Cancer Resources

Goals

Senate File 647, which took effect on July 1, 2025, provided $1 million to the University of Iowa to develop an Iowa Cancer Assessment and Intervention Plan. This work is being done on behalf of Iowa Health and Human Services (Iowa HHS) Division of Public Health. The effort is focused on better understanding why Iowa continues to experience a high cancer burden. For the 2018–2022 reporting period, Iowa had the second-highest cancer incidence rate in the United States and was one of only three states with an increasing rate of new cancers.

The project is designed to:

Quantify Iowa’s excess cancer burden and identify which cancer types, age groups, and populations account for the greatest number of excess cases.
Determine how much of Iowa’s excess cancer incidence can be explained by established demographic and behavioral risk factors.
Identify geographic areas and populations where excess cancer incidence persists after accounting for those factors and may warrant additional study.
Examine whether provider screening practices may contribute to Iowa’s elevated prostate cancer incidence.
Identify evidence-based interventions that could reduce cancer risk factors and improve cancer screening, and model their potential impact in Iowa.

Areas of Focus

1. Behavioral and demographic risk factors

Phase 1 evaluated established population-level factors associated with cancer incidence, including tobacco use, obesity, alcohol use, insurance coverage, and selected cancer-specific factors such as radon and ultraviolet exposure.

The analysis found that the selected risk factors and demographic characteristics accounted for approximately 76% of Iowa’s excess cancer burden among the five cancer types included in the statistical modeling. After adjustment:

No excess lung cancer cases remained among adults age 50 and older.
Only two excess melanoma cases remained.
Excess cases remained for prostate cancer, postmenopausal breast cancer, and colorectal cancer, identifying important areas for additional study.
These population-level findings should not be interpreted as establishing individual-level causation, but they indicate that addressing modifiable risk factors represents an important opportunity to reduce Iowa’s cancer burden.

2. Geographic patterns and environmental factors

Phase 1 examined county-level patterns to identify areas where significantly more cancer cases occurred than expected after adjustment for selected demographic and behavioral risk factors.

The analysis did not identify a consistent geographic pattern across cancer types. Counties identified as having more cases than expected should therefore be viewed as starting points for further investigation rather than evidence of a common environmental exposure or cancer cluster.

Phase 2 will build on this work by examining additional environmental factors and further investigating populations and geographic areas where excess cancer incidence persists after adjustment for known risk factors.

3. Screening and early detection

The project specifically examined whether prostate-specific antigen (PSA) screening practices may contribute to Iowa’s elevated prostate cancer incidence.

Self-reported PSA screening trends in Iowa were generally similar to national trends and surrounding states, although analysis of Iowa insurance claims identified some counties with higher screening rates. Additional research is needed to better understand which prostate cancer screening guidelines are being followed in clinical practice and the extent to which screening practices may influence observed incidence.

The project also reviewed evidence-based approaches for improving cancer screening more broadly, including health-system interventions such as electronic health record strategies designed to increase appropriate screening.

4. Evidence-based prevention and intervention strategies

The project reviewed the scientific literature and existing evidence bases to identify interventions demonstrated to reduce cancer risk factors or increase cancer screening.

These approaches range from individual-level strategies that promote physical activity to health-system approaches that improve screening and population-level policies addressing tobacco and alcohol use. Phase 2 will model the potential impact of selected interventions in Iowa to help inform future prevention strategies and investments.

Next Steps

Phase 2 of the project will build on the Phase 1 findings by:

Evaluating additional potential contributors to Iowa’s elevated cancer incidence, including additional environmental factors.

Further investigating cancer types, populations, and geographic areas where excess incidence remains after adjustment for known risk factors.

Continuing investigation of prostate cancer screening practices and their potential contribution to Iowa’s elevated prostate cancer incidence.

Modeling the potential impact of evidence-based prevention and screening interventions in Iowa.

Using these analyses to help identify opportunities for targeted cancer prevention, risk reduction, screening, and future public health investment.