CANCER IN IOWA - University Of Iowa
CANCER IN IOWA2020
The State Health Registry of IowaTwo in five Iowanswill be diagnosed with cancer in their lifetimes.Cancer is a major burden in Iowa and throughout the U.S. Reducing the nation’scancer burden requires the cooperation of many people, including physicians,researchers, public health professionals, policy makers and advocates, amongothers. All these people rely on cancer data in their effort to reduce this burden.Because of the critical need for data, cancer is a reportable disease in all 50states. In Iowa, cancer data are collected by the State Health Registry of Iowa,also known as the Iowa Cancer Registry (ICR).Since 1973 the ICR has been funded by the prestigious Surveillance, Epidemiology,and End Results (SEER) Program of the National Cancer Institute (NCI), and iscurrently one of nineteen registries nationwide providing data. Iowa representsrural and Midwestern populations and provides data included in many NCIpublications and national estimates and projections of the cancer burdenthroughout the U.S. Maintaining the confidentiality of patient, physician, andhospital data located in the ICR is of paramount importance. It is the responsibilityof the ICR to maintain a balance between the need to protect the data fromunauthorized access and release, while providing researchers and others withaccess to the important information necessary to conduct studies to help reducethe burden of cancer. To this end, the ICR has policies and procedures relatedto research uses, reporting, and release of Iowa cancer data to safeguard theconfidentiality of patients, physicians, and hospitals.The existence of the ICR allows for the study of the cancer experience of Iowansand focuses national attention and research dollars on this issue. The ICR is primarilyfunded through a contract with the NCI, but the contract requires a portion ofthe funding for the ICR be obtained from non-federal sources such as the state ofIowa. The University of Iowa also provides cost-sharing funds to support the workof the ICR. Additionally, the presence of the ICR and its database have helpedattract research projects and funds to Iowa from other federal agencies andfoundations.With Cancer in Iowa 2020, the Registry makes a general report to the public onthe status of cancer. This report focuses on: New cases and cancer deaths by county and top 10 cancer types by sex Estimates of the number of cancer survivors A comparison of changes in mortality for 2012-2016 for Iowa and thenation A special section on ovarian cancer A section on questions to ask when diagnosed with cancer and ways tocope with your emotions2
Estimates for New Cancers for 2020In 2020, an estimated 18,700 new, invasive cancers (and in situ bladder cancers) will be diagnosed amongIowa residents. Estimates of new cancers are given by county with shading by urban/rural status as well as thetop 10 cancer types by sex. Based on the 2013 Rural-Urban Continuum Codes, Iowa counties were classified assmall rural, large rural, and urban as shown in the figure ISONBLACK UNION8565RINGGOLDDECATUR45MARION265CLARKE50# 100MAHASKA210LUCAS55WAYNE45NEW CANCERS IN FEMALESTYPEBreastLungColon and rectumUterusSkin melanomaThyroidNon-Hodgkin lymphomaLeukemiaKidney and renal pelvisPancreasAll 5140STORY180DALLASAUDUBON NNESHIEK65FLOYD375WRIGHTHOWARD70CERRO GORDO80POCAHONTASMITCHELL50HANCOCK80BUENA VISTAWORTH70PALO TON75WAPELLO235DAVIS50140JEFFERSON90VAN BUREN50HENRY120SCOTT1,02025560LOUISADES MOINES270LEE250SMALL RURALLARGE RURALURBANNEW CANCERS IN MALES% stateLungColon and rectumBladderSkin melanomaKidney and renal pelvisNon-Hodgkin lymphomaLeukemiaOral cavity and pharynxPancreasAll othersTOTAL# 600% OFTOTAL26.014.18.36.85.84.84.34.23.43.119.23
Living with CancerA follow-up program tracks more than 99 percent of cancer survivors diagnosed since 1973. According to IowaCancer Registry incidence and survival data for 1973-2015, there are an estimated 148,465 cancer survivors(defined as people who are currently living with or previously had cancer), 79,560 females and 68,905 males.The following graphics show the survivorship by county and urban/rural status as well as the top 10 cancer typesby sex, 1,015920LINNDUBUQUE5,010JACKSONJONES1,295 9,995 406,3057801,0251,275 3,400545390GRUNDYHARDIN825BOONEAUDUBON GUTHRIEFAYETTEBLACK 00FLOYD2,675WRIGHTHOWARD635CERRO 70PALO ALTOBUENA T1,1802,560CEDARPOLKJASPER2,360 180 1,560 PPANOOSEWAPELLO1,810DAVIS675385FEMALE SURVIVORSJEFFERSON785VAN BUREN4008,160525HENRYSMALL RURALLOUISADES MOINES975 2,230LARGE RURALLEE1,890URBANMALE SURVIVORS# OFSURVIVORS% OFTOTALTYPE# OFSURVIVORS% 709.5Colon and rectum7,10010.3Colon and rectum7,0558.9Bladder4,9757.2Skin melanoma5,4156.8Skin melanoma4,9407.2Thyroid5,1056.4Non-Hodgkin lymphoma3,4205.0Non-Hodgkin lymphoma3,0503.8Kidney and renal pelvis2,8904.2Lung2,4103.1Oral cavity and pharynx2,6053.8Cervix2,3603.0Testis2,6003.8Kidney and renal 103.2All others11,32014.2All INGTON6051,140CLINTONTOTAL68,905
Estimates for Cancer Deaths for 2020Heart disease and cancer are the leading causes of death in Iowa. In 2020, an estimated 6,400 Iowans will diefrom cancer. These projections are based upon mortality data the Iowa Cancer Registry receives from the IowaDepartment of Public Health. Estimates of cancer deaths are presented by county with urban/rural status aswell as the top 10 cancer types by sex, ARE502603550STORY60AUDUBON GUTHRIE3035BOONEGRUNDYHARDIN40BUCHANANBLACK IGHTHOWARD30CERRO GORDO20POCAHONTASMITCHELL20HANCOCK30BUENA VISTAWORTH20PALO S40# OFDEATHS55JEFFERSON45VAN BUREN203025HENRY3534090WASHINGTON25MONROECANCER DEATHS IN FEMALESTYPEKEOKUKSMALL RURALLOUISADES MOINES100LARGE RURALLEEURBAN90CANCER DEATHS IN MALES% OFTOTALTYPE# OFDEATHS% 40011.8Colon and rectum2809.3Colon and 1103.7Non-Hodgkin lymphoma1404.1Non-Hodgkin lymphoma1003.3Bladder1203.5Brain802.7Kidney and renal pelvis1103.2Myeloma602.0Brain1103.2All others76025.3All others87025.7TOTAL3,000TOTAL3,4005
Trends in Cancer Death RatesThe average annual percent change (AAPC) is a summary measure that allows the use of a single number todescribe the average of annual percent changes over a period of multiple years. Below, AAPCs are presentedby sex for mortality rate changes in the top 10 cancers in Iowa compared to the nation between 2012 and2016.1 In Iowa, most of these cancers have seen decreases in the AAPC except for uterine cancer in females,esophageal cancer in males, and pancreatic cancer in both sexes. The largest decreases in AAPC in Iowahave been seen in prostate cancer in males and non-Hodgkin lymphoma in females. For the most part, Iowaand national AAPCs are moving in the same direction with the greatest AAPCs across the nation being seen forlung cancer in both sexes. However, national data show substantially larger decreases in lung cancer in bothsexes compared to Iowa data. Conversely, Iowa data show much larger decreases in prostate and bladdercancer in males compared to national data.FEMALE 2012-2016-5-4-3-2-1012Average Annual Percent ChangeMALE ukemiaKidney and renal pelvisAll sitesProstateBreastEsophagusMyelomaAll sitesColon and rectumNon-Hodgkin lymphomaOvaryColon and rectumNon-Hodgkin Average Annual Percent Change3IowaNationalAAPCs FOR TOP 10 CANCERS IN 0Lung-4.3-2.1Non-Hodgkin lymphoma-2.6-3.0Leukemia-2.6-1.4Ovary-2.3-1.9Colon and rectum-2.0-2.9Colon and rectum-1.6-2.1Non-Hodgkin lymphoma-2.0-1.7Myeloma-1.6-1.1All sites-1.8-1.3Breast-1.5-1.8Esophagus-1.10.3All y and renal 50.0Pancreas0.20.8Uterus2.31.4Brain0.6-0.1
Ovarian CancerAmong cancers of the female reproductive system, ovarian cancer is the deadliest. It is estimated that 13,940women will die of ovarian cancer in the United States in 2020.2 While it is the 11th most common cancer inwomen, it is the 5th leading cause of cancer-related deaths.The ovaries are a pair of organs that are part of the reproductive system in women. Each ovary is about thesize and shape of a walnut and is covered by a layer of tissue made of epithelial cells. Approximately 90% ofovarian cancers start in epithelial cells. Type I epithelial ovarian cancers often present at an early stage andtypically have a good prognosis. Type II epithelial ovarian cancers typically present at an advanced stageand have a poorer prognosis.3 Non-epithelial ovarian cancers are typically less aggressive than epithelialcancers.4 Figure 1 displays ovarian cancer cases in Iowa by cell type for diagnosis years 2008-2017, resulting in abreakdown of 20% Type I epithelial, 70% Type II epithelial, and 10% non-epithelial.Figure 1. Ovarian cancer by subtype, diagnosis years 2008-2017, IowaType I epithelial0%10%20%Type II epithelial30%40%50%60%Non-epithelial70%80%mixed mesodermalsquamousclear cellmucinousundifferentiatedother non-epithsex cordlow grade serousendometrioidhigh grade serousgerm celltrans cell (Brenner)90%100%non-specificIncidence and MortalityIn 2020 in the U.S., an estimated 21,750 new cases of ovarian cancer will be diagnosed.2 A woman’s risk ofgetting ovarian cancer in her lifetime is about 1 in 78.4 The incidence of ovarian cancer has decreased 36%in Iowa from 1988-1992 to 2013-2017 as shownFigure 2. Age-adjusted incidence and mortality rates,in Figure 2. Some of this decrease is the result ofovarian cancer, 1973-2017, Iowadecreased use of menopausal hormones after a18Mortality16141210864201973-719 778-821983-871988-919 293-971998-020 203-072008-122013-17Mortality rates in Iowa have decreased 35%from 1973-1977 to 2013-2017 due in part to thedecrease in new cases of ovarian cancer aswell as advances in treatment.4 Mortality rateswould improve if more cases of ovarian cancercould be detected at an earlier stage, before thedisease has spread to other parts of the body, butunfortunately no effective screening methods havebeen identified.IncidenceRate per 100,000 populationlandmark report in 2002 linked menopausal use ofestrogen plus progestin therapy to an increasedbreast cancer risk.4 Another contributing factor inthe decrease in ovarian cancer is the increaseduse of oral contraceptives (i.e., birth control pills),which lowers one’s risk of ovarian cancer.47
StagingCancer staging is the process of determining how far cancer has grown and spread in the body at the time ofdiagnosis. Ovarian cancer stages are numbered from 1 to 4 and generally, earlier cancer stages have betteroutcomes.Stage I: tumor limited to one ovary only or limited to both ovariesStage II: spread of ovarian tumor to other pelvic organs (the uterus, for example) and/or pelvic tissueStage III: spread of ovarian tumor to abdominal lining tissue, abdominal organs (the liver capsule, for example),and/or abdominal lymph nodesStage IV: spread of ovarian tumor beyond any location in the pelvis or abdomen (to the lungs, for example)Figure 3 shows the breakdown of ovarian cancerstage for cases diagnosed in Iowa from 2009-2015.Only 22% of cases were detected while the cancerwas confined to the ovaries. Over half the cases(57%) were diagnosed with spread to the abdomenor to distant areas in the body.Figure 3. Ovarian cancer by stage, diagnosisyears 2009-2015, Iowa15%Figure 4 shows the 5-year relative survival rates inIowa for ovarian cancer by stage of disease atdiagnosis for years 2009-2015. When ovarian canceris detected early, when it is still confined to theovaries, the 5-year relative survival rate is 95%. Thisrate decreases in relation to how far the disease hasspread at time of diagnosis, to 73% for stage II, 35%for stage III and 18% for stage IV. Unstaged diseasehas the poorest prognosis at 9% reflective of signsand symptoms of extensive disease at diagnosiswhere staging was not performed or if deathoccurred with insufficient time for staging.22%Stage IStage II6%22%35%Relative Survival Rate100%Stage I80%Stage II60%Stage III40%Stage IV20%Unstaged0%82-yearStage IVUnstagedFigure 4. 5-year relative survival, ovarian cancer by stage, diagnosis years 2009-2015, Iowa1-yearStage III3-year4-year5-year
Screening and Clinical PresentationPreventionThere is currently no effective routine screening for ovarian cancer inasymptomatic low-risk women as the tests available have not been shownto reduce mortality from ovarian cancer.5 Screening may be beneficialhowever, for women who have hereditary cancer syndromes.Many women have one ormore risk or protective factorsfor ovarian cancer which onlymarginally increase or decreasetheir risk. Most of what is knownabout risk and protectivefactors has not translated intopractical ways to prevent mostcases of ovarian cancer. Thus,if you are concerned aboutyour risk for developing ovariancancer, it is important to talkto your doctor or healthcareprofessional.Part of the reason for the high mortality rate with ovarian cancer is thatit is often diagnosed after the disease has spread. Unfortunately, ovariancancer may not cause any early signs or symptoms, or the symptoms areoften vague, which may delay diagnosis. The most common symptoms ofovarian cancer include: feeling bloated indigestion pain in the pelvis or abdomen trouble eating or feeling full fast (satiety) feeling the need to urinate often or urgentlyIf these symptoms are new (began less than 1 year ago) and occur morethan 12 days each month, tell your doctor about your symptoms. Thegraphic below utilizes the acronym B.E.A.C.H. in recognizing the subtlesymptoms of ovarian cancer.6 Recognizing these symptoms and discussingthem with your doctor may help find ovarian cancer earlier, leading to abetter prognosis from this disease.Talk About Ovarian CancerShare the B.E.A.C.H. SymptomsBEACHBLOATINGA persistently bloated stomach is one of the key symptomsof ovarian cancer. Talk to your doctor before you dismiss thebloating as being a ‘natural body change.’EARLY SATIETYIf you have trouble eating or feeling full quickly on a consistentbasis, pay attention. Appetite changes may be symptoms ofovarian cancer.ABDOMINAL PAINPay attention if you experience persistent pressure, and/orabdominal and pelvic pain as it may be a sign of ovariancancer. You may also experience lower back pain.CHANGES IN BOWEL & BLADDER HABITSFrequent urge to urinate and/or changes in bowel movementscan be symptoms of ovarian cancer. Persistent indigestion &nausea may also be present. Pay attention.HEIGHTENED FATIGUEPersistent fatigue may be a sign of ovarian cancer, especiallywhen accompanied with other listed symptoms. If constantfatigue is interfering with your work/leisure, it may be more thanstress.Risk Factors Family history of ovariancancer Inherited risk (passeddown through genes) Hormone replacementtherapy Overweight and tallerheight EndometriosisProtective Factors(potential to lower one’s risk) Having used oralcontraceptives Having had a tubal ligation Having given birth Having breastfed Having had a salpingectomy(removal of one or bothfallopian tubes) Risk-reducing salpingooophorectomy (removal offallopian tubes and ovarieswith no signs of cancer)More information can be found evention-pdq.9
TreatmentSurgery is the primary treatment for most ovarian cancers. The National Comprehensive Cancer Networkexperts recommend that ovarian cancer surgery should be done by a gynecologic oncologist.7 A gynecologiconcologist is a surgeon who has received highly specialized training in treating cancers that start in a woman’sreproductive organs. Ovarian cancer patients treated by gynecologic oncologists have better outcomescompared to patients who are not treated by these specialists.8 The two main goals of surgery are to find outhow far the cancer has spread and to remove all or as much of the cancer from the body as possible. Surgicaltreatment often involves removing both ovaries, both fallopian tubes, and the uterus, commonly called a totalhysterectomy. If cancer has spread outside of the ovaries, the doctor will perform a debulking or cytoreductivesurgery to remove as much of the cancer as possible. Optimal debulking is linked with better treatmentoutcomes, especially if there are no visible remaining cancer cells.Most women with ovarian cancer receive chemotherapy after primary treatment with surgery. Most ofthe chemotherapy drugs used to treat ovarian cancer are usually given by an intravenous (IV) infusion.Chemotherapy can also be injected into the abdomen (peritoneal cavity) to allow higher doses of the drugs tobe delivered directly to the cancer cells in the area.Targeted therapyTargeted therapy is a type of treatment that uses drugs or other substances to identify and attack specificcancer cells without harming normal cells. Antibodies are produced in our bodies by specialized white bloodcells and can be used to kill cancer cells, block their growth, or keep them from spreading. Bevacizumabis a monoclonal antibody that can be used with chemotherapy to treat epithelial ovarian cancer that hasrecurred. Poly (ADP-ribose) polymerase inhibitors (PARP inhibitors) are targeted therapy drugs that block DNArepair and may cause cancer cells to die.A new treatment called Hyperthermic Intraperitoneal Chemotherapy (HIPEC) has shown an improvement of3.5 months in recurrence-free survival and 11.8 months in overall survival when HIPEC was added to intervalcytoreductive surgery in patients with stage III diseas
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
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 .
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.
black holes limited their own growth by unleashing torrents of energy that drove away the surrounding gas (S&T: April 2005, page 42). These waves of unrest also dictated the ebb and flow of starbirth in the host galax-ies. This feedback process forged a close link between massive black holes and their surrounding stars. This view of abrupt but dazzling mayhem in major galaxies represents a .
