Feeding data on carcinoma cases into a computer is a fairly ghoulish form of bean counting. But the way Georgia Armenta Yee sees things, it's a good way to protect the public's health.
If only some cancer doctors would obey the law.
Yee is manager of the Arizona Cancer Registry, which is the Department of Health Service's fledgling computer bank of cancer cases that are diagnosed each year among Arizona residents.
The Arizona Cancer Registry, which is only one year old and is mandated by state law, will be a valuable public-health tool. The cases Yee collects from hospitals, doctors and outpatient clinics shed light on what races, sexes and age groups of Arizonans are at risk for getting certain kinds of cancers. The numbers also reveal who is getting to the doctor in time to be cured and who isn't. And in a few years, the registry should be able to red-flag geographical areas where abnormal "clusters" of certain kinds of cancer occur, such as the Maryvale leukemia cluster.
Problem is, Yee says, the state law has "no teeth" because it does not penalize doctors and hospitals who fail to follow the law by reporting the cancer cases.
And one group that reaps healthy profits treating cancer--the state's radiation oncologists--is refusing to follow the law by reporting its cancer cases to the state.
Result: The Arizona Cancer Registry is incomplete.
"I think it's kind of shameful," says Yee.
Especially since the cancer registry was legislated in the wake of the discovery of the Maryvale cancer cluster. From 1965 to 1986, children in that west Phoenix community died of leukemia twice as often as children in other parts of the country.
Beginning in 1983, state health officials knew about the Maryvale cancer cluster, but they failed to thoroughly investigate the tragedy.
In 1988, public outrage over the cancer cluster prompted legislators to pass the "mandatory reporting" law. It took state health officials and medical lobbyists another three years to hammer out the rules and regulations for the law. Because of this, the law didn't take effect until January 1992, when all hospitals, outpatient clinics and doctors were asked to report cancer cases.
In the end, the rules and regulations did not mention a single penalty for not obeying the law.
Tim Flood, the state epidemiologist who is Georgia Yee's boss, says this is because the legislature itself put no penalties into the law.
What it boils down to is that Flood and Yee have had to be extremely diplomatic in signing up hospitals and doctors. They've been remarkably successful so far with hospitals. Except for two hospitals--Vencor Hospital in Phoenix and Chandler Regional Hospital in Chandler--every hospital in the state is reporting newly diagnosed cancer cases.
Officials at Vencor and Chandler Regional both told New Times last week that they will report their cases soon. Both hospitals claim administrative staffing problems caused the delay. (They still have some time--the law allows six months after the end of the year to report cases. So 1992 data aren't technically late until June.)
"We want to participate and will participate," says Tom Jacobsen, chief operating officer of Chandler Regional Hospital. "We support this effort 100 percent."
This is not the attitude of Kent J. Rossman, M.D., president of the Arizona Radiation Oncology Society. Radiation oncologists are doctors who try to cure cancers by prescribing irradiation treatments. They sometimes treat patients who have not been diagnosed in either a hospital, an outpatient clinic or a pathology lab--institutions which are reporting their cases to the state. The radiation oncologists treat an important handful of patients who would otherwise slip through the cracks, Yee says.
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The radiation oncologists feel picked on.
"We oppose an arbitrary imposition of this law in a discriminatory manner," Rossman contended in a September 24, 1992, letter to Flood. "We find it difficult to understand how radiation oncologists can be singled out as the sole specialty, especially when we only see 30 to 40 percent of all cancer cases.
"Until we can be assured that we are part of an overall, comprehensive reporting requirement, we will delay our participation in the state registry. . . . If and when all physicians involved with cancer patients are required to report, we shall then implement these programs."
Rossman also asked the state for software to help ease the burden of the reporting, a request Yee says is "too expensive."
Rossman was on vacation last week and could not be reached for comment. After conferring with Rossman's partner, Burton Speiser, a secretary in Rossman's office said no one else could act as a spokesperson for the Arizona Radiation Oncology Society.
To Georgia Yee, the doctors' refusal to cooperate is "very frustrating."
It all goes back, she says, to the simple fact that there is "nothing put into the law that actually enforces it.