Prostate Cancer Mortality Risk May Depend on Where You Live

Prostate Cancer Mortality Risk May Depend on Where You Live

More than 1 million men died of prostate cancer in the United States between 1980 and 2014, but the risk of death from prostate and other cancers may depend on where you live. According to a new analysis that examined the trends and differences in cancer mortality rates among U.S. counties, cancer deaths are surging in some counties, even though overall cancer death rates dropped about 20% during that 34-year period.

The study, “Trends and Patterns of Disparities in Cancer Mortality Among US Counties, 1980-2014,” was published in JAMA.

Cancer mortality rates have declined in the U.S. in recent decades; however, major differences in cancer mortality still exist. Ali Mokdad, PhD, and colleagues estimated age-standardized mortality rates in U.S. counties for 29 cancers, using data from death records retrieved from the National Center for Health Statistics (NCHS) and population counts from the U.S. Census Bureau, the NCHS, and the Human Mortality Database from 1980 to 2014.

The researchers found that more than 19.5 million Americans died of cancer between 1980 and 2014. Of these, more than 1 million men died due to prostate cancer. Lung cancer killed more people in the U.S. than prostate or any other cancer.

Although many counties (1,558) had significant declines in prostate cancer death rates, percentage changes in male mortality rates between 1980 and 2014 ranged from a 69.4% decrease in Aleutians East Borough, and Aleutians West Census Area, Alaska, to a 26.1% increase in the mortality rate in Owsley County, Ky.

Researchers found the highest death rates from prostate cancer were in groups of counties in Mississippi, Alabama, Georgia, South Carolina, and Virginia. Counties in southern Florida and states along the U.S. border with Mexico had lower prostate cancer death rates.

Specifically, the highest death rate from prostate cancer in 2014 was in Madison County, Miss., with 64 deaths per 100,000 residents, followed by Macon County, Ala., with 57 deaths per 100,000 people, Wilcox County, Ala., with 55 deaths per 100,000 people, Phillips County, Ark., and Perry County, Ala., both with 54 deaths per 100,000 people.

The lowest death rate from prostate cancer was in Summit County, Colo., (10 deaths per 100,000 people), followed by Aleutians East Borough, Aleutians West Census Area, Alaska (11 deaths per 100,000 people) and Pitkin County, Colo., (13 deaths per 100,000 people).

“Such significant disparities among U.S. counties is unacceptable,” said Mokdad, lead author on the study and Professor of Global Health at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington in Seattle. “Every person should have access to early screenings for cancer, as well as adequate treatment,” Mokdad said in a press release.

The researchers reported that the national mortality rate from all cancers combined dropped by 20% from 1980 to 2014. However, 160 of the 3,000 counties analyzed, showed increases in all-cancer death rates during the same period, raising questions about access to care, prevention efforts, treatment, and other issues.

“As the U.S. enters a new debate about access to healthcare, these findings on the wide differences in cancer mortality should inform the discussion,” said Laura Dwyer-Lindgren, co-author of the study. “What’s causing cancer to be so much more fatal in one part of the country than in other parts demands further investigation,” she said.

“It is essential that state and local health officials, as well as other health policy decision-makers and cancer care advocates, take note of and act on this important evidence to save more lives in their communities,” said Christopher Murray, director of IHME.

Researchers pointed to some potential explanations for the high rates of cancer mortality in certain counties and regions. Cancer incidence could be high due to a combination of risk factor profile and poor prevention and screening programs. They also note that these high rates could be due to the lack of early detection for some cancers, and lack of specialized treatment, which could be deadly.

“For cancers with high survival rates, such as testicular cancer and Hodgkin lymphoma, wide differences in mortality rates in the U.S. should raise a red flag,” said Christina Fitzmaurice, assistant professor at IHME and the Division of Hematology at the University of Washington. “Clusters of counties with increasing death rates from these cancers need to be examined and questions raised regarding access to primary care for early detection and specialized cancer treatment services.”

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