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Delaware consortium fights back against state's high cancer rates.

THE STATISTICS in Delaware were grim.

From 1994-1998, the tiny state had a cancer rate that was about 10 percent higher than the national average.

For specific cancers, the figure was even grimmer: Lung cancer was 39 percent higher than the national average. Colorectal cancer was 15 percent higher. Prostate and breast cancers were 8 percent and 5.4 percent higher.

There were huge disparities in who got sick and who died from cancer, too. Rates of death from colorectal cancer for black Delawareans were 59 percent higher than rates for whites, and whites were more likely to be screened for colorectal cancer.

"We knew we had many people whose care wasn't coordinated and who weren't able to afford treatment," said Karyl Thomas Rattay, MD, MS, director of the Delaware Division of Public Health.

In 2001, then-Gov. Ruth Ann Minner looked at the figures and wanted to do better. She appointed a one-year task force that continues to this day, having morphed into the Delaware Cancer Consortium.

And the cancer rates started to come down.

For 2003 to 2007, Delaware's cancer death rate fell by 18 percent from the 1993 to 1997 period, compared to a 12 percent decrease nationally. More people are being screened for cancer, and the state has eliminated the disparity in colorectal screenings.

"Someone said that that was the only public health disparity ever to have been eliminated," said Bill Bowser, JD, chair of the consortium, adding that while he was not sure that statement was precisely correct, the group is "very proud of the work we've done."

The consortium, which is funded through the 1998 multi-state tobacco settlement, is a multidisciplinary group of health workers, state legislators, government agencies and non-profit groups that oversees the implementation of recommendations developed by the 2001 task force. Recommendations include increasing screening and reducing the threat of cancer from the environment.

To increase colorectal screenings, the state partnered with the Centers for Disease Control and Prevention to make screenings available to low-income people. It also placed screening navigators in acute care facilities to both help people get screened and also to follow up and get them into treatment if necessary. The state is now in the top three nationwide for colorectal cancer screening, Bowser told The Nation's Health.

Delaware is also working on behavioral changes, such as encouraging residents to quit smoking. The state's 11-year-old Clean Indoor Air Act bans smoking in workplaces and most indoor public places. All Delaware hospitals and many institutes of higher education have smoke-free grounds, and some whole towns, including the resort town of Fenwick Island, have banned smoking on beaches and in parks, said Rattay, who is a member of the consortium.

She credited the consortium's leadership under Bowser and core group of committed members with the initiative's success.

"This is an issue that people really care about and have repeatedly come to the table for," Rattay told The Nation's Health.

Bowser acknowledged that Delaware's small size is to its benefit when coordinating the consortium's efforts, but he said he hopes the state can serve as an example to others.

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Title Annotation:STATE & LOCAL
Author:Tucker, Charlotte
Publication:The Nation's Health
Geographic Code:1U5DE
Date:Oct 1, 2013
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