Cancer Incidence, Healthcare Access, and Support Resource Distribution in Delaware

Abstract

Delaware has historically experienced cancer incidence rates exceeding the national average, making an assessment of cancer burden, healthcare access, and support resource availability essential for informing public health policy and intervention. This paper analyzes cancer in Delaware from 2018 to 2022, examining patterns by cancer type, demographics, and geography, while also evaluating whether the distribution of oncology specialists and support resources align with the areas of greatest need among the population. The majority of the data about Delaware was sourced from the Delaware Department of Health and Social Services Division of Public Health’s report on Small Area-Level Cancer Incidence in Delaware 2018-2022. This information was then supplemented with additional research and data surrounding provider location, state screening program information, and cancer support organization resources. Between 2018 and 2022, Delaware recorded 32,090 newly diagnosed cancer cases with an age-adjusted all-site incidence rate of 469.9 per 100,000 people, which is greater than the national average of 448.6 per 100,000. Geographic analysis revealed variation across the state’s three counties and 15 cancer reporting zones. In this data, Kent County had the highest county-level incidence rate despite having the fewest cancer specialists. Sussex County however faced the most disparity in terms of access, having a cases-per-medical-oncologist ratio almost five times that of New Castle County. Both cancer support resources and screening programs had a majority concentration in New Castle County. The findings of this analysis highlight geographic and demographic disparities in cancer burden across the state of Delaware, and stress the importance of targeted interventions to improve the health outcomes of Delaware residents no matter where they live.

Introduction

Cancer is one of the leading causes of morbidity and mortality in the United States, accounting for approximately 600,000 deaths annually and leads to significant economic and social burdens on individuals, families, and healthcare systems.¹ Delaware has ranked among states with the highest cancer incidence rates in the United States in previous years, and this has continued in the most recent five-year reporting period. This paper is a comprehensive analysis of cancer incidence, demographic patterns, geographic distribution, oncology specialist availability, and cancer support resources across Delaware from 2018 to 2022, primarily utilizing data from the Delaware Cancer Registry and the Delaware Division of Public Health. The findings of the report indicate that Delaware continues to experience a substantial cancer burden compared with the United States overall.

Background

Between 2018 and 2022, Delaware recorded 32,090 newly diagnosed cancer cases, representing an average of approximately 6,418 cases annually.² The age-adjusted all-site cancer incidence rate in Delaware was 469.9 cases per 100,000 population which exceeded the national incidence rate of 448.6 cases per 100,000 population.³

The Delaware Department of Health and Social Services (DHSS) performed a county-wide analysis that displayed important geographic differences in cancer incidence. New Castle County accounted for the largest number of cancer cases (n=15,859), followed by Sussex County (n=10,295), and Kent County (n=5,933).² However, when population differences were considered through age-adjusted incidence rates, Kent County had the highest incidence rate (511.7 cases per 100,000 population), followed by Sussex County (480.7 cases per 100,000 population), and New Castle County (451.4 cases per 100,000 population)² (Figure 1). These findings demonstrate the importance of examining both case counts and incidence rates when assessing cancer burden.

Figure 1. Overall Cancer Incidence Rate by County, Delaware, 2018-2022 (per 100,000 people)².

Cancer Incidence Rates, 2018-2022

It should be noted that cancer incidence rates in this report are based on where the patient resides at the time of diagnosis, not the location of the diagnosing facility. Meaning, a cancer case diagnosed at the Helen F. Graham Cancer Center in New Castle County would be assigned to whichever county the patient lives in, not defaulted to New Castle County. Therefore, the geographic patterns recorded reflect where cancer patients actually live as opposed to where they receive care, thus strengthening the validity of using these rates to assess community-level cancer burden.

Cancer Incidence by Sex

Cancer incidence differed substantially between males and females in Delaware (Figure 2). The age-adjusted cancer incidence rate among males was 507.1 cases per 100,000 population, compared with 443.7 cases per 100,000 population among females.² This difference suggests that males experience a greater overall cancer burden than females within the state.

Figure 2. Cancer Incidence by Sex in Delaware 2018-2022 (per 100,000 people)².

Several site-specific cancers also demonstrated notable sex differences. Incidence rates for lung and bronchus cancer, colorectal cancer, melanoma of the skin, urinary bladder cancer, kidney and renal pelvis cancer, and leukemia were all higher among males than females.² These findings may reflect differences in behavioral risk factors, occupational exposures, screening practices, and biological susceptibility.

Overall cancer incidence rates by sex include gender-specific cancers such as prostate cancer (male only), breast cancer (predominantly female), cervical cancer, uterine cancer, and ovarian cancer (female only), and testicular cancer (male only). These cancers contribute to the observed difference in overall rates between males and females. When considering sex-specific cancers, the higher male incidence rate is partly driven by prostate cancer (136.3 per 100,000), while female rates are influenced by breast cancer (144.9 per 100,000) and uterine cancer (28.9 per 100,000).² Removing the sex-specific cancers and examining only cancers that affect both sexes would likely cause the gap between male and female incidence rates to shorten because prostate cancer is common among males and drives up the rate. This indicates that behavioral and occupational risk factors, not just biological differences alone may account for remaining disparities.

Cancer Incidence by Race and Ethnicity

Cancer incidence varied considerably across racial and ethnic groups (Figure 3). Non-Hispanic White Delawareans experienced the highest overall cancer incidence rate (485.8 cases per 100,000 population), followed by Non-Hispanic Black Delawareans (440.4 cases per 100,000 population) and Hispanic Delawareans (325.6 cases per 100,000 population).²

Figure 3. Cancer Incidence by Race and Ethnicity in Delaware 2018-2022 (per 100,000 people)².

Although Non-Hispanic White residents had the highest overall incidence rate, important disparities were observed for specific cancer types. Non-Hispanic Black Delawareans experienced substantially higher incidence rates for prostate cancer (195.1 cases per 100,000 population) compared with Non-Hispanic Whites (119.8 cases per 100,000 population). Similarly, incidence rates for pancreatic cancer and kidney and renal pelvis cancer were elevated among Non-Hispanic Black residents. In contrast, Non-Hispanic White residents experienced higher incidence rates for lung and bronchus cancer, melanoma of the skin, and urinary bladder cancer. These findings highlight the importance of targeted prevention and screening strategies for populations at elevated risk.²

Cancer Incidence by Age

Cancer incidence increased dramatically with age across all racial and ethnic groups (Figure 4). Among Non-Hispanic White residents, incidence rates increased from 62.0 cases per 100,000 population among individuals aged 0–39 years to 2,432.3 cases per 100,000 population among those aged 75–84 years.² Similar trends were observed among Non-Hispanic Black and Hispanic populations.

Figure 4. Age-Adjusted Cancer Incidence Rates by Age Group and Race/Ethnicity, Delaware 2018-2022 (per 100,000 people)².

The highest incidence rates were generally observed among individuals aged 75–84 years after which rates remained elevated among those aged 85 years and older.² These findings demonstrate that age remains one of the strongest predictors of cancer risk and underscore the importance of screening, prevention, and healthcare access among older adults.

The age-related patterns in Delaware mirror national trends. Nationally, cancer incidence also increases with age, with the highest rates observed among individuals aged 75 and older. Delaware's age-specific rates, however, exceed national averages across most age groups,³ suggesting that the age-related increase in cancer risk observed nationally is amplified in Delaware. This may be due to a couple of factors such as high early detection screening rates and a large retirement age demographic which is especially prevalent in Sussex County. Therefore, the importance of thorough and plentiful cancer screening and prevention programs targeting older Delawareans specifically is highlighted, since this population is impacted by both the universal age-related increase in cancer risk and Delaware's above-average overall cancer burden.

An important consideration when interpreting cancer incidence rates is the role that screening plays. Higher incidence rates in some populations or geographic areas could reflect greater utilization of cancer screening programs, which could lead to cancer detection that may otherwise go undiagnosed. On the contrary, lower incidence rates in some areas may reflect underdiagnosis due to limited screening access, not that there is actually a lower cancer burden.

Most Common Cancer Types

Analysis of site-specific cancers diagnosed between 2018-2022 revealed that breast cancer, prostate cancer, lung and bronchus cancer, and colorectal cancer accounted for the largest proportion of cancer cases in Delaware (Figure 5). Breast cancer represented the most common cancer type, with approximately 4,798 cases identified during the study period. Prostate cancer followed closely with 4,564 cases, while lung and bronchus cancer accounted for 4,038 cases and colorectal cancer accounted for 2,115 cases.²

Figure 5. Nine Most Common Cancers in Delaware vs U.S. Incidence 2018-2022 (per 100,000 people) ².

These four cancer types collectively represent a substantial portion of Delaware's cancer burden and should remain priorities for public health interventions, screening programs, and educational initiatives. Continued efforts to promote early detection and reduce modifiable risk factors may contribute to reductions in cancer incidence and mortality throughout the state.

Geographic Distribution of Cancer Incidence in Delaware, 2018-2022

The Delaware Cancer Registry, captures cancer cases based on the patient's county of residence at the time of diagnosis. The following data reflect all reported cancer cases diagnosed among Delaware residents between January 1, 2018 and December 31, 2022, regardless of where the patient received their diagnosis or treatment.

Cancer incidence in Delaware varies considerably across geographic areas, with meaningful differences observed at both the county and sub-county levels. The cancer reporting zone level groups census tracts into 15 meaningful geographic areas. Analysis of these zones reveals important patterns that county-level data alone would obscure.

Overall, the highest cancer burden in Delaware is concentrated in central New Castle County, particularly in the Middletown/Odessa/Townsend zone (A9009), which reported the state's highest all-site age-adjusted incidence rate at 634.1 per 100,000 population (Figure 6). This is notably higher than the statewide Delaware rate of 469.9 per 100,000 and the national rate of 448.6. The Bear/Glasgow zone (A9008) reported the second-highest all-site rate at 582.2, also well above state and national averages. In contrast, zones in northern New Castle County including North Wilmington/Greenville/Hockessin (A9005, 385.4) and North Wilmington/Claymont (A9003, 400.6) had the lowest rates in the state, falling below both state and national averages.⁴

Figure 6. Delaware All-Site Rate Cancer Rate 2018-2022 (per 100,000 people)².

At the census tract level, even greater variation is observed (Figure 7). Census tract 166.02 in southern New Castle County reported an exceptionally high rate of 1,179.1 per 100,000, far exceeding any other tract in the state. Other notably high tracts include 139.03 (734.4), 148.05 (738.8), and 149.06 (698.5), all located in central or southern New Castle County. Meanwhile, several tracts in Sussex County, particularly in the Laurel area (tracts 511-512), reported the lowest rates in the state, ranging from 163.4 to 246.5 per 100,000.⁴

Figure 7. Five-Year Age Adjusted All Site Cancer Incidence Rates by Zone, Delaware, 2018-2022⁴.

Cancer rates calculated for small geographic areas like census tracts should be interpreted carefully. Since census tracts have small populations, their cancer rates can fluctuate considerably from year to year based on just a few cases. For example, flipping a coin 10 times could produce 7 heads, but flipping it 1,000 times would likely show results closer to 50/50. The rates shown here represent the best available estimate for each tract, but the true rate could reasonably be a little bit higher or lower. Due to this, zone-level data covers larger populations and provides slightly more reliable estimates and is used for type-specific analyses in this report.

When examining geographic distribution by cancer type at the zone level, distinct patterns emerge. Female breast cancer incidence is strikingly elevated in the Middletown/Odessa/Townsend zone at 237.3 per 100,000, which is nearly twice the rate of the lowest zone, Wilmington (115.6 per 100,000). This geographic concentration of breast cancer in a rapidly growing suburban corridor warrants further investigation.⁴

Prostate cancer shows a different pattern, with the highest rates in Bear/Glasgow (172.8 per 100,000) and Dover/Smyrna (170.5 per 100,000), and the lowest rate in Seaford/Bridgeville (88.5 per 100,000).⁴

Lung cancer burden is most concentrated in Bear/Glasgow (78.3 per 100,000) and Milford/Harrington/Leipsic/Smyrna/Little Creek (68.0 per 100,000), while the lowest lung cancer rates are found in the affluent North Wilmington/Greenville/Hockessin corridor (33.7 per 100,000).⁴ Here there is a difference of more than two-fold that may reflect differences in socioeconomic status and behavioral risk factors such as smoking rates across these communities, however further analysis of these factors would be required to confirm this relationship across these communities.

Colorectal cancer follows a similar geographic pattern, with Bear/Glasgow (46.0 per 100,000) and Middletown/Odessa/Townsend (42.9 per 100,000) again reporting the highest rates.⁴

Taken together, these geographic patterns suggest that the cancer burden in Delaware is not evenly distributed. Central and southern New Castle County consistently show elevated rates across multiple cancer types, while northern New Castle County, particularly the wealthier suburban corridor consistently shows lower rates. Sussex County shows a more mixed picture, with some zones elevated (Millsboro/Long Neck area, 482.9 per 100,000)⁴ and others lower, reflecting the county's diverse mix of rural, coastal, and retirement communities.

Geographic Distribution of Cancer Specialists in Delaware and Alignment with Population Need, 2018-2022

Access to cancer specialists is a critical determinant of cancer outcomes, influencing timely diagnosis, treatment initiation, and survival rates. This analysis examines the geographic distribution of cancer specialists across Delaware's three counties and assesses whether specialist supply aligns with population-level cancer burden.

There are a total of 59 cancer-related specialists who were identified practicing in Delaware, spanning six specialty categories: medical oncology, surgical oncology, gynecologic oncology, urologic oncology, head and neck oncology, and gastroenterologic oncology. Medical oncologists represent the largest group with 38 providers, followed by surgical oncologists with 9 providers. The remaining specialties: gynecologic oncology, urologic oncology, head and neck oncology, and gastroenterologic oncology all have fewer than 5 providers statewide, indicating very limited specialty coverage outside of medical and surgical oncology.⁵ It is to be noted that the analysis utilizes only specialties and not any subspecialties that an oncologist may have.

Geographic Distribution of Specialists

The distribution of cancer specialists across Delaware is highly concentrated in New Castle County. Of the 59 total providers identified, 45 (76%) practice in New Castle County, with the majority located in Newark and Wilmington. Kent County has only four direct providers, with an additional single shared Kent/Sussex provider, making its adjusted total approximately five. Sussex County similarly has three direct providers plus one shared Kent/Sussex provider, for an adjusted total of approximately four.⁵ Therefore, while New Castle County accounts for 76% of all cancer specialists in the state, Kent and Sussex counties together account for only 24% despite representing a substantial portion of Delaware's cancer burden.

Within New Castle County, specialist concentration is further clustered in Newark specifically, where the majority of oncologists are affiliated with the Helen F. Graham Cancer Center at Christiana Care.⁶ So, even within New Castle County, patients in southern areas such as Bear, Glasgow, and Middletown which have the highest cancer burden in the state may be forced to travel long distances to reach specialists.

Alignment of Specialist Supply with Cancer Burden

Comparing specialist supply against cancer burden reveals disparities between where specialists practice and where cancer needs are greatest. Kent County has the highest cancer incidence rate of any county in Delaware at 511.7 per 100,000 population, yet has the fewest cancer specialists. Sussex County has 10,295 total cancer cases and an incidence rate of 480.7 per 100,000, yet also has very limited specialist coverage.²

To quantify this disparity, a cases per medical oncologist ratio was calculated for each county, incorporating the proportional allocation of Kent/Sussex shared providers:⁵

• New Castle County: 1:529

• Kent County: 1:1,187

• Sussex County: 1:2,574

These numbers show a striking disparity in access. A cancer patient in Sussex County faces a cases-per-oncologist ratio nearly five times higher than a patient in New Castle County (1:2,574 vs. 1:529). Kent County patients face a ratio more than twice as high as New Castle County patients (1:1,187 vs. 1:529). This means that on a relative basis, patients in Kent and Sussex counties have significantly less access to medical oncology services than residents in New Castle County, despite experiencing equal or greater cancer burden.

The geographic distribution of cancer specialists in Delaware does not align with the distribution of cancer burden across the state. New Castle County is well-resourced with specialists relative to its cancer burden, while Kent and Sussex counties are significantly underserved. Patients in these counties likely face longer travel times, longer wait times, and greater barriers to accessing cancer care. These findings suggest a need for targeted strategies to expand cancer specialist access in Kent and Sussex counties so that a greater number of people have access to the care they need.

Cancer Support Resources, Screening Programs, and Financial Assistance in Delaware

Support Organizations and Community Resources

Outside of medical care, there is a network of organizations whose goal is to provide support outlets to Delaware cancer patients, survivors, and caregivers. These entities provide emotional support, education, navigation services, and community connections that aim to complement clinical treatment. There are several organizations that provide services for a specific kind of cancer care, and others that provide general cancer education and assistance.

• Cancer Support Community Delaware is a local affiliate of an international nonprofit organization. It has locations in all three counties, and is one of the most geographically accessible cancer resources in the state. It is open Monday through Friday from 9 am to 5 pm, and the program offers support groups, healthy lifestyle classes, and financial assistance for cancer patients and survivors.⁷

• The Delaware Breast Cancer Coalition (BCC) provides resources specifically for breast cancer patients and their families. They aim to improve awareness, early detection rates, and access to care. Their mission is driven by empowering the community through outreach, education, and support services. An important feature of the coalition is its offering of mobile health initiatives serving low-income, uninsured, and underinsured individuals. Additionally, it coordinates services alongside state programs, and accepts most major insurance including Medicare and Medicaid. The BCC can be reached by phone for scheduling, transport assistance, and translation support coordination services (for those less proficient in English or with hearing/vision impairments). These services are particularly valuable for patients in underserved areas.⁸

• CancerCare is a national organization that has outreach in Delaware. Individuals can access a comprehensive range of free professional services delivered by master's-level oncology social workers. These services include individual counseling; support groups available by phone, online, and in person; resource navigation; educational workshops; publications;, and financial and co-pay assistance. In the most recent fiscal year, CancerCare provided financial and co-payment assistance to over 25,000 people nationally and answered nearly 42,000 helpline calls. Since these services are available remotely, CancerCare may be accessible to patients in Kent and Sussex Counties who lack local in person options.⁹

• Blood Cancer United provides personalized resources specifically for blood cancer patients. This includes access to information, clinical trial nurse navigators, and registered dietitians. Educational resources that are available include publications, videos, podcasts, and conferences. They also have support resources that include links to clinical trial support centers and online peer-to-peer support groups. Like CancerCare, Blood Cancer United is primarily digital so that makes its accessibility statewide less dependent on location.¹⁰

• At the institutional level, Helen F. Graham Cancer Center at ChristianaCare in Newark is Delaware's largest cancer center. They offer multidisciplinary care with a team of oncologists, surgeons, nurse navigators, social workers, and clinical research nurses. The center provides survivorship community programs and educational resources on the most frequently diagnosed cancers, including breast, lung, colorectal, skin, gynecologic, and prostate cancers. The Graham Cancer Center enrolls patients in clinical trials at seven times the national rate through its membership in the National Cancer Institute Community Oncology Research Program, and it partners with the University of Delaware and Delaware Biotechnology Institute through the Cawley Center for Translational Cancer Research. Because the Graham Cancer Center is located in Newark, accessibility for Kent and Sussex County residents may be more difficult.⁹

• Tunnell Cancer Center is a part of Beebe Healthcare in Lewes and serves as the primary cancer center for Sussex County. It offers cancer screenings, a survivorship series, and provides links for uninsured patients to the Choose Health Delaware marketplace for insurance options. Bayhealth Cancer Program serves both Kent and Sussex counties and holds accreditation from the American College of Surgeons Commission on Cancer. Bayhealth is a member of the Penn Cancer Network and participates in the Delaware Cancer Registry, providing the ability to monitor trends and contribute to research. Bayhealth also operates a Mobile Health Unit that travels on routes in central and southern Delaware providing community outreach, education, and accessible health exams.¹¹

Geographic Assessment of Support Resources

Analyzing the geographic distribution of support resources along with cancer burden reveals a pattern similar to that seen with the distribution of cancer specialists. The most comprehensive resources are located in New Castle County. Kent County has the fewest dedicated cancer support resources despite having the highest cancer incidence rate in the state. Outside of the Bayhealth campus in Dover there are not many options for nearby residents. Sussex County is somewhat better served due to the presence of both the Tunnell Cancer Center and Bayhealth, but still it significantly lacks resources compared to New Castle County. Statewide resources partially help offset this geographic imbalance but do not fully address the gap, and can rely on strong broadband internet access, which is not always available in all parts of Kent and Sussex County.¹²

Screening Programs

Cancers identified at earlier stages are generally more treatable and lead to better survival outcomes¹ and Delaware has several cancer screening programs that promote early detection across the population. Women aged 21 and older are encouraged to receive regular Pap tests and pelvic exams.¹³ Women who are aged 40 and older should receive annual mammograms.¹⁴ Men that are 50 and older and African American men 40 and older (given their elevated prostate cancer risk) should discuss prostate screening including PSA tests and Digital Rectal Exams with their provider.¹⁵ Men and women aged 45 and older should be given regular colorectal cancer screenings.¹⁶ This can include colonoscopy, sigmoidoscopy, or home-based Fecal Immunochemical Tests (FIT kits). Men and women ages 55 to 80 who currently smoke or have quit within the past 15 years and have a significant smoking history may be eligible for lung cancer screening through low-dose CT scans.¹⁷

• The Delaware Cancer Screening Program (DCSP), also known as the Screening for Life program, is the state’s primary free cancer screening initiative administered by the Delaware Division of Public Health. The program provides office visits, mammograms and clinical breast exams, Pap tests, prostate cancer screening tests, colorectal cancer screening tests, lung cancer screening tests, and health education and care coordination support to eligible individuals. Individuals must be Delaware residents between the ages of 21 and 64 who are not eligible for Medicaid, or age 65 and older without Medicare, who meet income guidelines between 139% and 250% of the Federal Poverty Level, and whose insurance does not cover screenings. The program has a presence in all three counties, as its major healthcare partners are ChristianaCare, Bayhealth, and Beebe Healthcare.¹⁸

• The Delaware Breast and Cervical Cancer Program provides free mammograms and Pap tests specifically for women who are uninsured, and has the same eligibility criteria as the DCSP Screening for Life program.⁸

• Mobile mammography services allow for greater screening access to underserved areas across the state. The Delaware Breast Cancer Coalition operates mobile health initiatives serving low-income and uninsured individuals statewide. TidalHealth has a mobile mammography coach that offers 3D screenings and serves southern Delaware and Sussex County. The Bayhealth Mobile Health Unit routinely tours central and southern Delaware providing community outreach, education, and accessible exams. Christiana Care also operates a mobile mammography unit that travels to underserved areas primarily in New Castle County. Having multiple mobile mammography services in Kent and Sussex counties is a meaningful offset to the concentration of fixed screening facilities in New Castle County, though access still depends on knowledge of these programs and the ability to schedule appointments easily and with flexibility.¹⁹

Financial Assistance

Financial barriers represent one of the most significant obstacles when it comes to individuals' ability to access cancer care. The average initial cost (first 12 months) of medical services related to cancer care at all sites costs approximately $43,516.²⁰ This is a high figure and contributes to expenses that can lead to financial toxicity, which is the negative impact of the high cost of cancer care. Delaware residents facing cancer diagnoses may be eligible for several forms of financial assistance that can cover screening, treatment, and supportive care costs.

• The Delaware Cancer Treatment Program (DCTP) is a state-administered program that helps uninsured Delaware residents access cancer treatment. Patients who are identified as having cancer through the DCSP Screening for Life program may qualify for treatment coverage through Medicaid or the Delaware Cancer Treatment Program, creating a pipeline from screening to treatment for uninsured individuals. Treatment may be covered for up to two years if a patient qualifies.²¹

• The Screening for Life program acts as direct financial assistance for the screening phase of cancer care. The program does not reimburse co-pays or co-insurance, but it does provide reimbursement for individuals with high deductibles relative to their income, specifically those whose deductible equals or exceeds 15% of their annual income.¹⁸

• CancerCare provides financial and co-payment assistance to help alleviate patients’ costs including transportation, practical needs, and cancer medications. The Cancer Support Community Delaware also offers financial assistance directly to cancer patients and survivors in the state. For uninsured patients at Beebe Healthcare, the Tunnell Cancer Center provides links to the Choose Health Delaware marketplace to help patients obtain insurance coverage.⁹

Delaware 211 which is accessible by dialing 211, can be utilized as a resource navigation line that can connect patients to financial assistance programs, transportation support, scheduling help, and translation services. This makes it a useful first point of contact for patients who are unsure where to start.²²

Next Steps

Melanoma Screening

Melanoma is the fifth most common cancer in Delaware. Data shows there are currently 1,616 individuals in the state with a melanoma diagnosis, and melanoma has a statewide incidence rate of 25.3 per 100,000 people (higher than the national rate of 23.1 per 100,000).⁴ Despite this, Delaware does not have a free or reduced cost skin cancer screening program. Individuals in Delaware must use insurance such as Medicare, Medicaid, or private insurance and schedule a skin exam with a dermatologist. Delaware has approximately 58 dermatologists. Most (43 of 58) are located in New Castle County which is significantly higher than the four in Kent County and eleven in Sussex County.²³

One possible solution is to establish a statewide skin cancer screening program modeled after the DCSP. The American Academy of Dermatology (AAD) already has a national "SpotMe" free skin cancer screening program in place.²⁴ Delaware's Division of Public Health could partner with the AAD to expand SpotMe events specifically in Kent and Sussex counties where access to dermatologists is limited. This would allow for residents in these counties to potentially detect skin cancer sooner which improves outcomes.

Lung Cancer Screening

DCSP covers lung cancer screening for eligible high-risk individuals. However, one big problem is the eligibility criteria is slim requiring people to be either ages 55-80 or current or recent smokers with 30 pack-year history.

Something that can be done to improve outreach is expand the DCSP eligibility for lung screening to align with USPSTF 2021 guidelines, which lowered the recommended screening age to 50 and reduced the pack-year requirement to 20. Therefore, more Delaware residents would be eligible for free screening under the existing program infrastructure. If more people are eligible under a broader criteria, it is more likely that they receive treatment sooner, thus improving their outcome. The state could also establish a dedicated lung screening program in Kent County, where lung cancer rates in the Dover/Smyrna zone are the second highest rates in the state.²

Prostate Cancer Screening

The DCSP mentions prostate cancer screening, but it is listed as "recommended by your doctor" as opposed to a routinely covered service such as mammograms or Pap tests. This means prostate screening access requires a patient to first have a primary care provider and secondly for that provider to recommend the screening. This produces a significant barrier in Kent and Sussex counties where primary care access is limited compared to that in New Castle County. This is particularly concerning for Non-Hispanic Black men in Delaware who have a prostate cancer rate of 195.1 per 100,000 far exceeding the White rate of 119.8, ² and residents in the Dover/Smyrna zone because it has the second highest prostate cancer rate in the state at 170.5.⁴

A solution to help alleviate this issue is to establish targeted prostate cancer screening outreach for Non-Hispanic Black men in Kent County. The American Cancer Society recommends that Black men begin prostate cancer screening discussions with their provider at age 40 due to elevated risk.²⁵ Delaware's DCSP includes this recommendation but does not have a targeted outreach program. A community-based program modeled after the "Men's Health Initiative" approach used in other states could reach Black men in the Dover area who face the highest prostate cancer burden.

Conclusion

This analysis of cancer incidence, specialist distribution, and support resource availability in Delaware from 2018 to 2022 reveals a state that continues to face a substantial and unevenly distributed cancer burden. Delaware's overall age-adjusted cancer incidence rate of 469.9 per 100,000 population exceeds the national average of 448.6 per 100,000, and meaningful disparities exist across geographic, demographic, and socioeconomic lines that demand targeted public health attention.²

While New Castle County accounts for the largest absolute number of cancer cases, Kent County carries the highest age-adjusted incidence rate in the state at 511.7 per 100,000 population, and Sussex County is not far behind at 480.7 per 100,000.² Socioeconomic factors, environmental exposures, access to care, and differences in screening utilization may be contributing to geographic variation in cancer incidence, though further research would be needed to confirm these relationships.

Recommendations

Based on the findings of this report, these are some recommended actions to address cancer disparities in Delaware:

• Expand oncology specialist access in Kent and Sussex counties through specialist recruitment incentives, tele-oncology programs, and strengthened referral pathways between primary care providers and cancer specialists.

• Expand and modernize the Delaware Cancer Screening Program, increase eligibility criteria for lung cancer screening to align with current USPSTF 2021 guidelines, provide universal recommendations for prostate cancer screening, and partner with the American Academy of Dermatology's SpotMe program to address skin cancer screening access gaps.

• Target outreach programs should be developed for populations facing the greatest disparities. Community partnerships with trusted community institutions in the Dover area could serve as an effective mechanism for reaching this population.

• Expand and coordinate mobile health services across Kent and Sussex counties.

• Address broadband and transportation infrastructure gaps in Kent and Sussex counties.

Cancer is not experienced equally across Delaware. Where a person lives, their age, their race and ethnicity, and their ability to access care all shape their cancer risk and their likelihood of receiving timely, high-quality treatment. This report has documented significant disparities in cancer burden and resource availability that follow clear geographic lines, with Kent and Sussex counties bearing a disproportionate share of the cancer burden while receiving a disproportionately small share of the state's oncology resources. Addressing these disparities will require commitment from healthcare systems, nonprofit organizations, policymakers, and community leaders working together to ensure that every Delaware resident has a fair opportunity to detect cancer early, access quality treatment, and survive.