Reducing your risk of lung cancer

This story first appeared in Healthy You - January 2026, The Gazette’s quarterly health publication.

Iowans are more likely to develop lung cancer than the average American. Demographics and even geology play a role, but beyond the numbers, there are steps many Iowans can take to avoid becoming among the state’s cancer statistics.

“There are many factors, obviously,” said Dr. Hamad Azam, a physician at UnityPoint Clinic Multi-Specialty and practicing physician at the Helen G. Nassif Community Cancer Center in Cedar Rapids. “But higher smoking rates is the dominant risk factor. This alone drives higher lung cancer rates.”

At 60.3 cases per 100,000 population, Iowa’s rate of new lung cancer cases exceeds the national average of 52.8. The share of people alive five years after being diagnosed with lung cancer is 27.1 percent in Iowa, lagging behind the nation’s 29.7 percent, according to the American Lung Association’s annual State of Lung Cancer report.

“We’re one of the few states in the country where that rate is rising,” said Dr. Margaret Byrne, clinical assistant professor of internal medicine at University of Iowa Health Care. “In most states that number is decreasing.”

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While the U.S. cancer rate is falling, Iowa has the second-highest rate of new cancers in the country, and the state’s overall cancer incidence is rising while the national rate declines, according to the Iowa Cancer Registry based in Iowa City.

“I do feel Iowa as a state is lagging behind other states,” said Byrne, who specializes in hematology and oncology. “It really starts with the risk factors, and the two that we know are cigarette smoking and radon exposure.”

Nearly 14 percent of Iowans are regular smokers — significantly higher than the nation’s 11.4 percent — and Iowa has one of the nation’s highest radon exposure levels. Radon, a gas produced by the natural decay of uranium found in nearly all soils, is lung cancer’s second-leading cause behind tobacco use.

If not quitting altogether, long-time smokers should consult their physician about enhanced screening to catch potential cancers early. Smokers’ risk is measured in “pack years.”

“That means how many packs have you been smoking (daily) for how many years, and we multiply those together,” Byrne said. “If you can quit smoking, that’s the ideal, or at least cut down.”

People ages 50 to 77 with a pack-year rate greater than 20 should have an annual low-dose computed tomography (CT) scan. The scans are conducted at the Nassif Center, the University of Iowa, and other clinics around the state, although access can be a factor for some Iowans.

“They should check with their doctor for screening,” Azam said. “There are many rural residents who lack the nearby screening sites and maybe the transportation to them.”

“That complicates things,” Byrne added. “The population that has a very high amount of cigarette smoking as a whole maybe don’t seek care as often.”

Still, the rural population and the access barrier are not unique to Iowa, Azam noted.

Environmental risks include exposure to certain chemicals or grain dust, and “passive smoking history too,” according to Azam. “If there is a family history, you have these risk factors.”

All Iowans should have their home’s radon level tested with kits available at hardware stores. An elevated radon level can be mitigated, most often through fan and pipe systems that vent radon outdoors before it enters the living space.

Iowans should be alert for such common symptoms as a chronic cough, chest pain or decreased appetite.

“Symptoms that are more concerning are a cough that isn’t getting better, or coughing up blood,” Byrne said. “You would absolutely need to get medical attention.”

An annual checkup with its accompanying blood test is a major factor in detecting cancer early in its development.

“Finding it early is really key for lung cancer,” Byrne said. “In the early stages, often (treatment) is just a surgery to get rid of it and keeping an eye on it through surveillance.”

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“When we do the screening scan, we find out before we see the symptoms,” Azam added.

A diagnosis triggers the formation of a team of oncologists, surgeons, nurses, radiologists, pathologists and other specialists.

“Patients do the best when they have good, strong, multidisciplinary care,” Byrne said. “It’s really important that all the appropriate people are in the room.”

In its earliest stages, cancer can usually be treated surgically through the removal of the cancer cells. Treating cancers in the more advanced stages 3 and 4 often means radiation and chemotherapy, which also damage healthy cells surrounding the affected area.

Advances in genetic testing of cancer cells has led to the development of what’s termed a precision or personalized medical strategy. Analyzing the cancer’s genes, proteins and other substances can give the care team a more focused approach.

“It’s looking at the actual genetic makeup of the cancer itself,” Byrne said. “In certain cases, we have medication that can target the cancer on the cells.”

“Those biomarkers can sometimes detect cancers early,” Azam added.

Targeted therapies based on the genotype of a patient’s cancer cells have produced much higher response rates, bringing improved quality of life for as much as 75 percent of patients.

“Molecular profiling of lung cancers has become standard,” Byrne said. “We use that information to really personalize the treatment. It’s essential that we do that testing.”