Running head: LUNG CANCER MORBIDITY RATES IN US: BALTIMORE CITY
Lung Cancer Morbidity Rates in US: Baltimore City vs Chicago
Group 3
Promise Okafor Amadi
Calandra Dyson
Lyliane Mbah
Monique Veney
Coppin State University
NURS 520 Epidemiology
Dr. Robin Warren-Dorsey
March 25, 2015
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LUNG CANCER MORBIDITY RATES IN US: BALTIMORE CITY
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Lung Cancer Morbidity Rates in US: Baltimore City vs Chicago
Tremendous advances in health care and technology have paved the way for a healthier,
longer living American population. According to CDC data, in the last 40 years alone since
1970, the life expectancy of the average United States citizen has risen 11% to 78.7 years from
70.8 years (Centers for Disease Control and Prevention [CDC], 2013). Although health
disparities and life expectancy differences still exist between races, the perspective seen is an
overall improvement in the nation’s health. However, despite living in an era in which we are
universally living longer than our fore parents could have even imagined, a significant portion of
the population are becoming sick from and dying from seemingly preventable illnesses such as
heart disease, diabetes and various types of cancers. The most recent available statistics from
2009 and 2010 list heart disease and malignant cancers as the leading causes of death among all
Americans of all ages and races. These top two diseases alone are accountable for nearly half of
all deaths combined (National Center for Health Statistics. [NCHS], 2013); however, the
remainder of this discussion will focus primarily on the morbidity associated with lung cancer,
particularly in Baltimore City, Maryland and Chicago, Illinois.
Lung cancer continues to be the leading cause of all cancer deaths in the United States of
America. According to the Centers for Disease Control and Prevention, in 2011, “207,339 people
in the United States were diagnosed with [morbidity] lung cancer, including 110,322 men and
97,017 women” and “156,953 people in the United States died from lung cancer [mortality],
including 86,736 men and 70,217 women” (Centers for Disease Control and Prevention: Lung
Cancer website, 2014, para. 1). Lung cancer is a disease in which cancer cells grow out of
control in the lung tissue. Lung cancers are usually grouped into two main types: small cell and
non-small cell. The categories refer to what the cancer cells look like under a microscopic
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examination. Non-small cell lung cancer is more common that small cell lung cancer (Centers
for Disease Control and Prevention [CDC], 2014).
The risk factors for lung cancer include smoking, second-hand smoke, radon, personal or family
history of lung cancer and radiation therapy to the chest. Smoking is the number one risk factor
for lung cancer. In the U.S., smoking is linked to 90% of lung cancers. Second hand smoke or
smoke inhalation from other people’s cigarettes, pipes or cigars also can cause lung cancer
(CDC, 2014). Radon is a naturally occurring gas that comes from rocks and dirt that gets trapped
in houses and buildings. Although this gas cannot be seen, tasted, or smelled, it also has been
linked to lung cancer. Asbestos fiber is another cause of lung cancer. This material contains a
silicate fiber that lines the lungs of the exposed person for almost the life time of the carrier. This
mode of infection is very common in work places where the substance is utilized to insulate
acoustic insulation and thermal pipes. In some parts of the United States the use of asbestos has
since been prohibited (CDC, 2014).
One factor that cannot been controlled, genetics or family history is also a risk factor for
developing lung cancer. Your risk for developing lung cancer may be higher if your parents,
brothers, sisters or children have had lung cancer. If you are a lung cancer survivor, there is a
risk that you may develop another lung cancer at another time. Additionally, cancer survivors
who have had radiation therapy to the chest are at a higher risk of lung cancer (CDC, 2014).
Identification of lung cancer usually depends on identification of symptoms and then
further diagnostic testing. Some symptoms of lung cancer include coughing that gets worse or
doesn’t go away, chest pain, shortness of breath, wheezing, coughing up blood, extreme fatigue
or feeling very tired all the time and unintentional weight loss (CDC, 2014). There are no
recommended screening intervals or protocols established for detecting lung cancer. However,
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the recommended screening test for lung cancer is low-dose computed tomography (low-dose
CT scan). This test is done by allowing an X-ray machine to scan body and using low doses of
radiation to take detailed pictures of the lungs. Candidates for screening include people who have
a history of heavy smoking, currently smoke or have quit smoking within the past 15 years and
are between 55 and 80 years old (CDC, 2014).
If lung cancer is diagnosed, testing is done to find out how far it has spread through the
lungs, lymph nodes and the rest of the body. Testing includes MRI, PET scan, CT scan,
radionuclide bone scan, pulmonary function test, endoscopic ultrasound, mediastinoscopy,
anterior mediastinotomy, lymph node biopsy and bone marrow aspiration and biopsy (National
Cancer Institute at the National Institutes of Health, 2014).
According to the American Lung Association (ALA), treatment approach will depend on
the type of lung cancer, stage of the cancer, other present health issues, and patient preferences
(ALA, 2015). The main treatment approach for either Non-Small Lung Cancer (NSCLC) or
Small Cell Lung Cancer (SCLC) will include; surgery, radiation, chemotherapy, and laser
therapy (2015). With surgical approach, the cancer cell or affected lobe or the entire lung maybe
removed (ALA, 2015). Radiation is usually done in combination with surgery or chemotherapy,
and in some cases both (ALA, 2015). Another approach for treatment is chemotherapy, which is
done to control the progression and spread of cancer (ALA, 2015). Other than the side effects of
chemotherapy, the main concern is that it only a small number of people can be cured with this
approach (ALA, 2015). With laser therapy, a highly focused beam of light is used to kill the
cancer cell (ALA, 2015).
Other treatment approaches specific for NSCLC includes: watchful waiting, targeted
therapy, photodynamic therapy, cryosurgery, and electrocautery (ALA, 2015). The doctor can
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watch the patient closely and treatment is initiated once the patient starts to show symptoms or
experience changes (ALA, 2015). Watchful waiting is used only in some rare cases of lung
cancer (ALA, 2015). In target therapy, medications such as a tyrosine kinase inhibitor are used to
block cancer cell growth (ALA, 2015). The photodynamic therapy consists of the use of
medicine and a particular light to treat the cancer (ALA, 2015). Cryosurgery will freeze and
destroy the lung tumor (ALA, 2015). The electrocautery approach uses a low-voltage electrical
charge to destroy the cancerous tumors (ALA, 2015).
Lung cancer has been a major killer and has constituted a heavy burden to United States
population and healthcare as a whole. The morbidity and mortality rates have declined, however,
in the last decade because of efforts made through awareness and education by the governmental
and advocacy agencies and authorities. Cigarette smoking is the major cause of lung cancer in
United States. People that smoke about 3 packs of cigarette per year have an increased risk of
getting lung cancer. The more packs you smoke, the higher the risk becomes. Passive smoking
is when you are exposed to and inhale cigarette smoke from the environment. Chances of getting
lung disease in this way is about 24%. Studies have shown that a lot of United States citizen have
died as result of second hand smoke inhalation. For this reason, various states have introduced
laws to protect citizens from this disease by introducing smoke free regulations in all public
places and about 50 feet away from public buildings (World Health Organization, 2003).
The burden associated with lung cancer disease not only includes morbidity, but also
encompasses mortality rate, loss of revenue in treating these patient and loss of income from the
family of the patient affected. This has a direct impact on national productivity figures, so much
so, that the federal government is spending enormous resources in combating its effects
including giving incentives to pharmaceutical companies and educating the public on the danger
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associated with smoking and second hand smoke (CDC, 2014). Notwithstanding, lung cancer
still poses a major concern for our nation as a whole as the number one cancer killer of all
Americans. For illustration purposes, a comparison of the effects of lung cancer morbidity in two
major U.S. urban cities Baltimore, MD and Chicago, IL, will be evaluated.
United States Census Bureau statistics from 2010, the last year available, lists the
population of Baltimore City at 620,961 down from 651,154 in the decade prior. Likewise, the
population of Chicago was noted to be 620, 961 in 2010, a 21% decline from more than 2 million
residents in 2000 population count (U.S. Census Bureau, 2000, 2010). Both Baltimore and
Chicago are considered to major urban metropolitan cities with similar population figures, as
recorded by the 2010 census. However, based on surveillance data obtained from both city health
departments, the morbidity rate from lung cancer in each city is remarkably different. While
Baltimore City carries an 823/100,000 residents or 0.82% lung cancer morbidity rate, Chicago’s
rate is 2.57% (2,572/100,000 residents) (Center for Disease Control, 2015Illinois Department of
Public Health, 2015). The difference between these two similarly populated cities is a staggering
31%.
Knowing the morbidity and mortality rates for specific disease processes, such as lung
cancer, in specific cities and regions of the country allows research and prevention efforts to be
geared or target toward those specific regions or populations. This in turn will ultimately help to
further eradicate fatal diseases, increase national productivity, decrease healthcare costs, increase
longevity and improve the nation’s overall health.
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References
American Lung Association (ALA), 2015. Lung cancer: Making Treatment decision. Retrieved
on March 18, 2015 from http://www.lung.org/lung-disease/lung-cancer/treating-lungcancer/preparing-for-treatment/making-treatment-decisions.html
Center for Cancer Surveillance and Control Maryland Department of Health and Mental
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http://phpa.dhmh.maryland.gov/cancer/SitePages/surv_data-reports.aspx
Centers for Disease Control and Prevention. (2013). How did cause of death contribute to racial
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Division of Cancer Prevention and Control, Centers for Disease Control and Prevention. (2014).
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What Screening Tests are There? Retrieved from
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Division of Cancer Prevention and Control, Centers for Disease Control and Prevention. (2014).
What are the Symptoms? Retrieved from
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0_DP_DPDP1&prodType=table
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United States Census Bureau. (2010). General Population and Housing Characteristics, Chicago.
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