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A dreaded diagnosis
By JIM ROSS and ALEX LEARY © St. Petersburg Times, published May 20, 2001
It affects everyone. Either you have it, someone you love has it or someone you know died because of it. Don't fit into those categories? There's no escaping this one: Everyone fears cancer, and with good reason. Two of every five Floridians will contract the disease during their lifetime. Some 40,000 in the state will die of cancer this year. That's about 109 people per day. In 1999, the latest year for which statistics are available, doctors diagnosed 935 new cancer cases in Citrus. That same year, the disease killed 447 county residents. About 115,000 people called Citrus their home that year. Similar statistics are recorded each year, meaning there are several thousand people here living with -- or dying from -- cancer. Add to that the family, friends and co-workers who know these people, and the cumulative effect is profound.
For statistical comparison, consider that Hernando County, which has a slightly larger population, registered 1,306 new cancer cases in 1999 and 523 cancer deaths. In Broward County, there were 8,460 new cases and 3,650 cancer deaths during 1999. Cancers of the prostate, lung and breast are among the forms most common in Citrus. In 1998, for example, doctors found 131 new breast cancer cases, 193 new lung cancers and 134 prostate cancers. The county's sizable retiree population, those 55 and older, accounts for 90 percent of the new cases and 91 percent of the deaths, statistics show. Those people may have brought their disease with them when they moved from a northern state or somewhere else in Florida. Perhaps they started smoking before the health risks were well known. Perhaps they were exposed to a cancer-causing element in their hometown. Some knew they were sick when they came; others found out long after establishing a Citrus County address. The upward trend is also driven by advancements in health care. New drugs and technologies have enabled people to live longer and, consequently, contract cancer.
"People are living beyond their heart attacks," observed Dr. Timothy Brant, a radiation oncologist in Lecanto. "They have their bypasses and they live long enough to develop cancer." But the elderly aren't the only ones caught in cancer's web. Statistics show that cancer has kept pace as the county has grown, and the disease afflicts people of all ages and walks of life. It is everywhere, if only we stop to look. Its human touch is pervasive, hurting victims' relatives, friends, even casual acquaintances. Cancer kills dreams, gives false hope, snuffs it out. "Your life can change in 24 hours," said Kathy Pedreira. Her husband, Leonard, was diagnosed with low-grade non-Hodgkin's lymphoma shortly before they moved to Beverly Hills from Beaver, Pa. He died in December at age 62.
When those efforts fail, there is an entirely different group that helps spot cancer, track it, treat it, get rid of it, help people deal with it, and ultimately, help people as they die from it. Cancer's capacity to inspire can't be overstated. Look no further than the Relay for Life, which brings together hundreds of survivors and their supporters to walk through the night and help the American Cancer Society raise money. Or look at young Jacqueline Dixon of Homosassa, who battled and beat leukemia before she entered second grade. During the next two days, the Citrus Times will explore cancer's strong, silent hold on this county. It is a story that could be told anywhere, since cancer knows no geographic bounds. It is a medical story and it is a business story. Mostly, it is a human story. * * * Cancer: A general term frequently used to indicate any of various types of malignant neoplasms, most of which invade surrounding tissues, may metastasize to several sites, and are likely to cause death of the patient unless adequately treated. That's what Stedman's Medical Dictionary says about cancer. When the reference book entry becomes human reality, those words only hint at the word's true definition. "The most frightening thing that can happen to anyone is to be told they have cancer," said Ted Malysz, 74, of Beverly Hills, who has beaten prostate cancer and managed to remain remarkably upbeat in the process. "My husband was worried silly," said Marie Conrad, 80, of Sugarmill Woods, whose breast cancer diagnosis came in March 1996. She had a lumpectomy and radiation treatment; the cancer is in remission. Reactions vary. Some people become the intellectual equivalent of a sponge, seeking to soak up information about cancer and treatment. Others shut down and depend on a loved one to help develop a game plan. Dr. V. Upender Rao has witnessed all those reactions and more. "They all have an impact on your life," he said. Rao is a cancer pioneer in Citrus. He has treated patients since 1982. He practices at the Cancer and Blood Disease Center, an imposing building that sits high on a hill above County Road 491. He dedicated the facility to his mother, Ahalya, who succumbed to cancer in 1980. A Citrus Hills tennis tournament, the proceeds from which go toward fighting cancer, also bears her name. Rao planned to become a cardiologist, but the intellectual challenge of oncology and hematology was too strong. "It takes you to a different dimension of medicine that most clinicians don't think of, or don't need to," he said. His story is not uncommon among the many doctors and health professionals who fight the good fight against cancer. They share a passion for patients and a compassion for the suffering that cancer visits upon them. Citrus has grown a lot since Rao established his practice, and the medical field has followed suit. Nowhere is that more evident than in the field of cancer treatment, where patients have much of the latest technology at their disposal. Still, some patients seek treatment, or a second opinion or surgery, outside Citrus. For example, 370 Citrus patients received treatment, surgery or at least a second opinion at the H. Lee Moffitt Cancer Center & Research Institute in Tampa during the first six months of this fiscal year. Homosassa resident John Barnes, 58, was one such patient. In January 2000, his Citrus County doctor told him he suffered from cancer and needed a kidney and surrounding lymph nodes removed. Dr. Albert Boholst recommended Barnes go to Moffitt. Barnes didn't necessarily want to go out of county. But he received excellent care in Tampa. "By the time I got out of there, I was tickled," he said. He also felt quite at home, having seen several Citrus residents who were at Moffitt for cancer treatment or followup care. Among the familiar faces were Walt Connors, the former court clerk and downtown Inverness business owner. There are myriad treatment options for cancer, from chemotherapy to radiation to surgery to drug regimens. These therapies often have serious side effects: hair loss, fatigue, nausea and worse. Some patients keep a brave face and manage to function in society. Leonard Pedreira volunteered in schools and continued to drive a car until days before he died. Others don't fare nearly as well, as the fight reduces them to shells of their former selves. "It got to the point where I actually prayed to God to take him," said 68-year-old Janice Mitchell of Holder, who lost her husband, Kenneth, to cancer in January. "When you watch someone die a little bit each day, that's rough. When he passed away, I was so thankful because he wasn't in pain and he didn't have to take all those drugs." Mrs. Mitchell said she would have never made it without help. In those tragic cases when cancer's grip is too tight, Hospice of Citrus County often becomes involved. "What we provide a lot of times is hope and dignity and an opportunity for a family to find some meaning in what can be a very frightening time," said hospice official Denise Tobin. In the past 15 years, hospice has helped thousands of people make the most of their last days. The organization helps plan funerals, subsidizes medication -- the average monthly bill is $22,000 -- and provides counseling to those about to lose a friend, partner, parent, source of income. The costs of cancer are staggering, but insurance often picks up most of the expense. For the uninsured, however, the effect is often insurmountable. Consider Wright, the Homosassa Springs woman who learned she had breast cancer in November. She lost her job and, by extension, her health care, two months earlier and now faces $20,000 in bills for a mastectomy and chemotherapy. Wright has been turned down by Medicaid, the government program for the poor, because she holds a college degree and, at age 57, can still work. But her doctor says she is not ready to return full time. Meanwhile, the hospitals are threatening to submit her to a collection agency. "If I had $20,000, I would give it to them," she said. "But I don't have it. I don't have $10,000, I don't have $5,000, I don't have $100." * * * Citrus County doesn't have any "hot spots" or "cancer clusters," as they are sometimes called, according to Marybeth Nayfield, who leads the county Health Department. In other words, people who live in a particular area don't have increased risk of getting the disease. Rather, the risk factors are more commonly known: age, family history, lifestyle choices and so on. "The key is to have appropriate screening. I think people get blase about it," Nayfield said, echoing a common refrain in the medical community. "Families and businesses throughout Florida are touched by this disease every day," said Don Webster, chief executive officer of the American Cancer Society in Florida, in a prepared statement. His agency publishes a chill-inducing list of statistics. One of every four Florida deaths is linked to cancer. Lung cancer is the state's No. 1 killer. Every year, 600 children and teens statewide contract cancer. In Citrus County, three people younger than 19 were diagnosed with cancer in 1999. Still, there is cause for optimism. Two-thirds of cancer deaths can be prevented by lifestyle changes, including diet and smoking, the American Cancer Society has reported. Anti-tobacco campaigns have showed people the link between cigarette smoking and lung cancer -- though doctors say young women do not seem to be heeding the warning -- and various medical and government groups are spreading the word about proper diet and exercise. Mammograms have helped catch breast cancer sooner and increased the chances of recovery. Prostate specific antigen testing, or PSA, which caught on in the late 1980s, has done the same for men. "In almost all the areas there is more awareness and patient information. People are seeking medical attention," Dr. Rao said. Although cancer cases continue to increase in Citrus, the National Cancer Institute reports that, between 1990 and 1997, the rate of new cancer cases nationwide declined nearly 1 percent. Meanwhile, the medical community is responding with better treatments. This month, for example, the federal Food and Drug Administration approved use of the drug Gleevec for treating chronic myelogenous leukemia, one of the four main types of that blood cancer. Researchers also said the drug can benefit people who suffer from a form of intestinal cancer called gastrointestinal stromal tumor, or GIST. But until researchers discover a cure, fear will always trump optimism. "It is a fact of life," Rao said of the suffering he sees. "It's a reality."
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Citrus Times |
"It's like living with an ax over your head," said Stephanie Wright, 57, of Homosassa Springs, who was diagnosed with breast cancer in November.
Meanwhile, education programs and better screening techniques have netted new cases of prostate and breast cancer that might not have been diagnosed until it was too late, if at all.
