Spikes and dips in cancer rates are not uncommon in public health statistics, but explaining why they occur and deciding what to do about them can often be as difficult as treating the disease itself. St. Louis Public Radio's Joseph Leahy takes a look at St. Louis County where the prostate cancer rate is unusually high.
“St. Louis County is very high and the question is why is that?”
Sixteen men join Bill Gurley on a recent winter night at the Second Baptist Church in the St. Louis suburb of Clayton.
Once a month, Gurley leads a prostate cancer support group meeting.
He’s has been an avid student of the disease since his diagnosis 13 years ago and become a guide for others in his community still finding their way.
Gurley says he’s not surprised how high incidences of prostate cancer are in St. Louis County.
“These anomalies show up all over the country for unknown reasons and as far as I know very little study has been done in most of them,” Gurley said.
According to a recent study, men in St. Louis County are significantly more likely to be diagnosed with prostate cancer than the rest of the state and the nation. The study, completed by the University of New England in December, finds the cancer’s incidence rate about 30 percent above Missouri’s average and almost 20 percent higher than the national average.
St. Louis County Health Department director Dolores Gunn says she’s troubled by the findings.
“St. Louis County is very high and the question is why is that?” Gunn said. “Is there something that’s going on because we’re diagnosing later? We don’t have access to care? Or, from a public health standpoint, is there something from that environment that’s putting us at risk for those high numbers?”
Not just anomalies
Dr. Ron Deprez, the study’s author, say higher screening rates in St. Louis County may be a factor – more men screened means more cases found – but he says that wouldn’t nearly account for why the county’s prostate cancer rate is so high.
“Good screening can do that, but it does level off after a while usually,” Deprez said.
The study finds that behavioral risk factors such as smoking, poor diets and sedentary lifestyles are actually below state and national averages.
Deprez says this would suggest that an answer explaining the high rates lies somewhere in the environment.
“When you see the size of the cancer rates – they’re not just anomalies,” Deprez said. “There’s something going on there – in my view. So, I think it should be followed up on.”
But investigating environmental factors that may be associated with the county’s unusually high prostate cancer rate will take time. Jamie Opsal, the Public Health Coordinator for the county’s health department, says responding to elevated cancer rates is more difficult than other public health concerns.
“There’s a difference between, like, the E. coli outbreak that we just experienced,” Opsal said. “That, we were on it right then. We got to it. We worked through our partners at the Missouri Department of Health and Senior Services and the Centers for Disease Control. And we worked night and day to figure out the source, where this is coming from?”
Prioritizing public health issues
With limited resources, however, Opsal says the county has to choose its public health priorities. And prostate cancer many not be the county’s top concern.
Though prostate cancer is the most common form of cancer in men, it is not the most deadly. In fact, while the incidence rate is high in St. Louis County, the study found the mortality rate for the disease is still about average.
Meanwhile, the county’s cancer statistics were part of a broader county health assessment, which revealed numerous other issues the county must address. For instance, breast cancer was also found to occur at a rate above the state's average. The report also recommends that diabetes and heart disease are issues the county should look into.
For these reasons, Opsal says the county health department can only do so much on its own.
“We alone cannot take care of all of the issues that were identified in this report,” Opsal said. “I don’t think any health department in the country could do that. If they could, we wouldn’t have these issues.”
Opsal says finding out what’s really going on will take further study and partnerships with groups like the American Cancer Society and Missouri’s Department of Health and Senior Services.
Above all, she says it will be up to the community to determine what its public health priorities are and what to do about them.