UI experts use data in fight against cancer
Mary Charlton, director of the Iowa Cancer Registry and University of Iowa professor of epidemiology, speaks during a Cancer in Iowa: 99 Counties Project presentation in Waverly, Iowa, which is located in Bremer County. At the meeting, Charlton shares the county’s most diagnosed new cancers and their risk factors, how those numbers compare to the state and the nation, and what screening tests are available for those cancers and how county usage of those tests compares with other counties.
A U.S. News & World Report article in 2023 sounded the alarm for residents of a rural county in northwest Iowa. Palo Alto County, the report stated, had the second-highest rate of newly diagnosed cancers in the country — and the highest in Iowa.
Seeking answers, Sarah Strohman, the county’s director of community health, hospice, and public health, turned to experts at the University of Iowa College of Public Health for guidance.
“We’ve always acknowledged that we live in an area that is a little more prone to cancer, but we didn’t realize how different we were from other areas,” Strohman says. “When it became a national headline, it understandably scared people.”
Mary Charlton, director of the Iowa Cancer Registry and UI professor of epidemiology, agreed to prepare a report about cancer incidence in the county and present it to the community. That data, Strohman says, opened eyes.
“We learned that we are ranked most highly in lung cancer, and that gave us something to work with,” Strohman says. “Since lung cancer is frequently caused by smoking and radon, we secured some funding for prevention education. Having this data made us feel we could actually do something. Before that report, cancer seemed too big to take on.”
The Iowa Cancer Registry at the University of Iowa has been tracking cancer cases, survival rates, and deaths from cancer in the state since 1973. This wealth of data has enabled researchers to learn that Iowa, for example, has the second-highest cancer rate (or incidence) in the United States. Such knowledge triggers resources — money, research, and doctors — to focus on improvements in prevention and treatment. It also has unearthed geographical variations in cancer diagnoses across Iowa, empowering county or regional hospitals to tweak care and support services to best meet patients’ needs.
When the report was presented to the community in November 2024, some 150 people showed up in person and another 50 attended virtually. The audience, Strohman says, ranged from police officers and members of the county’s boards of supervisors and health to cancer survivors and a high school biology class — and they were engaged.
“I think people wanted to place the blame on agriculture and have that be the reason for high cancer incidence. While that could be a component, the fact that a person smoked for years during college is not insignificant,” says Strohman, noting that the county’s population of 8,996 includes a high number of smokers and people who are less active. “Cancer isn’t caused by just one thing, and everybody needs to take responsibility on some level and make healthier lifestyle choices.”
The turnout in Palo Alto County, coupled with the fact that Iowa has the second-highest rate of cancer incidence in the country, led to a new public health initiative spearheaded by Charlton called Cancer in Iowa: 99 Counties Project. The UI College of Public Health and the Iowa Cancer Consortium, in collaboration with UI Health Care Holden Comprehensive Cancer Center and the Iowa Rural Health Association, plan to share similar county-specific cancer reports in each of the state’s 99 counties. Charlton says the team hopes to complete the presentations within a year.
Representatives from the 99 Counties Project are working with public health directors and health systems to schedule meetings for each of Iowa’s 99 counties. Those dates and locations (online or in-person) will be posted on the project’s website when available. If your county’s meeting already happened, you can find links to the presentation slides on the website.
So far, the team has visited with residents in seven Iowa counties: Bremer, Cherokee, Chickasaw, Dallas, Dickinson, Shelby, and Palo Alto. Charlton says she and her team start the conversation with what she calls “level setting” — defining key terms, explaining the role of the Iowa Cancer Registry, and emphasizing that no one thing causes cancer. Then they walk through the data: the county’s most diagnosed new cancers and their risk factors, how those numbers compare to the state and the nation, and what screening tests are available for those cancers and how county usage of those tests compares with other counties. They conclude by sharing statewide resources, including at the University of Iowa, and taking questions. [The presentations are published online as they become available.]
“If one of the top cancers is breast cancer, for example, we talk about mammography and share what their county’s breast cancer screening rate is compared to other areas and whether that is statistically significant,” says Charlton, who also is president of the Iowa Cancer Consortium. “Then we share risk factors for breast cancer and let them know that if you catch it early, your five-year survival rate is nearly 100%. If you catch it late, the five-year survival is more like 60%.”
Charlton says the hope is that the data empowers residents to make healthier choices, seek cancer screening tests, and press legislators for policy change and research funding.
“These presentations are meant to be a conversation opener and to give people some ideas about things to target in their community for reducing cancer risk. We reiterate that we hope this isn’t the last time we talk with them,” she says. “There are proven ways to prevent cancer and find it early. You can avoid risk factors and get screened. We have a lot of resources to help fight cancer, and policy changes at the local and state levels, such as taxes on tobacco, have a huge impact. We urge them to communicate their concerns with their state representatives and local policymakers and to let us know how we can help.”
One outcome of the conversation in Palo Alto County, where residents expressed concern about pesticides and radon, is that Mark Vander Weg, head of the UI Department of Community and Behavioral Health, added the community as a site in his multipronged study of lung cancer.
“These presentations are meant to be a conversation opener and to give people some ideas about things to target in their community for reducing cancer risk. We reiterate that we hope this isn’t the last time we talk with them.”
Cancer is among the leading causes of death worldwide, and more than 20,000 Iowans are diagnosed with cancer each year, according to the 2025 Cancer in Iowa report. Experts at the University of Iowa Health Care Holden Comprehensive Cancer Center are dedicated to fighting cancer and improving therapies.
With its “comprehensive cancer center” designation from the National Cancer Institute, Holden is one of 57 institutions across 36 states — and the only one in Iowa — recognized for its leadership, resources, and research in cancer medicine.
Charlton says the 99 Counties Project is an example of how the University of Iowa partners with state organizations to improve the health of Iowans.
“We don’t do our research in an ivory tower — we care about Iowans across the state and want to use our data and our expertise to help promote meaningful change and be a resource for them,” she says. “I personally invite state representatives and state senators to be part of these conversations, hoping to demonstrate to them that the University of Iowa is getting outside of Iowa City and working to improve the health of our state.”
In Palo Alto County, momentum in the cancer fight is palpable, Strohman says. County health officials have revised their community health improvement plan to include goals related to cancer, invited a representative from the agricultural industry to attend their meetings, prepared educational materials about well water testing to share with real estate agents, and applied for — and received — a grant from a local gaming corporation to provide free radon test kits to every household in the county.
“I feel like we are going to see some positive changes,” she says, “and although we’re focusing now on lung cancer, we aren’t forgetting that we still have breast cancer, skin cancer, colon cancer, and other cancers.”
