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University of Iowa News Release

March 22, 2005

State Health Registry Reports 'Cancer In Iowa: 2005'

The latest annual report on cancer in Iowa projects 15,800 new cancer cases and 6,500 cancer deaths in the state for 2005. The estimates were shared today by the State Health Registry of Iowa, which is based in the Department of Epidemiology at the University of Iowa College of Public Health.

The projections are based on data from the Iowa Department of Public Health and the Iowa Cancer Registry and include county-by-county statistics.

The "Cancer in Iowa: 2005" report also focuses on prostate cancer, which is the most commonly diagnosed cancer in men both statewide and nationwide. Since 1990, the prostate cancer death rate for men in Iowa has changed in an age-specific manner. The report examines this difference and how researchers are addressing it.

Links to the "Cancer in Iowa: 2005" report and reports from previous years are available in the "Publications" section at the registry's Web site, www.public-health.uiowa.edu/shri/. People may also request a copy of the report by calling the registry at 319-335-8609.

"Lung, breast, colorectal and prostate cancer still account for more than 50 percent of the new cancers and about 50 percent of cancer deaths," said Charles Lynch, M.D., Ph.D., UI professor of epidemiology and medical director of the registry. "Although there are many types of cancer, these are the four major types of cancer in Iowa and the rest of the country."

As in years past, the three most common types of cancer in women will be breast (28.8 percent), colorectal (13.8 percent) and lung (11.8 percent), and the most common types of cancers in men will be prostate (28.1 percent), lung (14.4 percent) and colorectal (12.5 percent).

The top three types of projected cancer deaths for women and men remain unchanged from previous years. For women, leading cancer deaths will be lung, breast and colorectal cancers. For men, leading cancer deaths will be lung, prostate and colorectal cancers.

Lynch noted a change in how new bladder cancer cases are estimated. Previously, the category included only invasive cancers, but it now includes both invasive and non-invasive cases. As a result, the estimates are nearly double what they were last year. New bladder cancer cases will strike approximately 200 women and 540 men in Iowa.

"After discussion with UI urologists, we now estimate bladder cancers in a way that is more consistent with reporting by the Surveillance, Epidemiology and End Results (SEER) program of the National Cancer Institute," Lynch explained.

The report estimates that 2,250 men will be diagnosed with prostate cancer this year, and 400 men will die of the disease. The prostate is a gland in males that is located between the bladder and rectum. Normally the size of a walnut, it produces prostate-specific antigen (PSA), which has the main purpose of liquefying the semen. PSA is made only by prostate cells, and a small amount of this protein makes its way into the blood stream where its concentration can be measured in a blood sample.

Between 1990 and 1992, the number of newly diagnosed prostate cancers in Iowa and nationwide increased dramatically as a result of more screening that included PSA testing. "However, the goal of screening," Lynch said, "is not to increase the number of newly diagnosed cancers but rather to decrease the number of deaths from the disease."

Screening is controversial as the U.S. Preventive Services Task Force says there is insufficient evidence to recommend routine screening, while the American Cancer Society and the American Urologic Association both encourage routine screening. These organizations are awaiting results of ongoing clinical trials.

"It seems that if you screen for prostate cancer, you can detect the disease sooner and treat it," Lynch said. "We are detecting more prostate cancer earlier in Iowa than we were 10 years ago."

From 1990 to 1992 compared with 2000 to 2002, cases of localized (confined to the prostate) and regionalized (spread only slightly beyond the prostate) cancer increased from 73 to 91 percent of all cases, while distant-stage diseases decreased from 12 to 5 percent and unstaged from 16 to 4 percent. The findings were similar for age groups of less than 65, 65 to 74 and 75 to 84 years. However, improvements were not as dramatic for men age 85 and older.

Between 1990-92 and 2000-02, the prostate cancer death rate in Iowa declined around 30 percent in men in the age groups less than 85 years of age, but declined only 10 percent in those 85 years and older. "This correlates with the stage shift information and supports the hypothesis that prostate cancer screening is saving lives," Lynch said.

Generally, men are screened beginning at age 50. Men with risk factors -- those who are African-American or have a family history of the disease -- should be screened beginning at age 40. The screening involves a PSA test and/or a digital rectal exam and is recommended for men who have at least a 10-year life expectancy.

However, there are no guidelines about when to stop screening, said Badrinath Konety, M.D., UI assistant professor of urology, who is leading a study to assess current prostate cancer screening practices for men age 75 and older in Iowa.

The collaborative study involves the Iowa Department of Public Health, the Iowa Consortium for Comprehensive Cancer Control (www.canceriowa.org), the UI Department of Urology and Holden Comprehensive Cancer Center at the UI. The effort is funded by the Centers for Disease Control.

Most men are not being screened after age 75 because typically they will die of something else within the next 10 years even if they have prostate cancer.

"We want to see if you can use a more tailored approach to screening prostate cancer in men age 75 and older and establish guidelines about how they need to be treated," Konety said.

George Weiner, M.D., chair of the consortium and director of Holden Comprehensive Cancer Center at the UI, said studying prostate cancer screening for older men is an important public health concern, given that Iowa has the second highest proportion of men age 85 and older in the country.

"The drop in overall mortality from prostate cancer is very gratifying and provides further evidence that the Iowa Comprehensive Cancer Control Plan is on target in promoting approaches to finding cancer in its earliest stages," said Weiner, who also is the C.E. Block Chair of Cancer Research.

"The study will help us determine if we should be doing things differently for older age groups. In addition, on the treatment front, Holden Center and other researchers continue to seek out improved therapies for prostate cancer, including vaccines," Weiner added.

More than 150 hospitals, clinics and medical laboratories across Iowa, as well as referral facilities in neighboring states, contribute data to the State Health Registry of Iowa. The registry is one of 17 registries nationwide that are currently funded to provide data to the National Cancer Institute. Iowa's registry staff includes 50 members, half of whom are located throughout the state and help collect data from many facilities. The registry has been gathering cancer incidence and follow-up data for the state since 1973.

REPORT CONTACT: For copies of the "Cancer in Iowa: 2005" report, visit the "Publications" section at www.public-health.uiowa.edu/shri/ or call the State Health Registry of Iowa at 319-335-8609

STORY SOURCE: University of Iowa Health Science Relations, 5137 Westlawn, Iowa City, Iowa 5224-1178

MEDIA CONTACT: Becky Soglin, 319 335-6660 becky-soglin@uiowa.edu