Pennsylvania Colorectal Cancer Alliance to Reduce Mortality and Enhance Screening (PA-CARES) - Colorectal cancer (CRC) is the third leading cause of cancer-related deaths in men and the fourth leading cause in women. SEER data estimates that over 150,000 Americans will be diagnosed with colorectal cancer in 2024, with approximately 53,000 deaths. Pennsylvania is the fifth most populous state in the country and had a higher overall cancer incidence rate (482.5 per 100,000) than the national average (436.0 per 100,000) in 2016. The state also reported a higher cancer mortality rate (164.3 per 100,000) compared to the national rate (156.0 per 100,000). CRC is the second leading cause of cancer-related deaths and the fourth most commonly diagnosed cancer. While the statewide CRC screening rate stands at 69.2%, significant disparities exist based on geographic location and race/ ethnicity (see Table 2). Rural counties consistently report higher CRC incidence and mortality rates than urban counties. Studies show that rural communities rank poorly on various health indicators and experience higher cancer-related mortality. These disparities are exacerbated by shortages of medical providers, limited access to healthcare services, transportation barriers, and a lack of specialty providers, such as gastroenterologists. The 2019 Burden of Cancer in Pennsylvania Report highlights although White and Black Pennsylvanians have similar CRC incidence rates, Black Pennsylvanians experienced the highest mortality rate in 2016—19.3 deaths per 100,000 compared to 14.0 per 100,000 among Whites. To address these challenges—low screening rates and high CRC incidence and mortality—the Pennsylvania State College of Medicine and its partners plan to launch the Pennsylvania Colorectal Cancer Alliance to Reduce Mortality and Enhance Screening (PA-CARES). Our proposed project will cover 28 counties in Pennsylvania, encompassing 38% of the state and serving approximately 4.2 million Pennsylvanians. Of these, 19 counties are classified as Appalachian defined by the Appalachian Rural Committee and 19 counties have regions designated as HRSA Rural Health Areas or Counties. The catchment area has a higher proportion of older adults, lower educational attainment, uninsured individuals, and residents living below the federal poverty level compared to both the state and national averages These factors have been associated with lower CRC screening rates in communities. Cancer incidence and mortality rates in the catchment area exceed both state and national averages. Our region includes 10 of the 20 counties with the highest colorectal cancer (CRC) incidence rates and borders an additional five counties on the list. Significant disparities are observed, particularly among the 12 counties designated as rural and Appalachian, as well as within Black and Hispanic communities (Table 2). Within the catchment area, the CRC incidence rate among Rural Appalachian residents is 41.8, while Black Pennsylvanians have an incidence rate of 52.9—both higher than the state average of 36.8. Additionally, CRC screening rates in the catchment area remain lower, at 66%, compared to state and national levels.
