BERLIN, MD. -- When he was growing up in this Eastern Shore town, Jim Barrett remembers being struck by how many of his neighbors had cancer.
"You could go to every house on my street and someone had been treated for cancer or died from it," said Barrett, the Worcester County Commissioners president who has kept a file on the subject since the mid-1970s.
Barrett's concern is supported by recent data, which show, surprisingly, that the Delmarva Peninsula, an unspoiled land with little pollution or heavy industry that comprises Delaware as well as Maryland and Virginia's Eastern Shore areas, has one of the highest cancer mortality rates in the country.
For the past three years, Maryland and Delaware led the 48 other states in cancer mortality projections, according to the American Cancer Society. The 1990 projection for Maryland is 194 deaths from all types of cancers for every 100,000 residents and 190 deaths in Delaware. And the most recent Maryland data available from the National Cancer Institute show the Eastern Shore leading the state in mortality, with seven of the 10 highest-ranking counties.
This spring, for the first time, researchers are looking at some of the reasons.
"I've had many people come up to me . . . saying, 'My mother died of cancer, my sister died of cancer,' " said Doug Moore, health officer for two Eastern Shore counties. "It makes you want to get a grasp on it."
Those two counties, Worcester and Somerset, launched a joint study last month with Johns Hopkins University, the first of its kind on the Eastern Shore.
"It's surprising that the numbers are so high," said Worcester County Commissioner Reg Hancock, whose county includes Ocean City. "Obviously, the problem needs more attention that its been getting."
Karen Johnson, a resident at Johns Hopkins who is conducting the study, described it as the first in-depth look into cancer deaths in the area. The study will involve collecting data showing the actual number of cancer cases, then correlating that with behavioral information and with national data.
Residents of the region have long attributed the prevalence of cancer to a variety of factors, including heavy use of pesticides in the farming areas, a high water table, antiquated sewer systems, a lack of education about cancer and its prevention and exposure to the sun.
Allan Topham, of the Delaware Tumor Registry, a state-run group that collects data on the number of cancer cases, suggested that the overall cancer rate on Delmarva may not be higher than the national average but that the types of cancer here seem more deadly.
"We've noticed a high incidence of the most incurable types of cancer on Delmarva," he said. "Combine that with late diagnosis and in some cases, such as lung cancer, that means a death sentence."
Other health officials say the nature of the people on Delmarva could be a factor.
"People on the Eastern Shore are the nicest people in the world, but they're also a very tough people," said Andrejs Strauss, head of oncology at Peninsula General Hospital in Salisbury. "They're more inclined than people elsewhere to let things go when they have a pain."
Several experts cite the area's high water table, and they point out the correlation nationally between coastal locations and high cancer mortality. Seven of the top 10 states for cancer mortality have coastlines.
"The water on Delmarva is so high to the ground that contaminants seep into it and are held," said George Staples, an environmental engineer based in Salisbury. "Not enough attention has been given to the relationship between ground water and the cancer rate."
The greatest number of cancer deaths on Delmarva seem to be from lung cancer, according to several researchers and doctors, who added that the leading cause of this disease is smoking.
"A good deal of the cancer we see on the Eastern Shore appears to be smoking-related," Strauss said.
Georgetown University's Linda Pickle, a physician, calls Maryland a "cancer crossroads" for four types of the disease: lung, prostate, breast and large intestine cancers. The Eastern Shore, she added, has an unusually high incidence of prostate cancer.
Health officials said they also have seen a great deal of throat cancer, as well as pancreatic, bladder and brain cancers on Delmarva and added that on Virginia's Eastern Shore there seems to be a high incidence of bowel cancer.
Officials hope to glean a better understanding of the problems through a series of studies planned for Delmarva. Besides the research being done by Johns Hopkins, those studies include:The Delaware Tumor Registry is planning joint studies with Maryland to determine the major types of cancer on Delmarva and to develop better treatment programs.
In Talbot County, a new cancer center scheduled to open in August will participate in Eastern Shore and statewide studies.
The Lombardi Cancer Center at Georgetown University is planning to look at the unusually high prostate cancer rate among black males on the Eastern Shore. The study hinges on the outcome of another study for the District.
The Maryland Tumor Registry has been gathering information since 1982, and it will release a report a year from now that identifies the cluster areas.
Officials caution that it's too early to draw any conclusions about the disease in this area.
"The crude numbers appear high," said Boon Lim, administrator for environmental health programs for Maryland, "but there hasn't been a detailed study on the Eastern Shore. We don't have the data to make any general statements."
Researchers say the issue is complicated and that it will probably take years of research before a clear picture of the problem is pieced together.
"It's misleading at this point to say we're really that much higher," Moore said. "There are so many variables involved, so much potential for error . . . . That's why we're doing our study."
Officials also pointed out that mortality data that is raising concerns is based on death certificates, which are not a good indicator. Some states keep better records and sometimes deaths can be caused by a variety of factors, although cancer will be the listing on the death certificate.
The Worcester-Somerset study, which should be completed by the end of the summer, was a direct result of concern among community residents, according to Moore. "As health officer, I don't treat individuals so much as I treat the community. A lot of people had questions. It was my job to come up with some answers."
In recent years, that concern has seemed to increase, according to many officials.
George Hurley, a lifelong resident of the Ocean City area who serves as president of the Ocean City Council and has battled skin cancer, said he has noticed a change in the past 10 years. "I could sit here and name the people," he said. "It seems like in the last 10 years it's become almost a weekly occurrence to hear of someone who has developed cancer or succumbed."
.... PER 100,000 POPULATION ....
Eastern Shore ............. 251.2
Baltimore Metro ........... 222.5
Western Maryland .......... 206.8
Capital Area .............. 158.3
Southern Maryland ......... 152.9
State Average ............. 200.7
Based on mortality rates for 1987 released by the National Cancer Institute.