Cancer, not heart disease, is now leading cause of death in Oakland

Joe Goodman has lived in different parts of Oakland—mainly East and West—for most of his 64 years. He remembers moving with his mom from Phoenix, Arizona, to Oakland’s Fitchburg neighborhood in 1962. He remembers driving his cousin’s Chevrolet in circles outside the Coliseum in the weeks following its opening. He remembers when the air “didn’t seem too as bad to breathe in” when he was in his backyard or walking to a friend’s house. And, most importantly, Goodman says, he remembers his life before he was diagnosed with lung cancer.

“I’ve been thinking a lot lately about my life and memories, and unfortunately about how I could have gotten my bad lungs,” Goodman said. “I never did once smoke a cigarette in all my years—at least not that I can remember—and no one in my family has had cancer as far as I know. There’s been a lot of diabetes and strokes and Alzheimer’s, but I’ll be darned if I know of anyone in my immediate family who’s got cancer or died from it.”

Cancer has become the leading cause of death among residents in Alameda County, exceeding deaths from heart disease, according to county health department data released this spring. Lung, breast, prostate and colon cancers make up the majority of cancer deaths, and mortality rates in the county are highest among residents of East, West and North Oakland, as well as areas of Cherryland and Livermore in southern Alameda County. The American Cancer Society notes that 1 in 2 Californians born today will develop cancer during their lifetime, and 1 in 5 are expected to die of the disease.

But although cancer has supplanted heart disease as the county’s leading cause of death, since 2010, the number of cancer deaths in Alameda County has been decreasing. Data from 2012‐2016—the most recent to be published by the California Department of Public Health this year—notes that in Alameda County, there were 11,472 deaths from cancer for an overall average adjusted rate of 143.3 cancer deaths per 100,000 people.

That’s compared to the previous period of year 2006 to 2012, when the rate was 151.1 deaths per 100,000 people.

In Oakland specifically, lung and respiratory cancer deaths are the most common types of cancer leading to death, followed by prostate, breast and colon cancers. But the total number of deaths from nearly all kinds of cancers is going down. From 2000 to 2002, 2,123 cancer deaths were recorded in Oakland. From 2015 to 2017, that number dropped to 1,960.

Matt Beyers, an epidemiologist and geographic information system analyst at the Alameda County Health Department, said drops in heart disease deaths have contributed to a 1.5-year increase in life expectancy in Oakland. Additionally, the drop in cancer related deaths has led to an increase of 0.72 years in life expectancy.

“While we can see that cancer is now the leading cause of death in Alameda County and in Oakland, deaths from cancer are going down—heart disease has just reduced more,” he said.

County health department officials said they can’t pinpoint specific reasons why heart disease deaths are dropping locally, but information provided by the California Department of Public Health attributes statewide decreases in heart disease deaths to earlier detection of hypertension (a condition involving high blood pressure), tobacco-free initiatives and legislation aimed at making healthy eating easier.

Still, Tammy Lee, community epidemiologist at the Alameda County Health Department, said a person’s or family’s socioeconomic status is associated with differences in cancer incidence, diagnosis and mortality. “As neighborhood poverty increases, rates of cancer mortality—and many other health indicators—go up,” Lee said.

Being low-income or living in a poor neighborhood can mean increased chronic stress, poorer access to healthy foods, increased availability or targeted marketing of alcohol and tobacco products, greater barriers to physical activity, and increased or disproportionate exposure to carcinogens, Lee added. “All of this can increase cancer risk or cancer risk factors like obesity,” she said.

In East and West Oakland, residents are disproportionally burdened by poverty and inadequate access to quality health screening and care, according to the county health department. Research from the American Lung Association says this can further contribute to late cancer detection and fewer treatment options, meaning survival rates are lower than they could be.

While the association notes improvements in lung cancer incidence and death rates across the state, the group also notes that California lags behind other states in the number of accredited cancer screening centers, with especially low numbers available to those in lower income communities. The association ranks California 45th in the nation in screening center access.

But Goodman, who says he’s always visited his doctor regularly, said his mind “always goes back to the air and the environment—what kind of effect did that have on my cancer?”

When it comes to cancer, experts say it’s hard to pinpoint specific causes. It’s rarely possible to find the cause in an individual, said Alana Powell, a cancer researcher for the California Department of Public Health. But studies on groups of people with cancer show certain risk factors are associated with specific cancers, which suggests that different types probably have different causes. “Cancer formation is a multistep process,” Powell said. “For most cancers, the time from a cancer-causing exposure to a clinically diagnosable cancer will average around 20 years, but it could be shorter or longer for certain cancers.”

For example, exposure to tobacco (through smoking and secondhand smoke) and to radon (a colorless and odorless gas that can seep into homes and buildings) are the two leading causes of lung cancer in California, said Dr. David Tom Cooke, at the University of California, Davis Medical Center. Additionally, Cooke said, family histories of lung cancer are a factor when determining an individual’s risk or reason for developing cancer.

“Lung cancer secondary to tobacco exposure is often diagnosed at older ages,” Cooke said. “However, never smokers who develop lung cancer, often develop lung cancer at earlier ages, many times in their 30’s or 40’s, or even earlier.”

Environmental factors like air quality also likely play a significant role in California. The American Cancer Society of California cites toxic air contaminants as responsible for “most of the known airborne cancer risk in California,” according to the group’s website. Long-term exposures to some environmental pollutants likely increases the risk of cancer, according to the group’s studies, but through routes that have not been well studied yet.

But publications from the California Cancer Registry, a program of the California Department of Public Health’s that monitors cancer across the state, note that the percentage of cancers that can be attributed to the environment is “probably small,” with most geographic differences in cancer rates seeming to result “more from the differences between people than from anything in their physical surroundings.” Cigarette smoking is associated with more than 85 percent of all lung cancers in California, according to the group, as well as cancers of the bladder, mouth and throat, stomach and pancreas.

Diet is also a risk factor, with higher rates of cancers recorded in people who eat high-fat diets that are low in fresh fruits and vegetables. Powell says it’s estimated that diet and tobacco together may account for approximately two out of every three cancer deaths.

Esther Goolsby, community outreach director at East Oakland’s Community for a Better Environment, said part of her group’s mission is to help people become more aware of the risks to their health, especially environmental factors, which she says aren’t getting enough attention. “We’re always told that it’s our lifestyles and not pollution or what’s being put in the air that’s causing problems,” Goolsby said. “So, we’re still stuck with long term health effects.”

In Oakland, air quality is a hot topic and a point of contention for many environmental groups, Goolsby says. East and West Oakland are both target areas for air quality and reduction emission programs implemented by the Bay Area Air Quality management District and the California Air Resources Board, and new programs aimed at improving the air are slated to increase heart and lung health for residents in those areas.

“If you just imagined generations and generations of people—children playing in our parks in the neighborhoods—with all that’s in the air and the soil, our bodies are going to develop these diseases or these health problems, regardless of whether we have other diseases run in our family,” Goolsby said. “There’s still a lot of cancer in certain parts of Oakland, and we need to figure out what else we can do to fix that.”