Iowa health leaders urged legislative action and lifestyle changes Tuesday night in Des Moines at a presentation about cancer in Polk County, where 827 people die of cancer each year on average, according to the Iowa Cancer Registry.

Iowa has the second highest rate of newly diagnosed cancers of all U.S. states, which is 14% higher than the national rate. Polk County is one of 59 Iowa counties with a cancer rate above the national rate. The county’s cancer incidence rate ranks at No. 53 of Iowa’s 99 counties.

“About 1 in 4 Polk County residents who die every year die by cancer,” said Juliann Van Liew, director of the Polk County Health Department. “This is not something that is experienced in every county or every state across the nation. It’s worse here in Polk County. It’s worse here in Iowa.”

Mary Charlton, a professor at the University of Iowa College of Public Health, director of the Iowa Cancer Registry, and president of the Iowa Cancer Consortium, said there is no single cause of cancer; it is a combination of genetic, lifestyle and environmental risk factors.

“Risk factors are things that increase your chances of getting cancer,” she said. “Talk about lifestyle factors. We’re talking about things like alcohol, tobacco, unhealthy diet, not being physically active and sunburns. We talk about genetics. We’re talking about family history of cancer or random mutations. When we talk about the environment, immune exposure to chemicals or radiation, and there’s a lot of other factors, such as just aging increases your risk for cancer, as do viruses such as HPV and hepatitis B, and medical conditions like chronic inflammation. All of these risk factors work together to contribute to cancer.”

The presentation Tuesday is part of the Cancer in Iowa: 99 Counties Project, which is working to present county-specific cancer data in each of Iowa’s 99 counties. The project is led by the Iowa Cancer Registry and University of Iowa College of Public Health, in collaboration with the Iowa Cancer Consortium, University of Iowa Holden Comprehensive Cancer Center and the Iowa Rural Health Association. The project is funded by a federal grant from the National Cancer Institute.

Charlton said the goal of the 99 Counties Project is to enhance community engagement and education around cancer prevention and control across Iowa’s 99 counties. 

Whitney Zahnd, assistant professor at the University of Iowa College of Public Health and past president of the Iowa Rural Health Association, said Polk County has 497.8 incidents of cancer per 100,000 population, which are age-adjusted results. This amounts to around 2,600 new cancer cases on average each year in Polk County, which is higher than the U.S. average.

“And looking at cancer deaths by race and ethnicity, non-Hispanic Black, Asian/Pacific Islander and non-Hispanic white [people] have higher cancer death rates than their peers nationally,” Zahnd said. “Non-Hispanic Black individuals have the highest rate in the county.”

A total of 357.9 Black males died of cancer per 100,000 population in Polk County, compared to 189.1 white males, according to registry data.

“The extent to which cancer affects us isn’t experienced the same across our community,” Van Liew said. “We have differential exposure, income, transportation, education, housing, environmental exposure, all of these social conditions that are leading to inequitable cancer-related health outcomes for those who are low-income, those in certain ZIP codes, those folks … by and large our communities of color.”

Zahnd also said there were 400 new cases per year of female breast cancer in Polk County, and about 54 deaths on average, with a higher incident rate for white women.

“We encourage … women who are ages 40 to 74 to get a screening with a mammogram every two years, and to have that conversation with your doctor about family history as well,” she said.

According to the registry, breast cancer is the top cancers diagnosed in Polk County followed by prostate and lung cancer.

“We see that [prostate cancer], both for incident rate and death rate, is about the same as the U.S. average over 291 new cases on average per year, 41 deaths for prostate cancer,” Zahnd said. “Very starkly, we see a very high rate of prostate cancer among Black men here in Polk County, and similarly, a high mortality rate for prostate cancer.” 

For lung cancer, data shows 330 cases in Polk County per year and 202 deaths per year.

“We see both for Black and white individuals, both of those rates for incidence and mortality are higher than the national average for lung cancer,” she said. 

Zahnd pointed to a “relatively new” screening for lung cancer.

“This is recommended for folks based upon their age and their smoking history,” she said.

She said radon is also a leading cause of lung cancer, and the leading cause among people who are not smokers.

“We also see that combination of both smoking and radon exposure putting smokers at particularly high risk of developing lung cancer, so we encourage folks to connect with Iowa Health and Human Services, the Iowa Cancer Consortium for more information about testing and mitigating for lung cancer,” she said.

Charlton said about 40% of cancers in the U.S. are attributable to modifiable risk factors like smoking, alcohol and diet. 

She said 15% of people in Polk County smoke.

“A lot of the counties that I’m visiting, they’re actually starting to tick up in their smoking rates, and one study projected that Iowa will have one of the highest rates of smoking in the country by 2030 if we don’t do anything,” she said.

Charlton said a tobacco tax is “the most evidence-based, single most effective intervention you can do to prevent cancer.”

“After the last tobacco tax was passed way back in 2007, smoking rates decreased in 92% of Iowa’s counties, and Polk County is no exception,” she said.

Another key preventative factor is to get active, Charlton said. 

Almost a quarter of Polk County residents — 23.7% — report no physical activity outside their job, data shows. Binge drinking and smoking also have higher prevalence in Polk County and Iowa compared to the national average.   

Charlton also pointed out that Iowa is one of the only states in the country that has zero restrictions on minors’ use of tanning beds. 

“The UV radiation you get from tanning beds is way more intense,” she said.

The Iowa Cancer Registry is a population-based cancer registry created in 1973, which publishes the Cancer in Iowa report among other cancer data. The registry is funded in part with federal funds from the National Cancer Institute (National Institutes of Health) and Department of Health and Human Services, according to the presentation.

The Iowa Cancer Consortium is a statewide coalition, with more than 60 organizational members, that is working to affect cancer prevention, early detection, treatment and quality of life. The presentation said the consortium’s funding comes from Centers for Disease Control and Prevention funding that is awarded to the Iowa Department of Health and Human Services.

To view the slides from the presentation, click here.