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The good news: Louisiana’s cancer rate is generally in line with national figures, which continue to fall.

The bad news: More people die of cancer in Louisiana than in any other state. The human cost to individuals and families is staggering, as is the economic toll.

Cancers diagnosed in Louisianans tend to be more advanced those found in residents of other states. It’s a health-care truism that the sicker the patient, the more expensive they are to take care of—and the less likely they’ll pull through.

The National Institutes of Health put the total 2006 cost of cancer in the United States at $206.3 billion: $78.2 billion for direct medical costs, $17.9 billion in lost productivity because of illness and $110.2 billion in lost productivity because of premature death.

Precise economic statistics on Louisiana proved elusive, though there’s plenty of other chilling data.

For example, breast cancer among Louisiana’s black women isn’t much different than among black women nationally, though the mortality rate is 17% higher. White women in the state, even with a lower rate for all types of cancers than the national average, nevertheless died from cancer at a higher rate than nationally.

At a time when the state is trying to convince the rest of the world that it’s “open for business,” high mortality rates make Louisiana seem scary to outsiders: a third-world society with serious quality-of-life and health issues.

Louisiana’s high mortality goes against the national trend, in which survival rates for certain common cancers are way up. Early detection is the key to survival, but many Louisianans aren’t getting it. More than 23% of residents aged 19 to 64 lack health insurance, and Louisiana is largely rural. That combination means poor access to primary care, including regular cancer screening and education, which means a lot of people are dying unnecessarily.

Todd Stevens, president and CEO of Mary Bird Perkins Cancer Center, calls Louisiana’s cancer mortality rates “abysmal.” The results of limited access are exacerbated by cultural attitudes toward cancer, which Stevens points out encompasses roughly 100 different diseases.

“People are frankly are frightened by cancer,” he says. “They see it affect a lot of people. The assumption is that it’s a death sentence.”

What those people don’t realize is they have an excellent chance of surviving breast, colon and prostate cancer. But only recently has any real effort been made to change attitudes and do something about Louisiana’s tragically high cancer mortality rate.

In 2002, after decades of providing free cancer radiation therapy for those who couldn’t pay, Mary Bird Perkins created the CARE Network, which delivers free cancer support services, education and screening to uninsured and low-income people in 16 parishes in the Baton Rouge and Northshore regions of the state. The CARE Network handles those two regions as part of the nine-region Louisiana Cancer Control Partnership formed in 2004 and funded by the Centers for Disease Control.

The CARE Network works with Encore Plus, part of the YWCA, LSU Health Care Services, Our Lady of the Lake Regional Medical Center and Woman’s Hospital in offering free screenings. It also takes screenings on the road: Its flagship is a $400,000 mobile medical clinic, dubbed “Early Bird,” with three exam rooms, portable mammography units and screening equipment.

Stevens says the CARE Network has screened about 16,000 people since 2002. The American Cancer Society estimates 22,540 new cancer cases will be reported in Louisiana this year and that 9,550 people will die from cancer—more than 3,000 of them from lung cancer.

Now the state is attempting to deal with its cancer mortality problem instead of ignoring it. It’s a very steep hill. Stevens says success will require a cultural shift in which uninsured people begin to trust and take advantage of access to care.

“When people ask me how long it’s going to take, I tell them it’s a generational investment,” he says.

Access to treatment also has a long way to go. Stevens calls access “the weak link in the chain,” despite the thousands of doctors, clinics and hospitals around the state doing their best to make cancer care available to everyone. “The system doesn’t function well, and it’s difficult to navigate,” he says.

Patty Andrews with the Louisiana Tumor Registry, which collects cancer data from across the state used to guide prevention and control programs, says the state’s high mortality rate is due in part to the state’s historically high incidence of lung cancer. It was the most frequently diagnosed type of cancer among Louisiana residents between 1999 and 2003, followed closely by prostate cancer, according to registry data.

Andrews isn’t sure why Louisiana—with only a slightly more smokers per capita than the national average—has a much higher incidence of lung cancer.

“The difference in our smoking rates is 24% versus 22%,” she says. “In my mind, I don’t know that it accounts for the large incidence of lung cancer rates. Do we have a population that has more propensity to lung cancer and less ability to fight it off?”

Pancreatic cancer is also high in Louisiana and colon cancer is becoming a disproportionate problem, Andrews says, with the mortality rate among men on the rise, even with age-adjusted statistics.

The reason cancer rates are falling nationally can be explained by the trend toward healthier lifestyles—something that still hasn’t caught on among large numbers of Louisiana’s population. While the state tends to follow national cancer trends, it follows well behind, usually by a few years, Andrews says. Another disturbing facet is that women’s lung cancer mortality rates continue to climb. Men’s lung cancer mortality, while much higher than women’s, has been edging downward since the early 1990s.

Despite the gains, given the magnitude of Louisiana’s poverty and health care access issues, and the difficulty of changing cultural attitudes, the state’s cancer mortality issues seem as hard to budge as Poe’s raven.

“We do have an active cancer control partnership, which is trying to make available more screening programs,” Andrews says. “Nothing’s going to turn around fast, but we’re working on it.”