Cancer mortality in Missouri increased by 2.5 percent between 1985 and 1995rising from an age-adjusted rate of 135.0 deaths per 100000 population in 1985 to a rate of 138.4 deaths in 1995. In 1985malignant neoplasm was the cause of death to nearly 1 out of 5 deceased persons compared to slightly more than 1 out of 4 in 1995. Cancer has been the second leading cause of death in Missouri for over a half century.

This article focuses on the changes in Missouri cancer mortality from 1985 to 1995. A recent national study¹ found a decrease in cancer mortality for the United States of 3.9 percent for the period 1990 to 1995 which reversed a long term increasing trend. Missouri data does not show this dramatic change but it is consistent in that all of the 2.5 percent mortality increase in Missouri occurred from 1985 to 1989 with little change since 1989. Generally Missouri cancer mortality is slightly higher than the United States as provisional 1995 data shows a 5 percent differential. Higher smoking rates in Missouri may explain this differential.

The primary reason for this 1985-1995 increase according to Table 1 is the increase in respiratory cancer mortality. The age-adjusted rate increased 12.7 percent between 1985 and 1995 from a low in 1985 of 41.1 deaths per 100,000 population to 46.3 in 1995. One in three cancer deaths are respiratory. According to the formula² used to calculate deaths attributed to smoking 80 percent of lung cancer deaths are included in this formula. According to the November 1995 edition of Missouri Monthly Vital Statistics this increase could be due to the increase in smoking-related deaths. Table 1 also shows that most of the other categories of cancer mortality have in fact declined except for female breast cancer which shows only a slight increase and urinary organs which has generally remained the same over this 11 year period, although, there was a 2 percent increase between 1985 and 1995.

The age specific cancer mortality rates for persons under 65 years of age show a decrease for each age specific group between 1985 and 1995. The decreases were sharpest for the youngest ages. For children under age 5, the cancer death rate decreased 36.7 percent from 3.0 per 100,000 population in 1985 to 1.9 in 1995. All three over 65 age groups had increases in cancer mortality with the largest increases noted for 65-74 and 75-84 age groups. This may reflect longer survival rates for persons diagnosed with cancer before age 65. Females generally have a smaller percent decrease than the males in those age groups under 65. The female age groups greater than 64 had a greater increase in cancer mortality than the same age groups for males.

The age adjusted cancer death rate between 1985 and 1995 for Missouri males decreased by 0.7 percent while the rate for females increased 5.9 percent. Table 2 shows an overall larger decline in cancer deaths among men than women in those age groups that have a decline. Despite this decline for males, the age adjusted cancer death rate is still nearly 45 percent higher for males than for females. In the age groups 65 and over, there is a greater increase in cancer deaths among women than men. The cause of this may be that women who are now in this age group began to smoke in larger numbers around the period of World War II and are, by way of higher cancer death rates showing the effects of that social trend now.

The age adjusted cancer mortality rate for blacks is higher than for whites. In 1995, the mortality rate for blacks and whites were 187.2 and 134.5, respectively. However, this differential is narrowing as there was a small decrease in the black rate of 2.9 percent versus a 2.4 percent increase in the white rate.

The map on the opposite page presents age adjusted cancer death rates by county in Missouri during the time period 1985-1995. The age adjusted mortality rate for the state was 137.7 deaths per 100,000 population, while county rates ranged from 102.7 in Johnson County to 179.5 in the City of St. Louis. Most of the counties in the highest quartile are located in the southeastern portion of the state. These include counties in the Bootheel areas as well as counties such as Madison Bollinger Butler Iron and Carter. The Northeastern portion of the state had only one county in the highest quartile Pike. The inner urban counties on each end of the state both had cancer rates in the highest quartile as well. Jackson and St. Louis City had rates of 142.8 and 179.5 respectively.

It is estimated that about two thirds of cancer deaths can be linked to tobacco use poor diet obesity and lack of exercise. The most significant of these behavorial factors and the one contributing greatest to the increase in cancer death in Missouri is smoking. New treatments have extended the life of some cancer patients. However a more effective approach to combating the disease is to practice healthy lifestyles which prevents its occurrence.

References: