Tuesday, March 5, 2019

While the overall number of new cases for most types of cancer in Iowa remains mostly unchanged, cancers related to the human papillomavirus (HPV) are on the rise, according to the 2019 Cancer in Iowa report issued Tuesday, March 5, by the State Health Registry of Iowa.

The report finds women are more likely than men to be diagnosed with HPV cancers. However, the number of HPV cancers among men is increasing, largely driven by increases in HPV-positive oropharyngeal (middle throat) cancers.

“Cervical cancer has been decreasing ever since the Pap test was introduced in 1940,” says Mary Charlton, assistant professor of epidemiology at the University of Iowa College of Public Health. “Unfortunately, there is nothing like the Pap test for the other HPV-related cancers, and they are dramatically increasing among both males and females.”

Charlton says this upward trend is even more substantial in rural areas, particularly the trend in oropharyngeal cancer.

The State Health Registry of Iowa is a part of the UI College of Public Health and works closely with the Holden Comprehensive Cancer Center in the UI Hospitals and Clinics.

HPV is a group of viruses that includes more than 150 different high- and low-risk types. High-risk HPV types can cause cancer in addition to inflammatory lesions. According to the report, most sexually active men and women will be infected with HPV at some point in their lives and most will never know they have been infected. An effective vaccine to prevent HPV was introduced in 2006 and could prevent 90 percent of HPV-related cancers every year.

“Immunizing adolescents and young adults against HPV greatly reduces their chances of getting six different cancers, in addition to protecting against genital warts,” says Nathan Boonstra, a pediatrician at Blank Children’s Hospital in Des Moines, Iowa. “It’s really amazing to realize we have such an easy way to prevent cancer, and the more people who are vaccinated, the more lives will be saved.”

However, Iowans have been slow to receive the vaccine. In 2017, the HPV vaccination rate in Iowa was only 38 percent. According to Heather Meador, clinical branch supervisor at Linn County Public Health, county-level efforts are encouraging more health care providers to talk to adolescent patients and their parents about the benefits of the HPV vaccine. 

“Iowa has mandatory immunizations for children entering seventh grade,” Meador says. “We are educating physicians on the need to provide the required immunizations for school along with the recommended HPV vaccine that has been proven to be highly effective in reducing HPV-related cancers.”

The 2019 Cancer in Iowa report estimates 6,400 Iowans will die from cancer in 2019. Lung cancer will continue to be the most common cause of cancer death for both males and females and will be responsible for about 1,630—or about one out of every four—cancer deaths in Iowa.

The annual report also projects an estimated 18,100 new cancers will be diagnosed among Iowa residents this year. Breast cancer will remain the most common type of cancer diagnosed among females, while prostate cancer remains the most common type among males.

Charlton says the number of new cancers and cancer deaths per year remains fairly flat overall.

“While it is encouraging that the numbers aren’t increasing dramatically, it’s also somewhat frustrating since two of the top cancers, lung and colorectal cancers, are largely preventable,” she says.

Charlton says that additional policies and programs to reduce smoking rates and increase colorectal cancer screening in Iowa would likely help decrease cancer incidence and mortality rates in Iowa.

“Cancer research is vital if we are to continue reducing the burden of cancer for the people of Iowa and beyond,” says George Weiner, director of Holden Comprehensive Cancer Center at the UI and professor of internal medicine. “This research includes evaluation of the best ways to improve public acceptance of approaches to cancer prevention we know are effective, such as the HPV vaccine.”

The report, based on data from the State Health Registry of Iowa and the Iowa Department of Public Health, is available online in the “Publications” section on the registry’s website or by calling the registry at 319-335-8609. The report includes county-by-county statistics, summaries of new research projects, and a special section focused on HPV-related cancers. 

The State Health Registry of Iowa has been gathering cancer incidence and follow-up data for the state since 1973.