understand: are there certain areas where we need more intensive and more focused efforts?"

Governor John Carney was happy with Delaware's positive momentum, and said the data gives them a satisfying reassurance about all of the work being put into their efforts to catch cancer earlier and get it treated. 

"After decades of dedicated early detection and screening efforts by a wide array of partners, it’s reassuring to see improvement in certain areas," Carney said. "I commend the Delaware Cancer Consortium and the Division of Public Health for expertly coordinating our state’s cancer prevention advocacy and education. I also thank those Delawareans who get their recommended cancer screenings, and encourage everyone to do the same."

By the numbers 

For 2013-2017

  • The state’s all-site cancer mortality rate--171.0 deaths per 100,000 people--was higher than the U.S. rate--158.3 deaths per 100,000.
  • Delaware males--204.1 per 100,000--ranked 17th for all-site cancer mortality (18th in 2012-2016) and had higher rates compared to U.S. males--189.5 per 100,000.
  • Delaware females--146.3.1 per 100,000--had a higher all-site cancer mortality rate compared to U.S. females--135.7 per 100,000--and ranked 17th for all-site cancer mortality, an improvement from 14th in 2012-2016.

Breast cancer

The most common type of cancer among women in Delaware.

  • From 2003-2007 to 2013-2017, female breast cancer mortality in Delaware decreased 2%, compared to the U.S. decline of 15%.
  • Female breast cancer incidence rate for Delaware--135.4 per 100,000--was higher than the U.S. female rate--126.8 per 100,000.
  • Delaware’s percent of female breast cancer cases diagnosed at the local stage increased from 42% in 1980-1984 to 68% in 2013-2017.
  • Delaware females 40 years of age and older who reported having a mammogram within the previous two years ranked third-highest nationally--79%--in the 2018 Behavioral Risk Factor Survey.

Colorectal cancer

The fourth most diagnosed cancer in the U.S. and Delaware. Delaware ranks 11th nationally for this type of cancer prevalence.

  • Between 2003-2007 and 2013-2017, incidence rates for colorectal cancer decreased by 26% in Delaware and 21% in the U.S.
  • During the same 10-year time period, mortality rates for colorectal cancer decreased by 21% both in Delaware and in the U.S.
  • Nearly 73% of Delawareans age 50-74 years reported meeting the recommendations, more than the national median of 70%.
  • For 2013-2017 in Delaware, non-Hispanic African Americans--44.6 per 100,000--had a statistically higher colorectal cancer incidence rate compared to non-Hispanic Caucasians--37.6 per 100,000.
  • Non-Hispanic Caucasians accounted for 78% of colorectal cancer deaths in Delaware in 2013-2017.

Lung Cancer

The most frequently diagnosed cancer, and most common cause of cancer deaths in both the state and the nation.

  • Delaware males--75.7 per 100,000--had a higher lung cancer incidence rate compared to Delaware females--61.3 per 100,000.
  • Delaware’s 2013-2017 lung cancer incidence rate improved to 17th, compared to 10th in 2012-2016.
  • Delaware’s 2013-2017 lung cancer mortality rank improved to 16th from 14th in 2012-2016.
  • Non-Hispanic Caucasians accounted for 82% of lung cancer cases in 2013-2017.
  • Hispanics--29.1 per 100,000--had a lower lung cancer incidence rate compared to both non-Hispanic Caucasians--70.7 per 100,000--and non-Hispanic African Americans--65.5 per 100,000.
  • Over the past decade, cancer incidence rates decreased among all sex, race, and ethnic groups. From 2003-2007 to 2013-2017 in Delaware, lung cancer incidence rates decreased:
    • 21% in non-Hispanic Caucasian males
    • 11% in non-Hispanic Caucasian females
    • 31% in non-Hispanic African-American males
    • 13% in non-Hispanic African-American females
    • 45% in Hispanic males
    • 55% in Hispanic females

Prostate cancer

Most diagnosed cancer in males Delaware and nationally. 

  • 33% of Delaware males 40 and older reported having a Prostate Specific Antigen (PSA) test in the past two years, compared to the national median prevalence of 32%. 
  • Between 2003-2007 and 2013-2017, prostate cancer incidence rates decreased by 30% in Delaware and 33% in the U.S.
  • Between 2003-2007 and 2013-2017, mortality rates for prostate cancer decreased by 31% in Delaware and 24% in the U.S.
  • In 2013-2017, Delaware’s non-Hispanic African Americans--205.8 per 100,000--had a much higher prostate cancer incidence rate compared to non-Hispanic Caucasians--110.3 per 100,000--and Hispanics--114.3 per 100,000.
  • Non-Hispanic African Americans--34.1 per 100,000--in Delaware had a higher prostate cancer mortality rate in 2013-2017 compared to Delaware’s non-Hispanic Caucasians--14.2 per 100,000.

Cervical cancer

Accounts for 1% of all female cancers in Delaware. 

  • Delaware ranked 20th in the U.S. for cervical cancer incidence, a six-place improvement from 14th in 2012-2016.
  • Non-Hispanic Caucasians accounted for 70% of Delaware’s cervical cancer cases in 2013-2017.
  • Non-Hispanic Caucasian females--48%--had a higher proportion of cervical cancer diagnosed at the local stage compared to non-Hispanic African American females--35%.
  • In 2013-2017, Delaware’s cervical cancer mortality rate--2.6 per 100,000--was not statistically significantly different from the U.S. cervical cancer mortality rate--2.3 per 100,000.