2019 Cancer In Iowa - University Of Iowa
2019Cancer in Iowa
Two in five Iowans will be diagnosed with cancer intheir lifetimes. Cancer is a major burden in Iowa and throughout the US.Reducing the nation’s cancer burden requires the cooperation of manypeople, including physicians, researchers, public health professionals,policy makers and advocates, among others. All of these people rely oncancer data in their effort to reduce the burden of cancer. Because ofthe critical need for data, cancer is a reportable disease in all 50 states.In Iowa, cancer data are collected by the State Health Registry of Iowa,also known as the Iowa Cancer Registry. The staff includes 40 people,with 16 situated throughout the state, who regularly visit hospitals,clinics, and medical laboratories in Iowa and neighboring states tocollect cancer data. The Registry maintains the confidentiality of thepatients, physicians, and hospitals providing data.Since 1973 the Iowa Cancer Registry has been funded by the prestigiousSurveillance, Epidemiology, and End Results (SEER) Program of theNational Cancer Institute (NCI), and is one of eighteen registries nationwide providing data. Iowa represents rural and Midwestern populationsand provides data included in many NCI publications and nationalestimates and projections of the cancer burden throughout the US.Beginning in 1990, about 5-10 percent of the Registry’s annual operatingbudget has been provided by the state of Iowa. In 2003, the Universityof Iowa began providing cost-sharing funds. The Registry also receivesfunding through grants and contracts with university, state, andnational researchers investigating cancer-related topics.With 2019 Cancer in Iowa, the Registry makes a general report to thepublic on the status of cancer. Beginning this year, maps are delineatedby urban/rural status to help understand any potential disparity bygeographic region. This report focuses on: new cases and cancer deaths by county and top 10by cancer site and sex estimates of the number of cancer survivors cancer versus heart disease as the leading cause of death a special section on HPV-related cancers a section on SEER data and the opportunity for research2
Estimates for New Cancers in 2019In 2019, data will becollected on an estimated18,100 new, invasivecancers (and in situbladder cancers) amongIowa residents. Estimatesof new cancers are givenby county with shadingby urban/rural statusas well as the top 10by sex, 50APPANOOSE80RURALNew Cancers in FemalesTYPESMALL 514595135CLINTON320WASHINGTONLOUISA60HENRY125VAN BURENJACKSONCEDAR610JEFFERSON585JONESLINN155SMALL URBAN Urban populationof 2,500 to 20,000 or more, adjacentor not adjacent to a metro areaLARGE URBAN Counties in metroarea of fewer than 250,000 or up to1 million WESHIEK22590BLACK HAWK BUCHANANTAMAJASPER110150120245WINNESHIEK URAL Completely rural orless than 2,500 urban population,adjacent or not adjacent to ametro areaCALHOUN65HARRISONBased on the 2013 Rural-UrbanContinuum Codes, Iowa countieswere classified 0BUENA VISTA POCAHONTAS HUMBOLDTIDA545WINNEBAGOKOSSUTHPALO ALTO10585WOODBURY75CLAY95160EMMET145DES MOINES275LEE230LARGE URBANNew Cancers in Males# OF CANCERS % OF TOTALTYPE# OF CANCERS % OF Lung1,28013.9Colon & Rectum7808.8Colon & Rectum8509.3Uterus6307.1Bladder6407.0Skin Melanoma4505.1Skin Melanoma5606.1Thyroid3604.0Kidney & Renal Pelvis4705.1Non-Hodgkin Lymphoma3303.7Non-Hodgkin Lymphoma4004.3Leukemia2703.0Leukemia4004.3Kidney & Renal Pelvis2602.9Oral Cavity3303.6Pancreas2502.8Pancreas2702.9All Others1,97022.1All Others1,95021.2Total8,900Total9,2003
Living with CancerA follow-up programtracks more than 99%of cancer survivorsdiagnosed since 1973.According to Iowa CancerRegistry incidenceand survival data for1973-2014, there are147,700 cancer survivors(defined as peoplewho are currently livingwith or previously hadcancer)—67,940 malesand 79,760 females.The following graphicsshow survivorship bycounty and urban/ruralstatus as well as by cancertype and sex, GGOLD320RURALFemale SurvivorsWINNESHIEK ALLAMAKEE7201,280980BLACK HAWK BUCHANANDELAWARE6,260 LAS230420830830JASPERBENTONPOWESHIEK2,280 17,590 70 3,390 2,040 1,020 1,280 9,880 400700GREENE1,070740 SSUTH560460 620MONONAWINNEBAGOBUENA VISTA POCAHONTAS HUMBOLDTIDA4,630570PALO WA880MAHASKAKEOKUK2,150 1,570 1,010 ANOOSE690SMALL ATINE8,1001,0702,080SCOTTLOUISAHENRY980VAN BUREN530DES MOINES2,240LEE390 1,910LARGE URBANMale 1,40039.4Prostate25,74037.9Uterus7,5309.4Colon & Rectum7,12010.5Colon & Rectum7,3309.2Bladder4,9907.3Skin Melanoma5,2306.6Skin Melanoma4,7907.0Thyroid4,9606.2Non-Hodgkin Lymphoma3,3504.9Non-Hodgkin Lymphoma3,0503.8Kidney & Renal Pelvis2,7704.1Lung & Bronchus2,5003.1Oral Cavity & 0302.5Leukemia2,3603.5Kidney & Renal Pelvis1,9602.5Lung & Bronchus2,2203.3All Others11,40014.3All Others9,56014.1Total79,7604Total67,940
Estimates for Cancer Deaths in 2019In 2019, an estimated6,400 Iowans will die fromcancer. Heart disease andcancer are the leadingcauses of death in Iowa.These projections arebased upon mortalitydata the Iowa CancerRegistry receives fromthe Iowa Department ofPublic Health. Estimatesof cancer deaths arepresented by countywith urban/rural shadingas well as the top 10by sex, LORRINGGOLDDECATURWAYNEAPPANOOSEDAVISVAN BUREN203515RURAL3020202025202535SMALL OUISA25HENRY50DES MOINES105LEE95LARGE URBANCancer Deaths in FemalesCancer Deaths in MalesTYPETYPE# OF CANCERS % OF AMAJASPER25BLACK HAWK BUCHANAN3590POLK3550MARSHALL125WINNESHIEK 2020BUENA VISTA POCAHONTAS HUMBOLDTIDA205WINNEBAGOPALO ALTO4035WOODBURY30CLAY3555EMMET45# OF CANCERS% OF 010.3Colon & Rectum2709.0Colon & dgkin Lymphoma1103.7Non-Hodgkin idney & Renal Pelvis1103.2Multiple myeloma702.3Liver1103.274024.6All Others82024.1All OthersTotal3,000Total3,4005
Leading Causes of DeathHeart disease has been the leading cause ofdecline in smoking, treatment of heart disease riskfactors such as lowering cholesterol levels and bloodpressure levels, improved treatment after a cardiacevent such as a heart attack, and increased physicalactivity. The decline in cancer deaths is attributableto the decline in deaths from cancers of the lung andprostate in males, breast cancer in females, and acontinued decline in colorectal cancer deaths in bothmales and females. Heart disease and cancer sharemany risk factors including tobacco use, obesity, andphysical inactivity. Objectives focusing on risk factors,early diagnosis/use of screening guidelines, and accessto health care may lead to further reductions in deaths.death in the US for more than a century. While heartdisease remains the leading cause of death overall,cancer has overtaken heart disease in many states.Cancer was the leading cause of death in two statesin 2000, but in 22 states in 2014.1Cancer is expected to surpass heart disease as theleading cause of death in the US by 2020.2 In Iowa, thisshift began in 2007, as shown in the graphic below.Heart disease mortality rates have declined 63% in Iowasince 1973 while cancer mortality rates have decreased13% during this same time period. Much of the declinein heart disease mortality can be explained by theAge-adjusted mortality rates,Iowa, 1973-2016190180Age-adjusted rate per 100,000 person-years5004501704001603503001502502007 2008 20092010 20112012 2013 2014150Heart 2013 2016Several type of infectious agents are associated with cancer. These include Hepatitis B & CViruses, Human Immunodeficiency Virus, Human Papillomaviruses, Human T-Cell Leukemia/LymphomaType1901 Virus, Kaposi Sarcoma-associated Herpesvirus, and Merkel Cell Polyomavirus. Bacteria, such asHelicobacter pylori, and parasites, including Opisthorchis viverrini and Schistosoma hematobium, arealso associated with specific types of cancer. Given this, we have elected to discuss cancers associatedwith Human Papillomaviruses in this year’s report.18061702016Detail highlighting years 2007-201620002015
Human Papillomavirus (HPV) Related CancersHuman Papillomavirus (HPV) is a group of virusesthat includes more than 150 different high- and low-risktypes. High-risk HPV types can cause cancer in additionto inflammatory lesions. In the US, about 79 millionpeople are currently infected with HPV, and about 14million will become newly infected with HPV each year,3making HPV the most common sexually transmittedinfection. Most sexually active men and women willbe infected with HPV at some point in their lives andmost will never know they have been infected. A vaccineto prevent HPV was introduced in 2006. The HPV vaccinecould prevent 90% of HPV-related cancers every year.HPV and CancerIn the US, HPV causes nearly 34,000 cases of cancereach year. In addition, about 300,000 US women undergoinvasive treatment for cervical precancers (cell changeson the cervix that might become cervical cancer if theyare not treated) caused by HPV. Currently, women aremore likely than men to be diagnosed with HPV cancers,however the burden of HPV cancers among men isFigure AAge-adjusted rate per 100,000 person-years1816increasing, largely driven by increases in HPV-positiveoropharyngeal cancers over the past three decades.In the US, the number of oropharyngeal cancersattributed to HPV is now higher than the number ofcervical cancers. In Iowa, this trend is also evident.Figure A provides age-adjusted incidence rates ofHPV-related cancers in Iowa by sex from 1973-2016.Cervical cancer rates have been decreasing in Iowasince 1973, although rates have increased slightlywithin the last few years. As seen nationally, the rate ofmale oropharyngeal cancer in Iowa has been steadilyincreasing over time, especially from the mid-1990son. Since 1987, the rate of other female HPV-relatedcancer has been steadily increasing, and since 2002,has mimicked that of male oropharyngeal cancer.Of the HPV-related cancers in Iowa, oropharyngealcancer makes up the largest proportion of HPV-relatedcancers (38%). Of these, 82% are male. Uptake of theHPV vaccine has been slow. The Iowa HPV vaccinationrate was only 38% in 2017. As vaccination rates increase,HPV-related cancer incidence rates will decrease.Age-adjusted incidence rates of HPV-relatedcancers by sex, Iowa, 1973-20161940sPap test is introducedCervix (squamouscell carcinoma,adenocarcinoma, andother carcinoma of cervix)2006HPV vaccineapproved14Oropharynx(squamous cell carcinomaof base of tongue,pharyngeal tonsils, anteriorand posterior tonsillarpillars, glossotonsillarsulci, anterior surface ofsoft palate and uvula,and lateral and posteriorpharyngeal walls)121086Other female HPV-related(squamous cell carcinomaof the vulva, vagina, anus,rectum, and ervical cancerOther female HPV-related cancer1993-961997-002001-042005-082009-12Male oropharyngeal cancer2013-16Other male HPV-related(squamous cell carcinomaof the penis, anus,and rectum)Other male HPV-related cancer7
There are rural/urbandifferences with regard to thetrend in incidence over timefor HPV-related cancers. Asshown in Figure B, there wasa distinctly higher annualaverage percent change inmale oropharyngeal cancerincidence in rural areaswhen compared to moreurban areas. Conversely, thedecreasing annual averagepercent change in cervicalcancer incidence was less inrural areas when comparedto larger urban centers.Figure C provides the 5-yearrelative survival of maleoropharyngeal, cervical, andother female HPV-relatedcancer by stage in Iowa from2008-2014. Localized stagemeans the cancer is only inthe area where it started andhas not spread. Regionalstage means the cancer hasspread to nearby tissues orlymph nodes. Distant stagemeans the cancer has spreadto distant sites in the body,such as the lungs or liver.8Figure BTrends in HPV-related cancer incidenceby geographic area, Iowa, 1997-2016Cervical cancerPopulation DensityOther femaleHPV-relatedcancerMale oropharyngealcancerAverage annual % Average annual % Average annual %change (95% CI*) change (95% CI) change (95% CI)Rural-1.4 (-4.7, 2.0)2.3 (-0.7, 5.5 )7.2 (4.4, 10.1 )†Small Urban-1.1 (-2.2, 0)3.4 (2.4, 4.5)†4.2 (2.9, 5.6)†Large Urban-1.7 (-3.0, -0.4)†2.0 (0.6, 3.4)†3.7 (2.7, 4.8)†State of Iowa-1.5 (-2.5, -0.5)†2.6 (1.9, 3.4)†4.3 (3.5, 5.1)†* CI Confidence Interval; 95% CI means that one can be 95% confident that thetrue population mean is between the lower and upper values of the interval† Statistically significant difference from 0 (no change) at p-value 0.05Figure C5-year relative survival of selectedHPV-related cancers by stage, Iowa, 2008-201495%100908083%78%75%70PercentWhile most high-risk HPVinfections are cleared fromthe body within two yearsin 90% of infected persons,the remaining 10% havea persistent infection.3Persistent infections canultimately lead to highgrade lesions and cancer anaverage of 5-14 years later ifundetected and untreated.The length of time it takespersistent HPV infectionsto develop into cancerlikely explains the increasein incidence rates of HPVrelated cancers even afterthe introduction of theHPV vaccine in 2006.6063%63%56%5043%40302012%100Localized Regional DistantLocalized Regional DistantLocalized Regional DistantMale oropharyngeal cancerCervical cancerOther female HPV-related cancerWhen the cancer is diagnosed at a localized stage, the 5-year relativesurvival for these cancers is very good (95% for cervical cancer, 83% formale oropharyngeal cancer, and 78% for other female HPV-related cancer).Differences were also seen in overall survival rates by geographic region.The 5-year relative survival rates for cervical, other female HPV-relatedcancer, and male oropharyngeal cancer were markedly lower in rural areascompared to small and large urban areas. Cervical cancer saw differences of61% in rural areas compared to 73% in small urban areas, rates for femaleHPV-related cancer were 57% in rural areas and 68% in large urban centers,and male oropharyngeal rates were 64% in rural areas comparedto 72% in large urban areas.
Screening and Prevention of HPV-related CancersCervical cancer is the only HPV-related cancer with arecommended and effective screening test. The Pap test(or Pap smear) has been available to women since the1940s as a method to detect potentially pre-cancerousand cancerous processes in the cervix. The decrease incervical cancer incidence rates for Iowa women is likelydue to earlier treatment of disease detected throughPap testing.In addition to the Pap test, patients can obtain a testthat looks for the specific HPV viruses that can causepre-cancerous cell changes. The United States PreventiveServices Task Force recommends screening for cervicalcancer in women 21 to 29 years with the Pap test everythree years. For women 30 to 65 years, several optionsfor screening are possible:1) A Pap test only and, with normal results,repeating every three years,2) An HPV test only and, with normal results,repeating screening tests every five years, or3) An HPV test and Pap test, and if both resultsare normal, repeating screening everyfive years.4Figure DEarly detection of cancer at the localized stage isimportant for improving relative survival. Figure Dprovides the distribution of stage at diagnosis forpatients diagnosed in Iowa between 2008 and 2014for some HPV-related cancers. Almost half (49%) of allcervical cancer patients were diagnosed with localizeddisease. Yet, only 8% of male oropharyngeal patientswere diagnosed with localized disease. There is noapproved, effective screening test for other HPV-relatedcancers such as oropharyngeal cancer. Some dentistsand doctors recommend to their patients, specificallythose who routinely use tobacco or drink alcohol, tolook in their mouths in a mirror every month to checkfor changes, like white patches, sores, or lumps. Regulardental check-ups that include an exam of the entiremouth are also encouraged for all patients as a wayto detect oropharyngeal cancers at an early stage.However, although some precancers and cancers in thisarea can be found early during visual examinations,HPV lesions tend to be located on the posterior oralcavity, an area difficult to see.5 Thus, prevention of HPVinfection and reducing the development of HPV lesionsthrough vaccination is recommended as a way to reduceoropharyngeal and other HPV-related cancers.Distribution of selected HPV-related cancersby stage at diagnosis, Iowa, 014%9%8%Localized Regional DistantLocalized Regional DistantLocalized Regional DistantMale oropharyngeal cancerCervical cancerOther female HPV-related cancer*%s do not add up to 100% because unstaged cancers are not included9
HPV VaccineAs of 2017, less than 50% of adolescents in the US werefully vaccinated against HPV, far short of the HealthyPeople 2020 goal of 80% of adolescents aged 13-15 years.In Iowa in 2017, HPV vaccination rates increased fromprevious years; however, only 38% of adolescents inIowa aged 13-15 had received a complete series ofHPV vaccine recommended for full protection. This ismuch lower than the 76% of 13-15 year olds in Iowawho received the Tdap vaccine, which protects againsttetanus, diptheria, and pertussis, which demonstratesthe crucial role providers play in improving the uptakeof the HPV vaccine. Furthermore, a gender disparityexists in Iowa regarding HPV vaccination among 13-15year olds with 42% of females having completed the HPVseries compared to 36% of males.9 This is particularlyimportant given the steady increase in male HPV-relatedoropharyngeal cancers and the lack of any effectivescreening method for those cancers.National studies indicate HPV is responsible for morethan 90% of anal and cervical cancers, 75% of vaginalcanc
estimates and projections of the cancer burden throughout the US. Beginning in 1990, about 5-10 percent of the Registry’s annual operating budget has been provided by the state of Iowa. In 2003, the University of Iowa began providing cost-sharing funds. The Registry also receives funding through grants and contracts with university, state, and
Iowa Chapter, American Academy of Pediatrics Iowa Dental Association Iowa Department of Public Health Iowa Health Care Association Iowa Hospital Association Iowa Medical Society Iowa Nurses Association Iowa Pharmacy Association Iowa Veterinary Medical Association Iowa‘s Statewide Epidemiology Education and Consultation Program State Hygienic .
Heart disease and cancer are the leading causes of death in Iowa. In 2020, an estimated 6,400 Iowans will die from cancer. These projections are based upon mortality data the Iowa Cancer Registry receives from the Iowa Department of Public Health. Estimates of cancer deaths are presented by county with urban/rural status as
Ovarian cancer is the seventh most common cancer among women. There are three types of ovarian cancer: epithelial ovarian cancer, germ cell cancer, and stromal cell cancer. Equally rare, stromal cell cancer starts in the cells that produce female hormones and hold the ovarian tissues together. Familial breast-ovarian cancer
Agricultural Biotechnology Stewardship Technical Committee (ABSTC), Iowa Corn Growers Association (ICGA), the Iowa Chapter of the American Society of Farm Managers and Rural Appraisers (ASFMRA), Iowa Farm Bureau Federation (IFBF), Iowa Independent Crop Consultants Association, Iowa Institute for Cooperatives (IIC), Iowa Soybean Association (ISA),
As the Chair and Co-Chair of the Kansas Cancer Partnership (KCP), we are pleased to provide . you with the 2017-2021 Kansas Cancer Prevention and Control Plan. This plan is the result of . Breast Biopsies Breast Cancer Cervical Cancer Colorectal Cancer Lung Cancer Prostate Cancer. Post-Diagnosis & Quality of Life throughout the Cancer Journey.
cancer, pancreatic cancer, breast cancer, lung cancer, liver cancer, kidney cancer, brain cancer & brian tumors, lymphoma, blood diseases, bone cancer & all types of viruses Used externally as a skin cancer treatment, treating carcinoma, melanoma, warts, moles & as a drawing salve People with in-operable cancers sent home to die have used black
Mary Charlton PhD, University of Iowa College of Public Health, Iowa Cancer Registry Jason Daniel-Ulloa MPH, PhD, University of Iowa College of Public Health Gabbi Dewitt BA, Black Hawk County Health Department Cindy Fiester BA, BSN, RN, Linn County Public Health Kimberly Ivester MS, BSN, RN OCN, Helen G. Nassif Community Cancer Center
Tier 3: Florida-based cancer centers in pursuit of designation as either a NCI-designated Cancer Center or NCI-designated Comprehensive Cancer Center Currently, there are three participating cancer centers: H. Lee Moffitt Cancer Center, University of Florida Shands Cancer Hospital, and University of Miami Sylvester Comprehensive Cancer Center.
