Cancer Registry Tracks Disease Afflicting 8,000 in County : Successful Program Voted by Legislature as Model for State

Words and numbers in red, blue and yellow hues glowed brightly on the computer screen while Deborah Woodward’s fingers skimmed across the keyboard, feeding the computer statistics about one of the estimated 8,000 people in Orange County who have cancer.

The patient’s name, address, type of cancer, method of diagnosis, treatment regimen, family history of cancer, alcohol use and smoking habits flowed into this computerized cancer registry operated by the Cancer Surveillance Program of Orange County. The 2-year-old program tracks cancer by occupation, geography and ethnic origins in an attempt to help health-care workers identify causes and risk factors linked to the disease.

This patient’s data will be updated annually for the rest of his life by Woodward, the surveillance program’s information specialist, or one of her 30 colleagues who work out of a maze of offices on the UC Irvine campus. CSP has proved so successful in tracking cancer cases that the state Legislature last summer voted to make Orange County’s program the model for a statewide tumor registry that will be phased in gradually in the rest of California over the next five years.

The program’s first batch of data is based on 4,823 cancer cases reported in Orange County in 1982. However, Hoda Anton-Guirgis, 43, who heads the surveillance program with co-director Dr. Dwight Culver, said that this represents just 75% of the county’s cancer cases for that year because the county’s 39 hospitals reported cancer cases to the program on a voluntary basis until last June, when the state’s Health Services Department made hospital reporting to the program mandatory.

Although the program, which operates on a $400,000 annual budget with funds from both private and public agencies, has been able to fully analyze data just for 1982, the tumor registry already has found that the pattern of cancer in Orange County differs in one significant way from the rest of the nation, Anton-Guirgis said.

Women make up only 31% of lung cancer cases in the United States, but in Orange County, the surveillance program has found that they account for 42% of this form of the disease. Lung cancer this year, according to American Cancer Society projections, will surpass breast cancer as the deadliest form of cancer among women in the United States.

This ominous development, Anton-Guirgis and other cancer investigators agree, is occurring as a delayed reaction to the entry of large numbers of women into the labor force beginning in World War II.

“Men smoked, and when women joined them in the work place, they began to smoke,” Anton-Guirgis said, noting that 75% of female lung cancer is linked to smoking.

Men, for whom lung cancer for years has been the deadliest form of cancer, started smoking in greater numbers earlier than women, studies show. Since it takes smokers 20 to 40 years to develop lung cancer, Anton-Guirgis said researchers had anticipated that during the ‘80s lung cancer would become the deadliest form of cancer among women. She expects the situation to worsen.

“We haven’t fit all the pieces of the puzzle together yet, but for some reason the number of women smoking is increasing faster than men,” Anton-Guirgis said. “Women are starting to smoke earlier, and they are smoking longer.”

She also is unsure why women make up a greater percentage of lung cancer cases in Orange County than in the rest of the nation. However, she said some studies suggest that the faster rise of two-career families in urban areas such as Orange County helps explain why lung cancer is higher here than in the nation as a whole.

Surveillance program manager Tom Kurosaki offered another explanation: “The higher socio-economic status of Orange County results in better medical care and more frequent and precise diagnosis of cancer than is the norm for the rest of the country. Orange County and San Francisco, which have similar socio-economic make-ups, have overall cancer rates of 382 and 383 per 100,000 people, respectively, while Detroit, which has suffered an economic downturn, only has a cancer rate of 308 per 100,000 people.”

Anton-Guirgis said she is deeply troubled that the number of teen-age girls smoking now exceeds the number of boys who smoke. Citing American Cancer Society figures, she said that while 1.6 million, or 10.7%, of boys between 13 and 17 smoke, 1.7 million, or 12.7%, of girls in the same age group are smokers. This is a sharp reversal from the ‘60s, when twice as many boys as girls smoked.

To combat teen smoking as part of the cancer surveillance prevention program, Anton-Guirgis, a professor of community and environmental medicine at UCI’s College of Medicine who holds a doctorate in epidemiology, gives talks at high schools. “I think the approach of some of these teen anti-smoking campaigns is wrong,” she said. “A lot of speakers try to scare kids into not smoking--or stopping--by telling them that smoking causes lung cancer.

‘Turns Off the Kids

“This just turns off the kids because it doesn’t offer any solution or hope. For the teens who’re already smoking, their attitude is: ‘Why should I stop since I’m going to die anyway?’

“In my talks I emphasize to young people that if they stop smoking now, the risk of their developing lung cancer is no greater than if they’d never smoked. Studies clearly show that if you’ve smoked for less than five years--and stop smoking--after five years of being cigarette-free, your risk of developing lung cancer is the same as if you’d never smoked.”

Within Orange County, Anton-Guirgis said the most striking surveillance programfinding is the unusually large number of Latino women with cancer of the cervix. While cancer of female reproductive organs accounts for 14% of all cancer in the county, Latino women constitute a disproportionately large 41% of these cases.

This high rate, Anton-Guirgis said, is linked to the large number of cervical cancer cases among Latinos. Cervical cancer accounted for 71% of reproductive organ cancer among Latino women, but only 37% of such cases among other ethnic groups.

“My speculation is that Hispanic women actually have a higher degree of risk factors associated with cancer of the cervix, or we’re not getting them to go to clinics for routine PAP smears and educational programs,” Anton-Guirgis said.

Anton-Guirgis hopes that in years to come data from the surveillance program will provide links explaining the high rates of lung cancer among women and cervical cancer among Latino women.

The demand for registries to monitor cancer trends has grown with the advent of improved treatments--and survival rates--for certain forms of cancer, Anton-Guirgis explained.

Older Registries

Six other California counties, including Los Angeles, have cancer registries older than Orange County’s, said Dr. Donald Austin, chief of both the state Health Services Department’s cancer prevention program and the California Tumor Registry.

However, Austin said the Orange County program was chosen as the model for the California Tumor Registry because, unlike the older cancer registries, the Cancer Surveillance Program has developed a computer system compatible with those of both the National Cancer Institute and the American College of Surgeons--the two national cancer registries in the United States. The program thus avoids skewing cancer data by missing--or duplicating--reported cancer cases, Austin explained during a telephone interview from his Berkeley office.

Cancer registries, with their abundance of information that promises to shed light on cancer causes and effects, are coming into vogue, Anton-Guirgis said, because she and many other scientists have come to believe not only that there is no single cause for any particular form of cancer but also that it’s unlikely a single cure will be discovered.

“Cancer registries are the only way we can find out scientifically which forms of treatment are most effective in increasing cancer survival rates and improving the cancer victim’s quality of life,” said Anton-Guirgis.

“I believe that lung cancer, for example, is caused by a number of factors such as smoking, occupation, age, stress and nutrition,” said Anton-Guirgis. “Therefore, the more profiles of patients’ life styles we can develop using cancer registries like the Cancer Surveillance Program, the more likely we are to uncover these multiple causes and the best cancer treatments.

Timely Information

“This way, you can apply what you learn while the victim’s still alive; you’re no longer waiting until he or she is dead and then applying this knowledge just for research that someday might help others who develop cancer.

“This approach helps not only the victim and his or her family--especially if it’s a genetic-related cancer--it also helps the general public. The earlier cancer patterns are detected, the sooner we can start prevention programs--such as stepping up cancer screening and testing--for others in these high-risk groups.”

After the surveillance program has gathered more information over the next few years on the incidence of cancer in different geographical areas of the county, Anton-Guirgis hopes she will also be able to answer the nagging questions some residents have about whether living near hazardous waste dumps increases their chances of getting cancer.

“I’ve received calls,” Anton-Guirgis recalled, “where people have told me: ‘Five people in my church have gotten cancer recently. I think it’s because of the toxic waste site near our neighborhood.’

“I can’t tell them whether this is an unusual cancer rate; until CSP started, there was no countywide tracking of the incidence of cancer by geographic area. It will take another three or four years of solid data collection before we can determine if there are some areas of the county that have higher cancer rates than others.”