ATLANTA – Cancer care is hard to come by in rural Georgia, as the medical payments system squeezes smaller service providers amid traditional challenges such as rising costs and inadequate transportation, state lawmakers learned Thursday.

A special committee of the House of Representatives is traveling the state to hear about access to cancer care, starting with a meeting in Gainesville when they heard from practitioners such as Dr. Harsha Vayas, who has a small medical office in Dublin.

“Over the decade and a half I’ve been here, things have significantly worsened,” said Vayas, who couldn’t attend and addressed the panel by video. “I believe we are at a moment of crisis, and we need to act before the last of the few practitioners like me are either driven out of business or get consolidated.”

Vayas said insurers have been pricing out smaller providers like him who have less leverage to negotiate than big hospital groups. Add to that the traditional problems such as transportation — some of his patients live 50 miles away — and medical costs, and fewer people are getting screened for cancer in time to catch it when it’s treatable, he said.

Georgia has a higher rate of cancer than the nation, said state epidemiologist and trained veterinarian Dr. Cherie Drenzek. The state had 472 people per 100,000 versus 436 per 100,000 nationally, she said. In 2022, 62,078 Georgians were newly diagnosed with cancer, with cancer of the lung and colon among the most frequent manifestations of the disease, although both have been in decline for more than two decades.

Rural areas, defined as counties with fewer than 50,000 residents, had slightly higher rates than the state average, a statistic that was more pronounced among women.

Dr. Nikita Machado, an endocrine surgeon, noted an alarming rise in thyroid cancer in Northeast Georgia, where the rate doubled that of the nation.

“The most important question then is why,” she said.

Parker Hyde, an associate professor at the University of North Georgia’s College of Health Sciences and Professions, speculated that pollution plays a role. He pointed to polyfluoroalkyl substances, known as PFAS. The non-stick and heat resistant properties of the chemical make it useful for stain resistance in rugs and flame retardant in firefighter suits, Hyde said.

“Now, the data is not strong on this, right? But we’re starting to see trend lines where there is some sort of a potential cause or potential linkage here,” he said.