Iowa is one of only.

Two.

States with rising cancer rates.

The good news.

More Iowans are surviving.

We'll talk about research and the work to address the cancer burden.

On this edition.

Of Iowa Press.

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This is the Friday, April 18th edition of Iowa Press.

Here is Kay Henderson.

If you've been following the news, you likely know that Iowa has the second highest rate of new cancer cases of any state in the country.

And also the only one of two states to have a rising rate.

The guess we have at the table today are experts who can tell us about the data.

And let me introduce them to you.

They are Sarah Nash.

She is director of research, analytics and dissemination for the Iowa Cancer Registry and an assistant professor in the Department of Epidemiology at the University of Iowa.

Welcome.

Thank you.

Also joining us are Kelly Wells.

She is the executive director of the Iowa Cancer Consortium.

Both guests are also co-leads of Community outreach and engagement at the University of Iowa's Holden Comprehensive Cancer Center.

I think I've done it all.

Thank you both for being here today and sharing your expertise.

Thank you so much for having us.

Joining our conversation, Stephen Gruber Miller of the Des Moines Register and Erin Murphy of The Gazette in Cedar Rapids.

So, Sarah, the Iowa Cancer Registry recently put out its annual Cancer in Iowa report.

I wanted to start by getting some top lines from that report.

What were some of the biggest things to your mind that came out of that?

Yeah.

Thank you.

so every year we put out a report and every year we focus on a different topic.

And this year we chose to focus on survivorship.

Like you said, we have the second highest rate of new, new cancers.

And we are one of only two states with an increasing rate.

And actually we have an increasing incidence rate and a decreasing mortality rate.

And the result of that is that over time, we have an increasing number of survivors in Iowa.

So we estimate that we have approximately 172,000 folks in Iowa right now.

That's about 1 in 20 who have had a diagnosis of cancer in their lifetime.

so we really wanted to bring attention to that in this year's report.

We wanted to, really talk about the needs that we are going to have to address of these, the survivor population.

so we know that cancer survivors have unique needs.

This is can be anything from the moment they're diagnosed, when, you know, you're just learning about a diagnosis and you're figuring out how it's going to be treated to everything from, you know, as you're transitioning from being an active treatment to being, you know, out of, out of cancer treatment and kind of create that life after cancer for yourself.

to many years later, some folks have long and late effects of cancer and and needs a very different depending on where you are in your journey and kind of when you were diagnosed with cancer, when you were diagnosed, whether you were diagnosed as a child or an older adult.

So we really wanted to bring attention to that, that huge issue.

in this year's report.

Kelly, as you saw the report and it's an annual report.

So there's obviously trend lines, something like the numbers Kate talked about were similar last year too.

But was there anything that stood out to you in the recent report?

Well, I think what Sarah mentions about survivorship is really important.

again, we're going to need to be prepared to care for this special population of Iowans that's growing.

It's also important to remember that survivorship is one of many different factors of cancer and cancer control that we as Iowans need to be thinking about, especially considering our second in the nation incidence rates.

we have a long road ahead of us in order to try and turn that around.

survivorship is certainly one factor.

We also need to be thinking about and investing in prevention, early detection, finding the best treatments as well, and certainly cancer research as well.

And Sarah, back to you on the on the data in the report.

And the report can be viewed on line for folks who who may look at that includes a breakdown by county as well on the sort of map.

And some counties are redder than others.

Was there anything in just looking at it?

It doesn't seem to be geographically concentrated where the higher rates were.

Do you know, is there anything in the numbers that speaks to you in, in, in sorry in any interesting way about the county level data?

Actually, I'm really glad that you brought this up.

Thank you for this question.

So there's a couple of different answers that I could could take for that one.

The first is when we're looking at different cancer types, there's really no place in Iowa that stands out for every single cancer type.

So our patterns are very geographically different depending on what type of cancer you're looking at.

So as an example, some of our leading cancers and some of the four cancers driving on high rates of breast, lung, prostate and melanoma, melanoma is really more common in the north part of Iowa.

Lung cancer is more common in the south part of Iowa.

We also see higher prevalence of smoking.

Prostate cancer is more common in the northwest corner of Iowa, and breast cancer is more common in our urban centers.

So the pattern is very different for each different cancer.

And we can go on and on and on with other different cancers.

The other thing that that I really wanted to talk about at the county level, which is why I'm really glad that you brought this up, is that the Iowa Cancer Registry currently has an ongoing effort where we are going to every single county in Iowa.

So we call it the Iowa 99 Counties Project.

We are collaborating with the Iowa Cancer Consortium, with the Holden Comprehensive Cancer Center, with Iowa Health and Human Services, and the Iowa Rural Health Association.

And we've done about what is like 1015 of these so far.

and we are really trying to get out to every state in Iowa, really to talk about their local cancer rates.

So we we work with that, local public health departments, and we talk about that.

The local rates the highest, the cancers that are most common in the county and then hopefully provide the residents some resources that they can use to address and prevent cancer in the community.

So I'm really glad that you asked that question.

Thank you.

Yeah.

I want to ask both of you as we you're talking about some of the trends or maybe lack of trends.

What do we know at this point already about causes?

What can be some of the causes of these cancers and what don't we know?

And Kelly, we'll start with you.

Yeah, absolutely.

Well, Sarah highlighted the four cancers that we we see are driving our high rates.

So these are four cancers where if we took them out of our data, our trends would look a lot more like the rest of the country.

And again those are lung cancer or melanoma prostate and breast.

So that is one thing that we know.

we of course can't forget the other cancers that exist for which we have, preventive measures that we can take, where we know risk factors as well.

but it's important to think about those, as well.

There is a lot that we know about how to reduce risk of cancer, whether it's for those for cancers or other cancers.

there are things we can do as individuals to prevent cancer.

but it's also important to consider what can be done through policy, policy to help us make the healthier choices or to help us not make the unhealthy choice, or to protect us from things that are out of our control, has the potential for the biggest impact overall.

When we're thinking at a population level, for helping to reduce our burden of cancer.

So, Sarah, maybe some of those specific causes that we do know about already.

Yeah, absolutely.

So like Kelly said, there's a lot we know and a lot we don't know.

so just to say we need to know more, right?

There are things that I wouldn't have questions about that we need to know more about, for example, like cancer and the environment.

We know that we need to know more about that.

But there are things that we can do now with the knowledge that we do have.

So for example, we know that one of the best things to prevent not just cancer, but also many other chronic diseases is physical activity.

we can we can make sure that we are getting our own physical activity.

we can at the community level, we making sure that we have safe spaces for folks to engage in physical activity.

And, you know, just giving people the opportunity to engage in physical activity that they enjoy.

We know that alcohol increases cancer risk.

We did our Cancer in Iowa report on alcohol last year, because only 40% of Americans even know that alcohol increases the risk of cancer.

so we know that decreasing alcohol consumption is something that we can work on.

Iowans are very good at consuming alcohol.

Unfortunately, we have, we report about 22% of Iowans, report binge drinking compared to about 16.5% for the US.

so that's another thing, eating your fruits and vegetables, eating a healthful diet, and making sure we have those things available for folks.

and then kind of using these behaviors to help us, encourage us to, to, have a healthy weight.

And then tobacco is one of the biggest predictors for, for actually tobacco is related to many different types of cancer.

And it is very strongly related to lung cancer, which is the leading cause of cancer mortality in Iowa.

So there's a lot that we can do in terms of tobacco cessation, tobacco prevention, and then also making sure that for these cancers, we're getting screened.

So Iowans get a getting screened as well.

Yeah.

And you know, I'm sure you both saw in January the governor called for $1 million of research to be invested into, you know, looking into the cause, other causes of cancer.

What?

You know, how far does that million dollars go?

And what do you think we'd be hoping to find out.

Kelly.

First of all, we have to say that we're really pleased that the governor has shown support and, acknowledging the importance of figuring out what's happening with cancer here in Iowa and making an investment in that.

we know our colleagues at the university are working closely with her team to develop a plan for that, and we're looking forward to learning more about that and being able to share that.

with Iowa.

I think it's also important to note that, cancer is so complex.

It is a mixture of a lot of different factors.

As Sarah mentioned, there's never going to be one thing that we can identify that causes cancer at an individual level or a population level.

And that means that we are going to need to invest in cancer for a long term and in a lot of different ways.

cancer, what we are seeing right now in our cancer rates is likely due to something that happened years ago.

So our rates started turning around in about 2013, I believe it was, and even that was probably a result of something that happened years before.

That means that we are not going to find one fix for cancer right now, and it's certainly not going to happen within a year or two.

What that means to us is that we all have to be prepared to consider addressing cancer as a long game.

We need investments that are long term in prevention, early detection, treatment, research.

and we need to come at it from a lot of different directions, whether that's funding for research, whether it is, access to care for people facing and diagnosis, access to screening so that people can find, cancer when it's most treatable.

We're going to need a multi-pronged approach.

And over a long period of time, I think there's a sense of urgency right now because we're all discovering that cancer is so high in Iowa.

It is important that there's a sense of urgency because it is.

We're talking about lost lives and quality of lives and lost dollars.

This is an economic an economic issue as well.

But we do have to be prepared again to settle in for the long term and invest long term from a lot of different directions if we're really going to make a difference.

Sara, very quickly, how do we compare to our neighboring states?

Sometimes things are.

Regional.

That's.

Yeah.

Is this a regional problem?

We actually did look into that because we were wondering, you know, is this something that is happening at the regional level, or is this something that is is unique to Iowa?

And when we compare to our neighboring states, the neighboring states do not have an increasing rate like we do.

So it's it's very interesting to see that, right, that we're not seeing necessarily that same pattern.

A very quick.

Question.

Iowans are hearing about cuts in federal support of research.

Is that going to affect the Iowa Cancer Registry?

potentially.

I think one of the things, but actually one of the things that Kelly and I were talking about earlier today is that there's a lot of uncertainty, and we don't yet know where the cuts are going to have an impact.

I will say the Iowa Cancer Registry is federally funded by the National Cancer Institute.

There have been, discussions about cutting contract from the from all of the National Institutes of Health by 30, 35%.

and if contracts are cut, that will impact the Iowa Cancer Registry, and it will impact our ability to collect these data and serve Iowans and understand the burden of cancer.

Now, this isn't just limited to the Iowa Cancer Registry.

we saw yesterday that the president presidential budget was released, and there are a lot of chronic disease related programs that are proposed to be cut.

And I think that could have potential far reaching impacts across Iowa.

We know that federal funding, there's obviously a lot of state support.

You talked about that earlier, but we know that federal funding really touches all of the programs, the research, the surveillance, the the screening, the early detection, the, you know, access to care pieces.

And so federal funding really touches every single piece of this giant problem that Kelly was talking about.

And so having the federal funding cuts, it could potentially be devastating, I think, to this problem that we're all trying to address together.

Yeah.

Kelly wanted to ask you I was medical system broadly, how equipped are we to deal with all the things that we're talking about here today and whether that's, you know, treatment of someone going through it or the survivors that you both have talked about, it's a big question.

So take it where you think, how are we equipped here in the state to handle all this?

Yeah.

Well, I think talking about potential cuts is certainly an important piece of this.

Right.

we need to be prepared for this in the future.

And again, talking about investing for it long term and from many different directions, we're going to need that in order to, continue our efforts.

Sarah talked about the rising number of cancer survivors that we're facing, who are going to need specialized care.

so there are a lot of considerations with that.

Very good question.

One group of folks that I often think about, when talking about access to care and medical system is rural Iowans.

Iowa's a very rural population.

About a third of Iowans live in rural areas, and rural Iowans face special considerations, especially when it comes to cancer care.

So, they often lack access to specialists, cancer specialists who are needed in order to get the best quality treatment.

It can be more difficult for them to, access cancer screening, and prevention services.

so I think I think we have some room to improve or to, enhance the services that are available, especially especially in rural Iowa.

And then we need to be thinking long term about how we're going to support this growing group of, of survivors.

So maybe one piece of this we hear a lot at the state House, about the physician shortages and how to address that.

What what you know, how significant is that issue as a part of this discussion?

Yeah, I think, that's a really important issue.

And Kelly talked about access to specialists.

And I think, you know, coming back to your question about the federal funding, I think one of the concerns with federal funding is that it's not only going to impact impact our ability to address the issue now, but it's going to impact our ability to invest in medical education and invest in the future.

Leaders, both in terms of clinical practice and in terms of research.

So I think, you know, if we if we think about right now, we may not have access to specialists that we need, particularly in the survivorship care space.

This problem has the potential to to grow over time.

If we're not able to invest in the way that we would like to.

One of the discussions at the Iowa State House that's gotten a lot of attention over the last two years really is about, the manufacture of roundup and whether lawsuits should be, when lawsuits should be able to be filed against them over concerns that their product might contribute to cancer.

I don't know who might be best positioned to answer this, but do we have data?

What does the data tell us right now?

What do we know, about whether this could be a contributor to start.

And then you make sure.

Okay, great.

so I think, you know, it's it's interesting you say this because I told you about the 99 counties project, and we're going to each county.

And this this is a question, I think, that we hear a lot, as well as that Iowans are concerned about the environment and about roundup and other things and the potential link to cancer and I think as an agricultural state, we're right to be concerned.

but I will say, we as we were talking earlier, there are things that we know and there are things that we we don't know enough about yet.

And I think this is one of those areas where we don't know enough yet.

And again, it's really important that we have long term investment in many different places to help us figure out this issue and these problems.

so I think that that is an area where we would like to know more at the Iowa Cancer Registry, we collect data on cancer, and we make our data available to those experts who are doing that work.

so we're really invested in helping to try and answer the question that you just answered.

We work with, for example, the center for Health Effects of Environmental Contaminants, cheek, and the Environmental Health Sciences Research Center, both at the University of Iowa.

And they really do have the experts who can help us answer this question.

So again, you know, Kelly's been talking a lot about partnership.

And this is another example of where we really need partnership to answer the to answer a big question that Iowans have.

Kelly.

Yeah, I would add to that, that, you know, there is more that we need to know.

And we also, you know, there comes a point where maybe we know enough and that it is still fair to start to take precautions.

I, I can't speak to that bill specifically.

but I know we work with a lot of partners who are very passionate about reducing environmental exposures.

and that that makes sense even if we may not have the same the data that shows similar connections to something like radon, if we have data that shows that a probable, connection, it's okay to start to reduce those exposures and to seek to reduce those exposures as well.

Well, let's talk about radon.

Yeah.

Talking about maps.

If you look at a map of the state of Iowa, the EPA says there are incredibly high levels of radon in every one of Iowa's 99 counties.

And radon is a huge contributor to lung cancer among nonsmokers.

So talk to us about what you see in the data and what Iowans.

Should be doing.

In their homes.

If you don't mind, I'm going to pass this one because I know that she knows she is an expert on.

Yeah, you're absolutely right.

We should all be thinking about radon here in Iowa.

we have the glaciers that moved through here years and years ago to thank for this.

It's a naturally occurring feature of our landscape.

uranium in the ground can decay and turn into radon, and radon can, seep through cracks in foundation, cracks in, house and building foundations and other, mechanisms for getting into to homes and at high enough concentrations, it can eventually cause lung cancer, be a contributor to lung cancer.

Thankfully, radon, it's very easy to test for, and it can be pretty inexpensive to test for.

you can buy a short term radon test kit at a hardware store or from your local public health department for probably $15 or less.

And, find out if you're radon levels in your home or your office are elevated.

It's a it's more expensive to fix.

though it is easy to fix a radon problem.

It is more, expensive.

It's generally about the cost of a larger home appliance or a smaller home renovation.

but thankfully we have a mechanism, to fix it, which everybody should be testing for radon, in Iowa.

And certainly, anybody should be testing their homes.

We hope also that landlords will support, renters who are testing for radon as well.

That is one place policy could certainly play a role in providing some protections there.

policy could also play a role in providing financial support for mitigation, because that is truly how you how you prevent, lung cancer.

And it's also important to note that, radon is the second leading cause of cancer.

If somebody is smoking and exposed to radon, that is an extra big risk factor.

so these things can interplay, and really increase a person's risk.

Well, and speaking of policy, Iowa is, relative to other states, has very little regulation of tanning.

and especially when it comes to younger Iowans, there have been bills proposing myriad restrictions.

we also know that you mentioned melanoma being one of the most the most prevalent in the state.

Kelly, I'll start with you.

But, Sarah, jump in if you'd like.

what would you like to see?

The state.

What kind of policy would you like the state to take regarding tanning and should minors be, if not parental permission, maybe even outright prohibited from it, in your view?

Yeah.

Well, as we talked about earlier, I think the the role of a successful policy is helping us make the right choice or the healthy choice, helping us not make the unhealthy choice and then protecting us, from factors we can't control.

And this would certainly fall into helping us make the right choice or not make that unhealthy choice.

and especially when it comes to minors, we know that early use of tanning beds can significantly increase risk of melanoma later in life.

and so putting protections into place that are going to keep minors out of tanning beds, is, I think, an important role of policy.

and then we should also be looking at outdoor workers.

So this isn't tanning beds specific, but making sure there are protections in place for outdoor workers, access to to sun protection as well.

policy at the business level or the organizational level could play a role, in helping with that.

And I apologize, I should where it is in our last couple of minutes, I'm going to move us on to Stephen as a question we might.

Ask.

Yeah, maybe I'll just we'll wrap up with this.

Right.

So pretty briefly, both of you, I mean, we've talked a lot, a lot of different issues, a lot of different solutions.

If you could pick maybe the most impactful policy solution that you think, this the state government should pursue, maybe.

Sarah, we'll start with you and let's hear, the magic wand.

Sure.

Although I'm probably going to steal Kelly's thunder because I think we'll probably will probably say the same thing.

And that is, I think the place where we have a lot of room to improve is in tobacco control.

And there are proven ways that we, at the policy level, know that we can be successful in tobacco control.

For example, increasing the tax on cigarets by more than a dollar or more has been shown to vastly reduce the prevalence of smoking, and that in turn reduces our risk for lung cancer.

Do you want to add anything on?

Yeah.

I think you're spot on.

I mean, if we had to focus one place, which I don't think we should focus just one place just because there hasn't been tight pricing.

But if we had to pick one, I think tobacco has the most opportunity.

It's one of the four cancers that's driving our high cancer rates.

It is the leading cause of preventable cause of death in the country and the leading cause of cancer death here in Iowa.

Iowa has a lot of room for growth.

The American Lung Association rates states every year, and Iowa does not do well.

So we have opportunity to put policies in place that are going to make it.

We have no more opportunities for conversation.

We are out of time.

Thanks to both of you for being here and sharing your views, I appreciate it.

Thank you.

Thank you for having me.

I really appreciate this.

You can watch every episode of Iowa Press at Iowa PBS.org for everyone here at Iowa PBS.

Thanks for watching.

Today.

Today.

Funding for Iowa Press was provided by friends, the Iowa PBS Foundation, the Associated General Contractors of Iowa, the public's partner in building Iowa's highway, bridge and municipal utility infrastructure across Iowa.

Hundreds of neighborhood banks strive to serve their communities, provide jobs, and help local businesses.

Iowa banks are proud to back the life you build.

Learn more at Iowa bankers.com.