Iowa has the second-highest rate of new cancer cases in the United States, with a rate 13% higher than the national average over the past five years, according to the Iowa Cancer Registry. Locally, Clayton County ranks 83rd among Iowa’s 99 counties, with first representing the highest rate.
These statistics were among the information shared when the Cancer in Iowa: 99 Counties Project came to Clayton County in September. Speakers shared state and county-specific data, provided resources, recommended actions, listened to attendees’ concerns and answered questions.
The cooperative project is organized by the Iowa Cancer Registry, Iowa Cancer Consortium, Iowa Rural Health Association, University of Iowa Holden Comprehensive Cancer Center and Iowa Department of Health and Human Services, with a goal of enhancing community engagement and action around cancer prevention across Iowa’s 99 counties.
Mary Charlton, PhD, director of the Iowa Cancer Registry and professor at the University of Iowa College of Public Health, and Amanda Kahl, MPH, an epidemiologist with the Iowa Cancer Registry, led the presentation.
As they introduced the project, Charlton recognized the weight of the information by sharing a quote from Dr. Irving Selikoff: “Statistics are people with the tears wiped away.”
“We recognize the numbers we share are your friends, family and loved ones here in Clayton County and the rest of the state of Iowa,” she added.
While Iowa ranks second nationally in new cancer cases, it ranks 23rd in cancer deaths. Of Iowa’s 99 counties, 64 have cancer incidence rates above the national average, while the remaining counties, including Clayton County, have comparable rates.
In Clayton County, home to approximately 16,800 residents, there are around 135 new cancer diagnoses and 45 deaths each year.
Charlton explained the complexity of cancer, noting there is no single cause, but rather a combination of genetic, lifestyle and environmental factors that can contribute to its development. Risk factors include tobacco and alcohol use, unhealthy diet, physical inactivity, sun exposure, family history, genetic mutations, exposure to chemicals and radiation, aging and certain medical conditions.
The presentation compared incidence rates, mortality rates and stages at diagnosis for the five most common types of cancer in Clayton County: prostate, female breast, lung, colorectal and uterine. Due to the county’s small population and number of cases, local rates generally remain comparable to national averages.
Cancer by type
Each year, approximately 22 new cases of prostate cancer are diagnosed in Clayton County, with fewer than six deaths. Iowa’s incidence rate is approximately 12% higher than the national average, with 133 new cases per 100,000 people compared to 119 nationally. Despite the higher incidence rate, mortality rates remain relatively consistent across Clayton County, the state and the nation.
Prostate cancer screening is done through a prostate-specific antigen (PSA) blood test. Men ages 55 to 69 are encouraged to discuss the benefits and risks of screening with their health care provider.
In Clayton County, 30% of prostate cancer cases are diagnosed at a late stage, compared to 24% statewide and nationally. Cancers diagnosed at an earlier stage are generally easier to treat and have higher survival rates.
For female breast cancer, Clayton County sees approximately 16 new cases annually, with fewer than six deaths. Incidence and mortality rates are comparable to state and national averages.
Breast cancer screening through a mammogram every two years is recommended for women ages 40 to 74. Nationally, approximately 77% of women ages 50 and older are up to date on screenings, compared to 80% in Iowa and 75% in Clayton County. The Iowa Cancer Plan has set a goal to increase the state’s screening rate to 81.4% by 2027.
Clayton County also has a higher percentage of breast cancer cases diagnosed at a late stage, making up 42% of diagnoses, compared to 30% statewide and 32% nationally.
One program working to increase screening rates is Iowa’s Care for Yourself – Breast and Cervical Cancer Program, which provides free or low-cost screenings to eligible Iowans ages 21 to 64 with household incomes below 250% of the federal poverty level.
Each year, approximately 15 new cases of lung cancer are diagnosed in Clayton County, with about seven deaths. While the county’s rates are comparable to the national average, Iowa’s incidence rate is approximately 15% higher than the national average and its mortality rate is 11.6% higher.
Lung cancer screening includes a low-dose CT scan, recommended for eligible adults ages 50 to 80 with a significant smoking history who currently smoke or have quit within the past 15 years. In Iowa, only 20% of eligible individuals have been screened.
Unlike prostate and breast cancer, the majority of lung cancer cases are diagnosed at a late stage. In Clayton County, 67% of cases are diagnosed at a late stage, comparable to 69% statewide and 68% nationally.
Smoking is the leading risk factor for lung cancer, followed by radon exposure. Radon, a colorless, odorless gas that can build up in homes, is the leading cause of lung cancer among people who do not smoke. The combination of smoking and radon exposure further increases the risk by 10 to 20 times, according to information provided at the meeting.
Clayton County Public Health has partnered with Fayette County Public Health through the Combat Cancer initiative to distribute free radon test kits to Clayton County residents. Qualifying residents may also be eligible for financial assistance with radon mitigation if testing reveals high levels.
For colorectal cancer, Clayton County sees approximately 10 new cases annually, with fewer than six deaths. Rates of new diagnoses and deaths are comparable to the national average.
Colorectal cancer screening is recommended for adults ages 45 to 75, with options including at-home stool-based tests and colonoscopies. In Clayton County, only 66% of eligible individuals are up to date on screenings, while the Iowa Cancer Plan’s goal is 80%.
Additionally, 66% of colorectal cancer cases in Clayton County are diagnosed at a late stage, compared to 62% statewide. Iowa Get Screened, a colorectal cancer screening program, works with federally qualified health centers and local public health agencies to increase screening rates.
The final cancer discussed was uterine cancer, with fewer than six new diagnoses and fewer than six deaths each year in Clayton County.
Unlike the other cancers discussed, there is no routine screening test recommended for uterine cancer in people without symptoms. Symptoms include abnormal vaginal bleeding or discharge, particularly after menopause, painful or difficult urination, pain during sexual intercourse and pelvic pain. Individuals experiencing these symptoms are encouraged to talk with their health care provider.
In Clayton County, approximately 70% of uterine cancer cases are diagnosed at an early stage.
Cancer risk factors and prevention
About 40% of cancers in the United States are attributed to modifiable risk factors, including smoking, alcohol consumption and diet.
Kahl explained that determining the cause of cancer in an individual is difficult because people are exposed to many different risk factors throughout their lives.
“There are very healthy people who did everything right and were still diagnosed with cancer. Conversely, there are people who lived unhealthy lives and were not diagnosed. While we can’t eliminate our risk, there are things we can do to reduce it,” Kahl added.
Actions that can help reduce cancer risk include avoiding tobacco, limiting alcohol, maintaining a healthy diet and weight, being physically active, reducing exposure to air pollution, using sun protection, receiving recommended vaccinations and staying up to date on cancer screenings.
Speakers also shared data on human papillomavirus (HPV), an infection that can cause several types of cancer. Iowa has the highest rate of oropharyngeal cancer, which affects the back of the throat, in the United States. Approximately 70% of these cancers are associated with HPV infection.
The HPV vaccine provides safe, effective and long-lasting protection against HPV-related cancers. Vaccination is recommended at ages 11 or 12, before potential exposure to the virus.
In Clayton County, only 43% of adolescents have completed the HPV vaccine series, compared to 54% statewide. The Iowa Cancer Plan has set a goal of reaching 80% by 2027.
In the 1990s, approximately 25% of Iowans reported smoking. Following increases in tobacco taxes and other prevention efforts, that rate has declined to 14.7% statewide and 12.2% in Clayton County.
Other risk factors discussed included binge drinking, smoking, physical inactivity and obesity. Clayton County ranks 72nd in binge drinking and 77th in smoking among Iowa’s 99 counties. For obesity, the county ranks 20th.
One statistic that stood out was Clayton County’s ranking of fourth in the state for no leisure-time physical activity, with approximately 31% of residents reporting none.
“You all live in the most beautiful county in Iowa, with beautiful parks and recreation areas. I was shocked to see that Clayton County ranked so high in no leisure-time physical activity,” Charlton said.
Statewide efforts and resources
Charlton also highlighted the Iowa Cancer Consortium, an organization anyone can join that provides cancer updates, training, educational resources, grant opportunities and workshops.
The consortium coordinates the Iowa Cancer Plan, which focuses on areas including health equity, early detection, diagnosis, treatment and survivorship.
“You wouldn’t believe it by the cancer rate in Iowa, but our cancer plan is really looked at by other states as an example. They envy how much partnership happens across the state,” Charlton said.
Charlton also discussed the role effective public policy can play in reducing cancer rates.
“Effective policy makes the healthy choice easier, the unhealthy choice harder and provides protections from risk factors outside of your control,” she explained.
Examples include increasing tobacco and alcohol taxes, prohibiting minors from using tanning beds, establishing zoning limits on tobacco and alcohol retailers, improving opportunities for outdoor physical activity and increasing access to affordable, fresh food. Residents interested in supporting cancer-related policy changes were encouraged to get involved with organizations such as the American Cancer Society and contact their legislators.
At the conclusion of the presentation, speakers highlighted additional resources available to Iowans, including the American Cancer Society’s CancerRisk360, an online assessment that helps individuals identify factors affecting their cancer risk. Concerns about potential cancer clusters can also be reported to the Iowa Cancer Registry.
Iowa Environmental Health has developed an Environmental Exposure and Health Risk Fact Sheet for individual concerns with those impacts. Residents who rely on private wells were encouraged to have their water tested through Iowa’s Private Well Grants Program, which provides free testing for eligible residents.
Speakers also emphasized the numerous organizations and initiatives working to investigate Iowa’s increasing cancer rates, study potential contributing factors and identify ways to reduce cancer risk.
The presentation, including county-specific statistics and additional resources from the Cancer in Iowa: 99 Counties Project and other organizations across the state, are available online.
