Opinion: Early detection is the best defense

Published: 5/27/2023 7:00:27 AM
Modified: 5/27/2023 7:00:03 AM

Andy Lowe is the executive director of the New England Rural Health Association and holds a faculty appointment at the University of Massachusetts Chan Medical School Department of Family Medicine and Community Health.

Cancer is the leading cause of death in New Hampshire. By the close of the year, the American Cancer Society estimates that nearly 3,000 of our loved ones and neighbors will have died of the disease. Another 10,000 or so will learn of their diagnosis for the first time.

For some readers, these statistics are not new, or perhaps even surprising. Cancer, many of us feel, is a hidden enemy lying in wait, ready to pounce unexpectedly on even the healthiest among us. For our most vulnerable populations, especially the 47% of our residents living in rural communities where healthcare access can be a challenge, the outlook is even dimmer.

As the executive director of the New England Rural Health Association, a non-profit organization dedicated to improving the health and wellness of rural communities across New England, I would like to offer a different perspective by sharing some recent heartening news from the oncology world. But before I do that, it’s important to understand why, when it comes to fighting cancer, it turns out that early detection is the best defense.

Cancer is a disease that, if caught in time, affords a host of treatment options for patients and the clinicians who care for them. For most cancers, five-year survival rates are close to 90% if caught early. Cancer screening methods such as pap smears, colonoscopies, mammograms, and so on, are so effective that they have become a routine part of preventive primary care.

Some screenings, however, do have limitations, such as the type of cancers they can detect. Unfortunately, the vast majority of cancer deaths in New Hampshire result from those types for which we lack early detection. The good news is that new cancer screening technologies are on the horizon. These technologies could significantly expand the current number of cancers that can be detected via screening from five, currently, to dozens more including pancreatic, liver, and cancers of the head and neck.

By analyzing a sample of a patient’s blood, doctors are able to detect cancer signals that identify the kind of cancer a patient might have and where it may be located in the body, all before symptoms even start. Never in our history have physicians had the ability to screen for such a wide range of cancers. That this revolution in care is just around the corner should have us all excited.

However, advances in medical science are just part of the solution. What remains now is solving the issue of accessibility. A recent report by the National Grange highlights this challenge. In addition to being older, poorer, and sicker in general than their urban counterparts, rural citizens all over the country have overall higher cancer incidence rates and late-stage diagnoses compared to non-rural populations.

Mortality rates are also higher, and the disparity between rural and urban areas is getting worse. The reasons for these disparities are varied, but the commonalities of poverty, lack of insurance coverage, lack of access to healthcare providers, and age are recurring themes for rural populations.

The coming multi-cancer early detection technologies, or MCED, as these new tests are known, promise to address some of these disparities, particularly for convenient access to screening. Blood samples can be drawn quickly and easily at small clinics or mobile units and then sent to larger labs with the sophisticated equipment needed for analysis.

Ensuring those who could benefit most from these tests will be able to get them is another matter. Effective policies and regulations will need to be crafted at the federal and state levels to enable equitable access to MCED for all people regardless of geographic location or insurance status.

I’m pleased that over 300 members of Congress, including every member from New Hampshire’s delegation, supported federal legislation last year that updates our national Medicare program to provide a pathway to cover cutting-edge screenings for seniors. This legislation gained incredible momentum in a short time.

Now, the current session of Congress has another opportunity to pass the Nancy Gardner Sewell Medicare Multi-Cancer Early Detection Screening Coverage Act (H.R. 2407). With your help in calling attention to this important issue, we hope to raise the necessary support once again.

Leaps in healthcare technology do not happen frequently, and true revolutions are even rarer. We are now at a unique inflection point in cancer treatment, with historical implications for our vulnerable, underserved populations. The technology is available; let’s make it universally accessible by summoning the political will to overcome policy and procedural hurdles around coverage.

Congress boldly did this for the first generation of cancer screenings, and we know they can do it again. New Hampshire and its citizens are counting on it.

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