While statewide colorectal cancer (CRC) incidence and mortality rates have significantly declined during the past decade, it remains the third most commonly diagnosed cancer and the third leading cause of cancer-related death in Maine. Furthermore, colorectal cancer is significantly more likely to be diagnosed at a late stage (51.8% of new cases) than at a local stage (38.2% of new cases) in Maine, indicating an ongoing need for screening awareness and education. Despite recent success, health inequity regarding colorectal cancer screening and prevention remain, and the proportion of colorectal cancer diagnosed at a late stage among Maine’s 50+ population continues to rise.
Due to its size and rural nature, geographic disparity remains a major challenge in Maine. There is variation in three-year colorectal cancer incidence rates between Maine counties; Maine’s northern most county, Aroostook County (48.3 per 100,00) had an age adjusted incidence rate significantly higher than Maine overall (37.0 per 100,000). In addition to geographic challenges, populations in rural areas face additional socioeconomic barriers to screening. Behavioral Risk Factor Surveillance System data for Maine indicates that the prevalence of CRC screening is lowest among individuals with lower education and an annual household income of less than $25,000, uninsured individuals, and those ages 50 -54.
In order to address the inequities in CRC screening currently facing Maine’s underserved and overburdened populations, the Maine Center for Disease Control and Prevention, and the Maine Primary Care Association (MPCA) will collaborate to expand the implementation of appropriate evidence-based interventions (EBIs), focusing first on federally qualified health centers (FQHCs) with colorectal cancer screening rates below 60% and eventually ensuring EBIs are used by all 20 FQHCs in the state. MPCA community health center members include all 20 FQHCs in Maine and operate more than 70 service delivery sites across the state. Maine’s community health center network spans as far north as Fort Kent, as far south as North Berwick, eastward to Lubec, and westward to Rangeley. These rural health centers served nearly 210,000 patients in 2018, or almost 16% of Maine’s total population.
According to figures from the Health Resources and Services Administration’s (HRSA’s) 2018 Uniform Data System (UDS), Maine’s FQHC colorectal cancer screening rates range from 80% to 43%. Half of Maine’s FQHCs have colorectal screening rates less than 60%. During the first year of funding, 2 -3 FQHC’s will be selected to participate in the implementation readiness assessment. MPCA has more than 35 years of experience working with their member community health centers on quality improvement initiatives, workforce development, community outreach, and implementation of health information technologies. Collaboration with MPCA will allow the deployment of EBIs to increase colorectal cancer screening across Maine’s community health centers that are still significantly below Maine’s current CRC screening rate.
