Cancer Prevention in Rural America

“Prevention is a very important part of solving the problem of cancer” Eva Vertes

Sunday, December 1, 2024

Dear Mr. President, Honorable Members of Congress and Distinguished Staff and Fine Citizens,

It is certainly concerning that Cancer is the second leading cause of death in the U.S. Its costs at 88 billion dollars per year are a significant burden to our health care institutions for access and care, and even more so to our citizens burdened by the cost of that care. Surprisingly, it is our rural residents that have higher rates of some of the deadliest and most preventable cancers, such as lung, colorectal, and cervical cancer. Unfortunately, the rural areas are making less progress than urban areas to reduce the number of cancer cases and deaths in their communities.

Primary Barriers that are seen as promoting higher per capita rural cancer rates in these communities include a lack of: prevention education, screening opportunities, treatment opportunities, and survivorship groups. These challenges occur due to:

Less Access to Care: specifically cancer preventative care, screenings, and treatments that require a lot of appointments.
Higher risk Factors: Rural residents have higher percentages of important risk factors for cancer, like smoking and obesity.
Less Access to Behavioral Resources: In rural areas it is harder to access resources for quitting smoking, physical activity, and healthy eating
Financial Issues: The cost of getting cancer-preventing vaccines, such as the HPV vaccine, may be a problem for some rural residents
Cultural Differences: the stoicism and sense of hardiness present in rural cultures can make it less likely someone will seek preventative care.

There have been several strategies which have demonstrated success in reducing rural cancer rates which include:

Partnering with faith-based organizations to provide smoking cessation resources
CDC’s Tips from Former Smokers educational campaign. Credited with at least a half a million people giving up cigarettes.
Offering HPV vaccinations at lower out-of-pocket costs. Policies like the Federal Vaccines for Children Program have expanded access to multiple vaccines at a reduced out-of-pocket cost. Data clearly shows that reducing out of pocket costs by: paid for vaccinations, providing insurance coverage, or reducing copayments, increases vaccination rates in rural areas.
Promoting colorectal cancer stool tests. Colorectal cancer is the second leading cancer killer in U.S. adults. Unfortunately colonoscopies can be difficult for rural patients due to the requirements of a day for preparation, the challenge in getting access to a colonoscopy, and someone needed to drive the sedated patient home. Options include the stool test which can be done at home with a mail-in kit. The kits have been shown to raise screening rates.
Expanding patient transportation options. Unfortunately even after receiving a cancer diagnosis, rural residents are less likely to seek early-stage treatment and necessary follow-up care, resulting in a higher likelihood of death. Provider shortages in rural areas and lack of transportation play a key role in rural resident cancer deaths. A valuable program, State Rural Transit Assistance Programs (RTAPs) provide community leaders with workshops on, on-site-training, educational materials, and peer assistance to help them develop public non-emergency medical transit programs.
Rural Cancer Prevention Case Studies:
West Virginia: Southern Coalfields Tobacco Prevention Network. This network provides tobacco-use policy guidance and prevention programs to a network of schools in six county coalitions. Focus is on those who use tobacco the most, such as coal miners. They have a program “Spit It Out” offering cessation services for hundreds of smokeless tobacco users which has resulted in five workplaces going tobacco-free.
Nebraska: Accountable Care Organizations: ACO’s are networks of health care providers who share responsibility for providing patient care. They typically provide coordinated and high-quality care to their Medicare patients. In Nebraska a rural primary care ACO leveraged the incentives to promote colorectal cancer screening. They used electronic health records and team-based care providers to identify patients eligible for and in need of screening. They then made sure the patients completed the procedures. This promoted colorectal cancer screenings at lower costs.
Idaho: In rural Idaho, a clinic raised its colorectal cancer screening rates from 53% to 69% by: gathering baseline data; sending electronic and mail reminders to patients; using appointments and public health events to promote screenings; utilizing stool tests for patients without insurance coverage; and encouraging competition between clinic providers on their screening rates.
Georgia: Salud es Vida: Hispanic women have higher rates of cervical cancer than any other ethnic group in America. However they often lack Spanish-speaking health care providers. In rural Georgia the Salud es Vida (Health is Life) program targeted female Hispanic farmworkers. The program educated lay health workers (promotoras) about cervical cancer and HPV vaccine that can prevent it. After receiving the information, the promotoras became more willing to be screened, and then filled a critical gap by promoting screening and vaccines to others in their communities.

If we could promote and expand any or all of these great efforts to care for our fellow citizens, we will have the opportunity to make an enormous impact on the incidence of cancer and likely its outcomes to our diverse and needy rural communities.

Respectfully submitted,

Stepehen F Hightower MD FACP

fixingushealthcare.com

Copy to: We The People at fixingushealthcare.com

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