One of the deadliest forms of cancer for Nebraskans is also one of the most difficult to recognize.

Today is World Pancreatic Cancer Day as activists hope to raise awareness and raise the odds of survival.

Wendi Cihacek, with the Pancreatic Cancer Action Network, says the symptoms can be extremely vague.

Cihacek says, “It can include abdominal pain, mid-back pain, unexplained weight loss, jaundice, loss of appetite, indigestion, changes in stool or new onset diabetes.”

Since the symptoms are so basic, people who are hit by this type of cancer usually lose the fight nine times out of ten, as it can advance quickly and quietly, remaining undetected.

“You kind of have to be your own advocate in the aspect of being diligent in knowing the symptoms,” Cihacek says. “If you have a family history of pancreatic cancer or pancreatitis or diabetes, it could increase your risk of getting pancreatic cancer.” Other risk factors include diet, age, smoking and obesity.

Cihacek got involved in advocating for pancreatic cancer awareness in 2006 after losing her brother-in-law to the disease. Each year, around 300 Nebraskans are diagnosed with pancreatic cancer and some 260 die from it, the state’s number-three cancer killer behind lung and colon cancer.

“It’s one of the nation’s deadliest with a five-year survival rate of just 9%,” Cihacek says. “It’s the third-leading cause of cancer death in the United States and it’s expected to become the second-leading cause of cancer death by 2020.”

One goal is to double the survival rate by 2020, which she says is possible through more research, clinical initiatives, patient services and advocacy year-round.

A new national report card on premature births gives Nebraska a letter grade of “C” as nearly 10% of births in the state are early, which is very close to the national average.

Stacey Stewart, president of the March of Dimes, says while Nebraska’s numbers are improving, they’re still unacceptably high.

“When babies are born prematurely, that means their health is really threatened at the time of birth and often these are babies that grow into children and young adults who experience health challenges down the road,” Stewart says. “In fact, prematurity and the consequences of prematurity are the leading causes of death for children between the ages of zero and five and it’s the leading cause of infant mortality.”

There’s an “alarming trend” in the U-S of babies being born too soon, according to Stewart. The preterm birth rate rose for the third year in a row, a trend signaling an urgent health crisis for moms and babies.

More than 700 American women die in childbirth each year and some 50,000 suffer life-threatening complications, making the U.S. the most dangerous developed country in which to give birth.

Stewart says, “If we look at all of these outcomes around moms and babies, what we’re finding in the U.S. is that we have unacceptably high outcomes, especially for the wealthiest country in the world, and especially given the sophistication of our health care system.”

This is the 11th year the March of Dimes is releasing the annual Premature Birth Report Card, which grades all 50 states on their rates of preterm birth and reveals racial, ethnic and geographic disparities within each state.

In Nebraska, the preterm birth rate among black women is 40% higher than the rate among all other women.

“We need to make sure we do even more to make sure there’s expanded health care coverage for women, that there’s accessability of that coverage for those women wherever they live,” Stewart says. “Even if they live in rural areas, that shouldn’t mean that they have to be denied the health care coverage they need, especially the prenatal care that they may need.”

To encourage supporters to raise awareness and advocate for policies that protect moms and babies, the March of Dimes launched a nationwide campaign called #BlanketChange. It aims to bring attention to the urgent health crises moms and babies face, including increased rates of maternal mortality and preterm birth.

Nebraska was among 16 states that got “C” grades. There were 15 “Bs”, 14 “Ds”, just one “A” for Vermont, and four “F” grades, for Alabama, Louisiana, Mississippi and West Virginia.

Almost two-thirds of Nebraska’s counties are considered “maternal care deserts” in a new national report.

Stacey Stewart, president of the March of Dimes, says 61 of Nebraska’s 93 counties are critically lacking when it comes to health care specifically for pregnancy.

Stewart says women in those counties are at greater risk of complications from childbirth, including the death of the mother, the baby or both.

“A maternal care desert is a county that lacks even the basic obstetrics services to help mothers safely deliver their babies,” Stewart says. “The county will not have even one hospital that offers obstetrics services and also not have any OBGYN or certified nurse midwife.”

She says Nebraska’s numbers are “startling” as nearly 66% of the state’s counties are ill-equipped. Nationwide, about 35% of all counties fall into the maternal care desert category and Stewart says a majority of them are rural counties.

“About 20% of all the women who live in maternal care deserts actually live in urban and metropolitan areas,” Stewart says. “It doesn’t mean that just because you live in an urban area, all of the sudden you’ve got all the resources available to you that you need.”

More than 700 American women die in childbirth each year and some 50,000 suffer life-threatening complications, making the U.S. the most dangerous developed country in which to give birth.

Women of color are most at risk of facing complications, and black women are more than three times as likely as white women to die from pregnancy-related causes.

“We have in the U.S. some of the worst rates of maternal mortality in the world,” Stewart says. “Our rates of maternal mortality have doubled over the past 25 years. What it means is that women are dying at higher rates as result of pregnancy and childbirth as compared to women in other developed countries around the world and that simply is unacceptable.”

The March of Dimes is launching #BlanketChange, a social and video advocacy campaign focused on the iconic receiving blankets used to swaddle nearly every newborn baby.

The following 61 Nebraska counties are listed as maternal care deserts:

Antelope, Arthur, Banner, Blaine, Boone, Box Butte, Boyd, Brown, Burt, Butler, Cedar, Cherry, Clay, Colfax, Dakota, Dawes, Deuel, Dixon, Dundy, Franklin, Frontier, Garden, Garfield, Gosper, Grant, Greeley, Harlan, Hayes, Hitchcock, Hooker, Howard, Johnson, Keith, Keya Paha, Kimball, Logan, Loup, McPherson, Merrick, Morrill, Nance, Nemaha, Pawnee, Perkins, Phelps, Pierce, Red Willow, Rock, Saline, Saunders, Seward, Sheridan, Sherman, Sioux, Stanton, Thayer, Thomas, Valley, Washington, Webster and Wheeler.