‘Early detection saved my life’

IOWA CITY — Though screening rates have rebounded since the early days of the COVID-19 pandemic, researchers are emphasizing a continued push toward improved cancer screening rates in a new report out this week.

In the new 2022 Cancer in Iowa Report released Monday by the State Health Registry of Iowa, based in the University of Iowa College of Public Health, officials highlighted the importance of early screening to detect cancer at its earliest stages, when treatment of the disease can be most successful.

When the novel coronavirus first arrived in the state two years ago, everyday lives were disrupted and, as a result, many Iowa put off or avoided medical care — including routine cancer screenings.

“While we do not yet know the extent of the impact of this decrease, it is possible that the missed screenings during the pandemic led to delayed diagnosis of cancer, more advanced stage of disease at the time of diagnosis and an increase in avoidable cancer deaths,” said Dr. Mary Charlton, director of the State Health Registry of Iowa/Iowa Cancer Registry at the University of Iowa.

It’s estimated 41 percent of U.S. adults delayed or avoided medical care — including critical cancer screenings — between March and June 2020, when the COVID-19 pandemic first began.

Those rates have rebound in the months and years that followed, but researchers say a continued improvement in screening rates overall could prevent future deaths.

Researchers project 20,000 Iowans will be diagnosed with cancer this year, with breast cancer as the most common cancer diagnosis at 14.1 percent of all predicted diagnoses. That’s followed by prostate at 13.5 percent, lung at 12.9 percent and colon/rectum at 8 percent.

An estimated 6,3000 Iowans are expected to die from cancer in 2022, with lung cancer making up nearly a quarter of these deaths. This year’s projection makes cancer among the leading causes of death, following heart disease.

The 2022 prediction is a slight decrease from the 6,400 deaths projected for 2021 in last year’s Cancer in Iowa report.

There are nearly 160,000 Iowans living with cancer or who survived cancer since 1973, when the registry first began collecting this data.

‘Early detection saved my life’

Shortly after her 40th birthday in July 2021, Waukee resident Lindsay Schmauss decided to receive her first mammogram. She had no family history of cancer and wasn’t experiencing any symptoms, but decided to get the breast cancer screening “because that’s what you’re supposed to do as a woman when you turned 40,” she told reporters during a news conference Monday.

That decision likely saved her life, said Schmauss, a grants administrator for the Iowa Department of Public Health.

To her shock, Schmauss was diagnosed with stage 1A breast cancer, meaning the disease was invasive and was starting to spread. That phone call turned her world “upside down in a single moment.”

“The faces of my six-year-old son and two-year-old daughter are flashing across my mind,” she said. “I kept thinking how could this be happening?”

Six weeks later, she received a double mastectomy and has been on the road to recovery since. Reflecting on her experience, Schmauss said her decision to get a mammogram when she did likely saved her life.

“If I waited even six months after turning 40 to get that mammogram, my doctors told me, ‘We would be having a much different conversation,’” she recalled.

“Early detection 100 percent saved my life,” Schmauss said.

Socioeconomic impacts

The COVID-19 pandemic also has highlighted the limited access to cancer screenings, as well as health care in general, faced by some groups, said Dr. George Weiner, director of University of Iowa Holden Comprehensive Cancer Center.

Research shows groups facing the greatest barriers are inner city minorities and those living in underserved rural communities, he said.

In last year’s Cancer in Iowa Report, researchers determined Black Iowans were diagnosed with and dying from cancer at higher rates than any other racial or ethnic group in the state. Largely to blame were the socioeconomic barriers and the structural racism this group faces at all levels.

Charlton said research indicates there are reduced screening rates among Black Iowans and other Iowans of color, but other disparities — such as lower thresholds for developing certain types of cancers — increase this populations’ risk factors overall.

“It's almost just at every level that there's something working against them, especially our Black population,” she said. “I think getting the screening rates up in that population is really important.”

While lifestyle changes are key in preventing certain cancers, it’s also important to note that those steps can be very challenging for some lower socioeconomic groups, said Dr. Andrew Nish, director of the John Stoddard Cancer Center at UnityPoint Health-Des Moines. Because of the United States’ current food systems, these groups have less access to fresh food, making it difficult to maintain a good diet.

Report highlights trends in certain cancers

Researchers also raised concerns about the latest trend in cervical cancer, which is caused by an infection of types of human papillomavirus, or HPV, for most cases. The rate of new cases has been increasing since 2012, but the percent of Iowans screened for cervical cancer has been decreasing since 2008.

Dr. Richard Deming, director of the MercyOne Cancer Center in Des Moines said he had concerns that the political discourse around COVID-19 vaccines in American could be affecting the acceptance rate of other vaccinations, such as the HPV vaccine.

“One hundred percent of cervix cancers are caused by HPV, we can prevent cervix cancer and four other cancers that are caused by the HPV, and that’s by getting the HPV vaccine,” Deming said. “I’m really concerned about where we are with conversations about vaccines.”

In 2020, approximately 77 percent of eligible Iowans between the ages of 21 and 65 had been screened for cervical cancer in the three years before. Though that rate still is higher than the national average, the state public health department’s Healthy Iowans programs aims to increase that screening rate to 92 percent in the next year.

State public health officials also have set higher screening goals for other types of cancer, including colorectal cancer, which is current at 74 percent. The goal is 80 percent for 2022.

Two-thirds of colorectal cancer deaths in the United States can be prevented through routine screening, which is recommended for everyone aged 45 and older, the report stated. A United States task force focused on preventive care recently lowered the screening age after seeing an increasing cancer incidence rate among those under the age of 50.

Since 2000, screening rates for breast cancer has remained steady at 80 percent.

New breast cancer cases have been rising since 2013, but mortality rates for those diagnosed has been on the decline over the past 20 years, likely due to improved treatment options and early detection, the report stated.

Only one in four cases of lung cancer in Iowa is diagnosed at the “localized” stage, when the disease is at its most treatable. Screening is recommended for adults between the ages of 50 and 80 who have a 20-pack year smoking history and currently smoke or have quit within the past 15 years, according to the report.

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