That is the conclusion of the South Carolina Cancer Alliance in its first "Cancer Report Card," released Friday. The alliance gave the state an "A" because people here are less likely to develop cancer but an "F" because the rate of death in South Carolina is much higher than the national average.

"Something is not right," said Gailya Walter, who worked on the report card for the Columbia-based alliance.

One likely reason for the higher death rate: many South Carolinians don't have their cancer detected until it's too late. The report indicates the state's prevention and screening efforts need improvement.

According to the report, 8,320 South Carolinians died of cancer in 2002, the year studied.

"I would have to presume that many of those were unnecessary," said Dr. Terry Day, an oral surgeon at the Medical University of South Carolina and chairman of the alliance. "Many could have been prevented."

Those people, he said, could have been diagnosed and treated without significant complications.

The alliance is a nonprofit group made up of doctors, hospitals, other businesses, patient advocates and the government. It is dedicated to reducing cancer and is developing a five-year "Cancer Control Plan" for South Carolina.

The plan, funded in part through a $300,000 two-year federal grant, will deliver recommendations on how the government can work with communities, health care organizations, businesses and individuals do to reduce cancer. It is expected to be published in June.

The report card grades South Carolina's incidence and death rates for 19 cancers based on a comparison with national averages. It is designed to provide the alliance with a baseline of information to compare how well the plan performs.

"We can now begin to implement programs across the state and track the success of our efforts," said Jenny Sanford, wife of Gov. Mark Sanford and a member of the alliance.

Perhaps the first area to target: tobacco use.

By far the biggest killer was lung cancer, which accounted for 30 percent of all cancer deaths in the state in 2002. The report card gave the state failing marks for the number of people with the disease and the death rate.

Figuring out why is simple: More than a quarter of the state's residents smoke, and more than a third of young adults reported that they had a cigarette at least once in the past 30 days.

Nearly 90 percent of lung cancer is caused by smoking or secondhand smoke.

It's not just lung cancer, either. South Carolina also received failing marks for esophageal cancer, oral cancer and pancreatic cancer, in both the number of people with the diseases and death rates. All three are among the many cancers in which tobacco use can be a contributing factor.

"Smoking seems to be a major factor in causing cancer in our state as well as other problems," Day said.

Even so, the number of new cancer cases in this state is lower than the national average. The alliance gave the state "A" marks for a variety of different cancers, including bladder, brain, breast, leukemia, liver, Non-Hodgkin's lymphoma and uterine.

Day could not explain why the rate of cancer here is less than elsewhere. Even so, he said the cancer rate here is hardly good news: The report card compares cancer incidence with the rest of the nation, and cancer is a big killer everywhere.

"It still remains a major health problem for our state, not only in death rates and physical problems, but also financially," he said. "The financial effect on health care is significant."

The death rate in the state may stem from the fact that a lot of the state's population is poor and that many people live in rural areas

"There are many rural areas of the state, and those people have less access" to health care, said Dr. Carol Sherman, medical director at the Hollings Cancer Center at MUSC.

Also, nearly 30 percent of South Carolinians are black, a segment of the population that has traditionally struggled to gain access to health care services.

The state has a particular problem with prostate cancer, for instance. It was the most common cancer diagnosed among men in the state in 2000, and black men have the highest rate of prostate cancer in the world.

South Carolina has the nation's third-highest rate of prostate cancer mortality.

Breast cancer, meantime, is the second-leading cancer killer among women, causing 627 deaths in 2002. Black women were less likely to get the disease than white women, according to the report card, but they were more likely to die from it.

"We do know that in a number of cancers, African-American patients are diagnosed with more advanced cancer than the non-African-American population," Day said. "We're worried that it could be due to access."

According to the Kaiser Family Foundation, a nonprofit that tracks health care trends, South Carolina's cancer death rate is the 13th highest in the nation.

The national cancer mortality rate is 195.6 deaths per 100,000 people. In South Carolina, that ratio is 206.8 deaths per 100,000.

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