Closing the Colorectal Cancer Screening Gap in Rural Maryland

by Eric Wargotz, MD, FCAP

MedChi President – The Maryland State Medical Society

In rural parts of the state, including Western Maryland, patients face a persistent reality: the health care they access is often determined by geography, not by medical need. Some patients in rural communities must travel more than an hour just to see a gastroenterologist. For individuals juggling hourly jobs, caregiving responsibilities, or limited transportation, that distance alone can determine whether screening happens at all.

Colorectal cancer is the leading cause of cancer-related deaths in Americans under 50. Yet this disease is highly treatable when caught early. Patients diagnosed at a local stage have a 91 percent five-year survival rate. For those diagnosed after the cancer has spread, that rate plummets to approximately 15 percent. The difference between these outcomes is not luck; it is screening.

In Maryland, approximately 2,700 new cases of colorectal cancer will be diagnosed this year, and 980 will die from the disease. Too many of these cases will be advanced at diagnosis. Rural patients face unique barriers to traditional screening methods. A colonoscopy often requires travel to a gastroenterologist’s office, specialized preparation, and recovery time. When screening becomes logistically impossible, it does not happen. Patients delay. Years pass. By the time symptoms appear, the cancer has progressed.

Working in medicine, I have seen this pattern repeat: patients in rural areas are screened at lower rates, diagnosed later, and face poorer outcomes.

Innovation offers a pathway forward. Guardant Health’s Shield blood test, the first and only FDA-approved blood test for primary colorectal cancer screening for those 45 and older at average risk, represents a breakthrough for rural communities. It is just a blood draw, something our patients can have done at their local primary care clinic during a routine visit, without preparation or need to travel too far. When screening fits into patients’ lives rather than requiring their lives to pause, more people get screened.

As physicians, our obligation is to meet patients where they are, literally and figuratively. In rural Maryland, that means recognizing that the current infrastructure leaves entire populations behind. This is not about replacing colonoscopy, which remains a critical tool for those who can access it. It is about ensuring that no one in Maryland who is eligible goes unscreened simply because they live in a rural area. It is about recognizing that the distances between Baltimore and a small town in Garrett County are not measured only in miles but also in mortality rates.

I encourage my colleagues to discuss screening options with their patients, particularly those in rural areas. Educate them on their options. Patients deserve to know that screening exists and that it fits their lives.

In colorectal cancer prevention, rural communities in Maryland have waited long enough. Innovation is here; access must follow. If we act now to expand screening pathways, we can ensure that geography no longer determines who survives this preventable disease.