As this weekend’s Dempsey Challenge in Lewiston raises money and awareness in support of people who have cancer, a look at Maine shows the challenge that lies ahead.

Maine continues to have one of the highest overall cancer incidence rates nationally, mostly from tobacco and alcohol use, obesity, and exposure to environmental contaminants.

However, state officials say public awareness, improved health care delivery, better access to healthy foods, and more attention on environmental factors can help Mainers avoid the disease.

Maine ranks sixth highest in the nation for age-adjusted cancer rates, with 482 cases per 100,000 people, based on five-year, age-adjusted data from the U.S. Centers for Disease Control and Prevention.

The most common cancers in Maine are female breast cancer and prostate cancer, with age-adjusted rates of 134 and 113, respectively, per 100,000 people, according to data in the Maine Center for Disease Control and Prevention 2025 Annual Cancer Snapshot.

Maine’s female breast cancer rate is only slightly higher than the national rate and the state’s prostate cancer rate is lower than the national rate.

However, Maine does have rates higher than the national average for lung/bronchus cancer, urinary bladder cancer and melanoma, a type of skin cancer.

Overall cancer rates in Maine steadily declined from the 1990s until about a decade ago, and have since more or less plateaued.

The only exception is cancer among women age 49 and below. For them, the rate has increased slightly in recent years, but represents less than 10% of new diagnoses in Maine in 2022, according to the 2025 Snapshot.

Cancer happens when cells do not divide normally — dividing too much and mutating, she said. This happens more in older individuals, which is why cancer is more prevalent in the older population. But many cancers are caused by exposures to certain elements and chemicals.

Many of the most common types of diagnosed cancers in Maine are caused by cigarette smoking, obesity, and radon and arsenic exposure, Dr. Dora Mills, MaineHealth’s chief improvement officer, said.

Mills, former director of Maine’s CDC, worked for years on the campaign to bring cigarette smoking rates down in Maine.

Mills said cigarettes and secondhand smoke exposure can cause a number of cancers, including two types with high rates in Maine: lung/bronchus and urinary bladder. Smoking can also cause cancers of the mouth, throat, larynx, esophagus, stomach, colon, rectum, kidney, liver, pancreas and blood, among others.

At one point in the 1990s Maine had the highest rate in the nation of youth smoking, Mills said. In 1996, about 4 out of 10 high school students smoked cigarettes.

Because of public education targeting youth and legislation banning smoking in public places in the 1990s and early 2000s, the rate of smoking and later vaping by high school students and young people has declined, as has the number of people exposed to secondhand smoke.

Because the incubation period for some cancers can be between 20 and 35 years, some people who started smoking in the 1990s are now developing cancer, which could be one factor in why Maine has a higher rate of lung and bladder cancers, she said. She expects those cancer rates will go down over time.

“We cleared the air in many public places, including places of employment, throughout the ’90s and early 2000s and … you’re still seeing the impact of that, of people having been exposed to secondhand smoke years ago,” she said. “But we’re also probably starting to see the reduction in cancers because of those laws that created smoke-free places.”

The state has outlined goals in the Maine Cancer Plan 2021-2030 for reducing the rates of youth and adults using and being exposed to tobacco products.

Among many actions, the plan calls for providing training to retailers to prevent youth tobacco sales, creating policy and environmental changes to discourage tobacco product use, helping youth and adults quit using tobacco products, increasing the prevalence of in-person tobacco treatment in schools, conducting counter marketing campaigns across Maine targeting youth, supporting a statewide ban on flavored tobacco products and increasing taxes on tobacco products.

Naturally occurring arsenic and radon are also a factor in Maine cancer rates, Mills said. Arsenic can cause bladder, kidney, lung and liver cancer. Radon can cause lung cancer.

Maine has higher rates of arsenic and radon in well water. Radon is also emitted from granite into homes, she said. More than half of Mainers get their water from wells and there are no regulations requiring frequent testing and filtering.

In response, the state calls for testing of owner-occupied homes and rental properties, along with installing radon mitigation systems in homes with high radon test results, according to Maine’s Cancer Plan.

The plan calls for public education on radon and arsenic prevention, water testing and mitigation, raising awareness about the relationship between radon, smoking and lung cancer, reducing financial barriers to installing radon mitigation systems, helping low-income residents get free arsenic tests, and more.

Two other significant factors in Maine related to cancer are obesity and alcohol consumption, Mills said. Maine has high rates of obesity, which can cause colon, breast, gallbladder, pancreas, liver, kidney and other types of cancer. Alcohol has been linked to breast, colon, esophagus, liver, mouth, throat and other types of cancer.

To that end, Maine’s plan calls for efforts to increase consumption of fruits and vegetables, and participation in aerobic and strengthening activities. State goals include increasing access to healthier foods and drinks for children in schools and day cares, messaging about healthy eating and physical activity, and increasing the awareness of the benefits of breastfeeding and breast milk, along with other efforts.

To reduce the number of youth and adults who consume alcohol, the state’s plan calls for raising awareness about alcohol safety and prevention measures.

Rural Mainers tend to be more at risk of cancer because the rates of smoking, obesity and arsenic/radon exposure tend to be higher in this population, Mills said. Some people are exposed to more than one of these elements.

The good news, Mills said, is that more rural hospitals are offering cancer treatments and screening, allowing more Maine residents to be diagnosed and treated sooner. Telehealth has also played a role in making medical appointments more available and manageable for people living in rural areas.

People who smoke or vape should get a full CAT scan of their lungs starting at about age 50, Mills said, though some doctors might recommend screenings at a different age, depending on circumstances and history. People should start screening for colon cancer at age 45.

The American Cancer Society recommends that women at average risk for breast cancer can start yearly screenings at 40. Women should start getting yearly exams by age 45. Women 55 and older can be screened every other year if they choose.

There are also more ways to prevent certain types of cancer, such as the HPV vaccine, Mills said. HPV was a leading cause of cervical cancer, but rates have come down over time as more people get the vaccine.

It can often be unclear why someone developes a certain type of cancer, and no one should be blamed for developing cancer, even if they engage in high-risk behaviors, Mills said.

Overall, Mills recommends these steps to reduce the risk of developing cancer:

Reduce exposure to tobacco-based products and nicotine (such as but not limited to cigarettes and vapes), maintain a healthy weight, eat fruits and vegetables while limiting meats and processed foods, have private wells tested for radon and arsenic, and have the air in your home tested for radon.

“This is not meant to blame somebody who has cancer,” Mills said. “…  But we do know that your chances of getting cancer are much, much higher if you’re getting exposed to tobacco, being tobacco-addicted, and the radon and arsenic, obesity, a poor diet and alcohol. Those all increase your chances of contracting cancer. But it’s a matter of knowing that and making choices, an informed choice.”