Poweshiek County cancer session highlights screening and prevention needs

Contributed by lowa Cancer Registry

Iowa has the second highest rate of new cancers in the United States. In contrast, Poweshiek County is one of few counties in Iowa with a cancer incidence rate similar to the U.S. average.

The county still has a higher percentage of cases of melanoma cancer than the average for Iowa and the U.S.

These statistics were presented for more than 20 people attending a recent Cancer in Iowa: 99 Counties Project session to discuss cancer trends in Poweshiek County.

The event that happened on Wednesday, Nov. 14, was hosted by the Iowa Cancer Registry and the University of Iowa College of Public Health with support from the Iowa Cancer Consortium, Holden Comprehensive Cancer Center and Iowa Rural Health Association.

The 99 Counties Project is a public health initiative designed to improve cancer education and engage communities across the state, according to the official website. The project presents county-specific reports showing rates of new cancers and cancer deaths compared with state and national averages, along with risk factor data from the Center for Disease Control’s (CDC) Behavioral Risk Factor Surveillance System.

“Every person, every row of data in our database, was a person who went through a diagnosis of cancer, and have family and friends and other loved ones that went through that journey with them,” said Mary Charlton, professor in the College of Public Health at the University of Iowa, director of the Iowa Cancer Registry and the elected president of the Iowa Cancer Consortium.

Iowa’s rate of new cancers in the United States is 14 percent higher than the U.S. rate, Charlton said. 

Over half of Iowa’s counties have a higher incidence rate, or rate of new cancer cases, than the U.S. rate. Poweshiek County is in the minority with rates that are similar to the rest of the country.

Each year, according to data from 2018 to 2022, there are about 126 new cancer diagnoses in Poweshiek County, said Amanda Kahl, an epidemiologist at the Iowa Cancer Registry.

Compared with other counties, Poweshiek ranks 76th out of 99 on cancer diagnosis and 73rd out of 99 for mortality, with 99 being the county with the fewest new cases and deaths. 

Breast Cancer

There are about 17 new cases of female breast cancer each year in Poweshiek County, a number that is statistically similar to what is seen at the national level. There are less than six deaths per year from female breast cancer.

According to Kahl, 76 percent of women in Poweshiek County are up-to-date with their breast cancer screening, a number slightly lower than Iowa’s 80 percent screening rate for breast cancer. 

“We want to promote breast cancer screening so we can find breast cancer in an earlier stage, when it’s easier to treat and has higher survival rates,” Kahl said.

In Poweshiek County, 65 percent of female breast cancers were diagnosed at an early stage and 35 percent were diagnosed at a late stage. 

“This late stage proportion is slightly higher than what we see at the state of Iowa level, where only 31 percent of female breast cancers were diagnosed at a late stage, and it’s also slightly higher than what we see for the U.S.,” Kahl said.

A state program, the Care for Yourself Breast and Cervical Cancer Program, provides free or low-cost breast and cervical cancer screenings to eligible Iowans.

Prostate Cancer

Each year, Poweshiek County sees about 17 new cases of prostate cancer, a rate that is similar to the national level. Fewer than six men die from the disease annually, making the local mortality rate too small to calculate reliably. 

Screening for prostate cancer is done through the prostate-specific antigen (PSA) blood test. Men between the ages of 55 and 69 are encouraged to discuss with their doctor whether a PSA test is right for them. 

“With screening we are able to find cancers at an earlier stage, when they’re easier to treat and have higher survival rates,” Kahl said.

In Poweshiek County, 66 percent of prostate cancers were diagnosed at an early stage, while 34 percent were diagnosed at a late stage. This proportion of late-stage diagnoses is nearly 10 percentage points higher than what is seen at both the state and national levels.

Lung Cancer

Poweshiek County records about 17 new cases of lung cancer each year, a rate comparable to the national average. There are roughly 11 deaths from lung cancer annually and the local mortality rate is similar to the U.S. level.

Screening is recommended for adults aged 50 to 80 who have smoked within the past 15 years. Only 17 percent of eligible Iowans have been screened for lung cancer, a rate just slightly higher than the national level. “This is a relatively new cancer screening guideline, and so there’s still work to be done around educating people about this,” Kahl said.

Stage distribution in Poweshiek County shows that 27 percent of lung cancers were diagnosed at an early stage, while 73 percent were diagnosed at a late stage. This pattern is similar to the national trend, with slightly fewer late-stage cases than the statewide average.

Smoking is the leading cause of lung cancer, with radon exposure as the second leading cause, Kahl said.

Colorectal Cancer

Poweshiek County sees about 12 new cases of colorectal cancer each year, a rate comparable to the national average. Fewer than six deaths occur annually, and mortality rates are similar to those seen statewide and nationally.

Current screening guidelines recommend that adults ages 45 to 75 undergo testing, either with an at-home stool test or a colonoscopy. In Poweshiek County, 67 percent of adults in this age range are up to date on screening, similar to the national average and slightly below Iowa’s state rate.

Stage data shows that 35 percent of colorectal cancers in the county are diagnosed at an early stage, while 65 percent are diagnosed at a late stage. This proportion of late-stage diagnoses is higher than both state and national averages. Iowa’s Get Screened Colorectal Cancer Program works with local health agencies and federally qualified health centers to increase screening rates.

Melanoma cancer

Each year, Poweshiek County sees about nine new cases of melanoma, a rate significantly higher than the U.S. average. Fewer than six deaths occur annually and mortality remains very low statewide and nationally.

Melanoma does not have an official screening guideline, but self-exams are recommended. Residents should watch for new or changing spots on the skin and consult a doctor if any appear suspicious, Kahl said.

In Poweshiek County, 85 percent of melanomas are diagnosed at an early stage, a proportion similar to the state and national averages. 

Since about 92 percent of melanoma cases are linked to UV exposure, preventive measures include wearing broad-spectrum sunscreen, covering up with clothing and hats and avoiding indoor or outdoor tanning. Even a single tanning session can increase melanoma risk by 20 percent. Iowa does not restrict tanning bed use for minors, Kahl said. 

Risk factors and prevention

Charlton said cancer has no single cause, resulting from a mix of genetic, lifestyle and environmental factors that affect how cells grow and divide.

Risk factors are the things that increase your chances of getting cancer, such as tobacco, alcohol, unhealthy diet, not being physically active and getting sunburns from either being outside or using tanning beds. 

“There’s typically many years between exposure to risk factors and cancer development, which makes it really difficult to prove connections,” Charlton said. “If you suspect a cancer cluster in your community … please do reach out to the Iowa Cancer Registry.”

Kahl also emphasized the importance of the HPV vaccine, which offers safe, effective and long-lasting protection against the virus, helping to reduce cancer risk. The vaccine is recommended for children at ages 11 or 12 but can be given as early as age nine.

In Poweshiek County, only 56 percent of adolescents are up to date with their HPV vaccine series.