This is the fourth article in a series presenting the findings of Gloucester's recent Community Health Needs Assessment.

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Although some cancer rates in Gloucester are higher than in the rest of Massachusetts, many of these cancers are lifestyle related. These cancers are largely avoidable if good health habits are adopted.

"In this community, many of the cancers are due to behavioral causes," said Dr. Candace Thompson, a primary care physician at Cape Ann Medical Center. "We have increased rates of cancer, probably because of self-induced carcinogens such as tobacco and alcohol, as well as too much sun exposure, poor diets and a lack of exercise."

Cancer is the second leading cause of death across the country, and Gloucester follows the national trend regarding the types of malignancies most commonly diagnosed.

"We don't have something going on here that not happening elsewhere, which is good news, but not exciting news," Thompson said.

Prostate, lung and colorectal cancer are the top three cancers found in men, and breast, lung and colorectal cancer are the three leading diagnoses in women.

It is well known that most cases of lung cancer are caused by smoking, but many people don't realize that smoking is also a leading cause of colorectal cancer, the third most common cancer in both men and women. This is a slow growing cancer, Thompson said, but it is often not detected in time to cure it.

"It is such a preventable thing that it's a shame when someone dies of it," she said.

Since the last health survey was conducted in 1997, lung, breast and prostate cancer have decreased on Cape Ann, but instances of oral and cervical cancers have increased. Cervical cancer mostly strikes women ages 20 to 44, and although rates have risen, this disease can now be largely prevented with the new vaccine Gardisil. Up to 80 percent of cervical cancer is caused by the human papillomavirus (HPV), which is transmitted through unprotected sexual activity. Vaccinating girls and young women before they are sexually active will avert most cervical cancers. The remaining 20 percent of these cases are attributed to other factors, including smoking.

Prostate cancer is not known to be lifestyle-related, but its detection is associated with a lack of medical care, Thompson said. Early discovery and treatment are the only known preventative measures men can take at present, so a yearly digital rectal exam and PSA blood test are recommended.

Regular screening is also paramount to reduce deaths from breast cancer, Thompson continued, because the cause is probably "multi-factorial," although certain conditions, such as being overweight, smoking, eating a low-fiber diet and genetics are suspected to increase risk.

Thompson said that most people want to hear that cancer is caused by a single agent that they can avoid, but this is not usually the case.

Gloucester is detecting lower rates of breast cancer than other towns in the state, but it is being found in advanced stages so hospitalization rates are higher and treatment may not be as effective. Overall rates of mammography are also low, with "only about half of the women getting the mammograms that they should," Thompson said.

It is important for all women to schedule a yearly mammogram after age 40 and for those at higher risk to do so more often in consultation with their medical provider. There are free screening programs for women of limited means, and patients in Massachusetts can order their own mammograms, so "cost should not be a factor" in testing, Thompson said.

She also noted that only 10 percent of breast cancer cases are considered genetic in origin, so no woman should believe herself immune.

"I see a lot of women in their 50s who have never had a mammogram, and they come in with a lump (in their breast), when it could be too late." Late-stage breast cancer treatment is available, but those who seek early intervention usually have more options.

Early examination for colorectal cancer is also important, Thompson said, and needs to be accelerated to save more lives. Screening may involve either "stool cards" that test feces for blood, and flexible sigmoidoscopy or colonoscopy, both of which examine the lower intestine. Thompson also pointed out that "not everyone needs a colonoscopy. You can get stool cards from your doctor that will detect microscopic blood in your stool" and avoid the more invasive test.

There are fewer reliable screening tools on hand to spot lung cancer, since the effectiveness of chest X-rays and sputum tests have been disputed. But since this cancer has a clear root cause, smoking cessation is the recommendation, not better detection. Thompson said smoking has decreased since the last community health survey, but is still far too prevalent in Gloucester, especially among pregnant women.

This is not good news, since several other forms of cancer found locally are linked to smoking and alcohol consumption. Both pharyngeal (throat) and oral and facial cancers are more prevalent on Cape Ann than elsewhere in the state; pharyngeal cancer is related to smoking and drinking, and oral cancer is caused by tobacco use, including chewing. And when people are imbibing alcohol and using tobacco, healthful eating may also fall by the wayside, so other problems ensue.

"Poor nutrition combined with substance abuse and lack of medical care are a deadly combination," Thompson said.

Although smoking and drinking are responsible for certain cancers, the biggest risk factor is age, and those over age 55 comprise 76 percent of all cancer cases. As lifespans increase, so do cancer risks, because, "at some point, your body's cells will stop doing what they are supposed to do," Thompson said.

Because people are living longer and contracting cancer becomes more likely with age, it is important to seek regular medical care and schedule the appropriate screenings so cancer is detected early, when it can be arrested more effectively. Thompson urged families to establish a regular health care routine, and hopes parents talk to their children about the need for health maintenance, because "if it starts in the family, then it can start in the community." And since we are living longer, developing lifelong healthy eating and exercising habits becomes even more critical for reducing the risk of cancer.

Thompson acknowledged that the presence of poverty in Gloucester makes life challenging for many of its residents, and health care often suffers when finances are constrained.

"Poverty is reflected in a lot of these health issues, including a lack of regular medical help. People just don't have enough money or health insurance to get the tests sometimes," Thompson said.

The new Gloucester health clinic will help low-income residents access better health care more often, she believes.

"It's going to be great. A one-stop shop for children and adults that encompasses both physical and mental health."

Thompson said ongoing, inclusive discussions about health and working together to offer solutions is the key to reducing morbidity (illness) and mortality (death) from cancer.

"Gloucester is very active and concerned with improving community health," she pointed out. "From smoking cessation groups to free health screenings, we're always looking for input from the community."

For more information and to share your ideas about how to improve community health, contact the Gloucester Health Department at 978-281-9971 or by e-mail at healthdept@ci.gloucester.ma.us. Watch for additional articles in this column for a continuing discussion of other concerns noted in the Community Health Needs Assessment.

This article is part of a regular health education series provided by the Gloucester Health Department and Addison Gilbert Hospital.