Dying from cancer: Could where you live determine your fate?

Washingtonians in certain parts of the state are dying from cancer at higher rates than those in neighboring counties, according to a first-of-its kind analysis.

King County residents have a lower death rate for all cancers than people in Pierce and Snohomish counties, according to the study by the University of Washington’s Institute for Health Metrics and Evaluation.

And people in a handful of southwestern Washington counties tend to have higher death rates than the state and national averages.

Factors such as income, education, drinking, smoking and obesity appear to be the chief reasons for such disparities, said Dr. Ali Mokdad, the study’s lead author. Those disparities can be seen even within King County, Mokdad said.

“We in Seattle do fare better than almost every county in the state. But that’s masking disparities by neighborhood and area. Parts of South King County tend to smoke more, have more obesity and mortality is higher,” Mokdad said.

Published in the Journal of the American Medical Association (JAMA) on Tuesday, the study is the first to look at death rates for 29 types of cancer in all 3,100 U.S. counties over 35 years, Mokdad said.

In parts of the country that are relatively poor, and have higher rates of obesity and smoking, cancer death rates rose nearly 50 percent, while wealthier pockets of the country saw death rates fall by nearly half. Data was adjusted to account for age differences between counties.

Better screening and treatment have contributed to the improvement in the nation as a whole — but the study underscores that not all Americans have benefited from these advances.

From 1980 to 2014, the U.S. death rate per 100,000 people for all cancers combined dropped from about 240 to 192 — a 20 percent decline. More than 19 million Americans died from cancer during that time, the study found.

The picture was rosiest in Colorado ski country, where cancer deaths per 100,000 residents dropped by almost half, from 130 in 1980 to just 70 in 2014; and bleakest in some eastern Kentucky counties, where they soared by up to 45 percent.

“We all know this is unacceptable … in a country that spends more than anybody else on health,” Mokdad said.

[Check out the county-by-county map for cancer death rates. Above the map, click on the down arrow next to the “cause” tab and scroll down for the list of various types of cancer.]

The Affordable Care Act took effect in the study’s final years and has emphasized prevention services, including no-cost screenings for breast, colorectal and cervical cancers. Any resulting benefits wouldn’t be evident in the latest results, because cancer takes years to develop, Mokdad said.

It’s unknown whether similar coverage will be part of the replacement system the Trump administration and Congressional Republicans say they are seeking.

An editorial published with the study by Stephanie Wheeler, a University of North Carolina health-policy specialist and Dr. Ethan Basch, a University of North Carolina cancer specialist, notes that many areas with the highest cancer death rates also strongly supported Donald Trump, “raising hopes that future policies developed by the incoming administration will provide resources” for these communities.

Ahmedin Jemal, an American Cancer Society researcher, said better understanding variations in cancer death rates will help target cancer prevention and control.

Among the more striking disparities in Washington:

King County saw a 24 percent decline in overall cancer death rates from 1980-2014. But Cowlitz County in southwest Washington had an increase of 1.7 percent.

Grays Harbor County, another economically depressed southwest Washington county, had just a 1.9 percent decrease. The state average was a 15.6 percent decrease.

The survival rate for those diagnosed with testicular cancer is 95 percent, leading Mokdad to say, “No one should die from it.” In Washington, the death rate is lowest in King County, and among the lowest in other more urban counties such as Snohomish, Pierce and Clark.

But rural areas account for almost all of the Washington counties with testicular-cancer death rates above the state and national averages, with Walla Walla, Pend Oreille and Columbia counties faring the worse.

The difference between best and worst is likely from a combination of access to care through insurance and quality of care, according to Mokdad.

For breast cancer, all Washington counties saw at least a 16 percent decrease in deaths over the 35-year study period. And some rural counties such as Cowlitz and Grays Harbor did better than the state and national averages in percentage decline, perhaps because of improved education and preventive care.

But in terms of death rate, Cowlitz and Grays Harbor counties still rank among the worst in the state for breast cancer.

National disparities include:

•In counties with the highest 2014 cancer death rates, six of the top 10 were in eastern Kentucky. Six of the 10 lowest rates were in the Colorado Rockies.

•For lung-cancer deaths, four of the five counties with the highest 2014 rates were in eastern Kentucky, with rates up to 80 percent higher than in 1980. Three of the five counties with the lowest 2014 rates were in the Colorado Rockies, where rates dropped by up to 60 percent.

•Death rates for breast and colorectal cancers increased in Madison County, Miss., and in 2014 were at least five times higher there than in Summit County, Colo., where the rates fell. These are among cancers that can be successfully treated if detected early.

“We don’t want to forget that King County could do better,” Mokdad said. “Even if we are a top performer in our state, we’re not in the country.”