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Iowa has second-highest cancer rate; only state with cancer cases rising
‘I think it's just a lot of things collectively that we need to do as a population’
- University of Iowa released the 2023 "Cancer in Iowa" report Tuesday.
- Iowa ranks second, behind Kentucky, for its cancer incidence rate.
- The report points to Iowa's aging population as part of the reason for the spike, but it also notes body mass index, physical activity, binge drinking and smoking as risk factors.
- Analysts predict 20,800 new cases of cancer will be diagnosed this year - up 800 from last year.
- The top cancers diagnosed this year will be breast, lung, colon and rectum and skin melanoma.
- Despite the increase in cases, deaths from cancer are predicted to decrease in 2023.
Fifty years after Iowa began collecting and analyzing data on residents diagnosed with cancer through its Iowa Cancer Registry, statistics reveal Iowa has the second-highest cancer incidence rate in the nation and is the only state with a rising rate of cancer.
“We’ve really been trying to dig into that because it just seems so unbelievable that here in Iowa we would have the second-highest rate of new cancer cases around the country,” University of Iowa associate professor of epidemiology Mary Charlton, who directs the Iowa Cancer Registry, told reporters Tuesday.
Kentucky has the highest cancer rate, lining up with its high smoking rate, Charlton said.
“We don't have as high a smoking rate, we don't have as high a lung cancer rate,” she said. “But what we do have is a relatively high rate of just about every major cancer type across the board.”
In sharing details of the UI-based registry’s 2023 “Cancer in Iowa” report, Charlton noted analysts predict 20,800 new cancer cases will be diagnosed this year — up 800 from last year and double the number of cases recorded 50 years ago at the registry’s outset in 1973.
Given early detection and treatment advancements, the registry estimates 6,200 Iowans will die from cancer this year — 100 fewer than 2022 and on par with 50 years ago.
“So the same number of deaths, double the rate of cases,” Charlton said. “So the bad news is, yes we are high in cancer. But the good news is people aren't dying from it nearly as much as they used to, and we're keeping that number of deaths stable.”
'No smoking gun’
The top cancers diagnosed for 2023 will continue to be breast, accounting for 14 percent of the total; followed by prostate and lung, each accounting for 13 percent; colon and rectum, accounting for 8 percent; and skin melanoma, accounting for 6 percent, according to the report.
Iowa’s top cancer killers for 2023 will be lung, accounting for 23 percent; colon/rectum and pancreas, each at 8 percent; and breast cancer at 7 percent.
As the Iowa Cancer Registry celebrates its 50th anniversary, the 2023 report notes the spike in cases is tied, in part, to Iowa’s aging population, “as advancing age is the leading risk factor for cancer.”
“In fact, persons over age 65 accounted for almost 60 percent of newly diagnosed cancers and 75 percent of all cancer deaths during the last five years (2015-2019),” according to the report.
The rise in cases also ties to Iowa’s larger population — growing from 2.9 million in 1973 to 3.2 this year — and the improvement and corresponding increase in cancer detection among Iowans.
“But it seems like a mountain of pebbles,” Charlton said. “There's not just one silver bullet that explains why we're so high. But we've been trending this way for a long time in our ranks, and so it's really time to turn it around.”
Iowa was among nine states included in the original Surveillance, Epidemiology, and End Results program — spawned from the National Cancer Act of 1971. While the other original registries — like in Connecticut, New Mexico, and the metropolitan areas of Detroit, San Francisco-Oakland, and Atlanta — have seen incidence rates go down since the early 1990s, Iowa’s have been trending up since that time.
With cancer registries now in 50 states, Iowa tops most in incidence of at least eight types of cancer — ranking first nationally in oral pharynx cancer diagnoses; second in leukemia; fifth in melanoma; and sixth in Non-Hodgkin lymphoma.
“Increasing awareness of risk factors can help Iowans lower their risk for cancer and inform policies, programs, and initiatives,” according to the report, identifying obesity, diet, physical activity, alcohol, and tobacco use among risk factors.
To that point, the report notes Iowans have a higher body mass index than the national average; engage is less physical activity than the rest of the country; do more binge drinking; and smoke more.
“There's no smoking gun,” Charlton said. “I think it's just a lot of things collectively that we need to do as a population.”
Data collected through the registry and other research can help — including investigation into environmental risk factors like secondhand smoke; air pollution; asbestos; contaminated water; and pesticides.
Comparing data with similar states — heavy in farming activity, for example — can help drill down into potential impacts of environmental factors, Charlton said.
“But we still see Iowa as very different from those surrounding states,” she said, noting, “Those investigations are ongoing, and that’s really where cancer cluster investigations come in.”
Former teacher Diane Anderson knows well the process of cluster investigations after being diagnosed in September 2020 with an aggressive “triple negative metaplastic breast cancer” and learning in the months since of more than a dozen others in her school district also diagnosed with breast cancer.
“In August 2022, I became aware of yet another teacher from Hudson Community Schools — the district I taught in for 34 years — diagnosed with breast cancer, which now brought the number up to 12 of us in 10 years,” she told reporters Tuesday, noting the tally now is 13.
She contacted her local public health department, which put her in touch with UI, which instigated a cluster investigation — digging into whether environmental factors could be leading to cancer diagnoses in the district.
“In the final report, a cluster was not determined, but one could not be ruled out,” Anderson said, praising the investigation for raising awareness and encouraging proactivity. “Their work has proven to be so important within our cancer community, which I'm now a part of.”
Vanessa Miller covers higher education for The Gazette.
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