Report of “Cancer in Iowa” urges return to screening after COVID-19 is suspended

Immediately after Lindsay Schmouth performed two mastectomy to treat breast cancer in 2021, she thanked the surgeon for saving her life.

“She said,’No, Lindsay, you saved your own life by getting that mammogram,'” says Schmouth.

A grant manager from the Iowa Public Health Service in Des Moines, Iowa, shot the first mammogram two weeks after his 40th birthday. This spurred the birthday card I received from the gynecologist and reminded me that it was time to start breast cancer screening. .. Schmouth says he was shocked to find out that he had stage 1A breast cancer because he had no family history of breast cancer (or any type of cancer) and was healthy.

“I was looking forward to robbing 40 with a storm, and well, it turned out to be a storm, but it wasn’t what I imagined,” says Schmouth. “I joined the company because I had to do it as a woman when I was 40. If I had been waiting for the screening six months after I turned 40, the conversation would have changed a lot. The cancer was invasive and was beginning to spread. It was life-saving to get the mammogram when I went and to discover the cancer as soon as we did. “

The 2022 Iowa Cancer Report, published by the Iowa Department of Health, emphasizes the importance of cancer screening for early detection of illness at times when treatment is more likely to be successful.

It was estimated that between March 2020 and June 2020, when COVID-19 declared a global epidemic, 41% of U.S. adults delayed or avoided medical care, including cancer screening. The focus on screening this year is especially timely. Experts show that cancer screening rates are recovering, and the extent of the impact of this reduction in screening is unknown, but may have led to delayed diagnosis and increased unavoidable cancer deaths. There is sex.

George Weiner, director and physician of the University of Iowa Holden Center for Cancer, said: “They should go back to it because screening can reduce the chances of advanced cancer or death from cancer.”

According to the report, screening rates for breast, cervical, and colorectal cancers in Iowa are slightly higher than the median screening rates in the United States, but there is still plenty of room for improvement. The Iowa Department of Public Health’s Healthy Iowa Program has a breast cancer screening target of 85% (currently 81%), a cervical cancer screening target of 92% (currently 77%), and a colorectal cancer screening target. Is set to 80% (currently 74%).

One of the trends is manifested in cervical cancer. The screening rate has declined since 2008, but the proportion of new cases has increased overall since 2012.

“There is no longer any reason to have a case of cervical cancer,” said Mary Charlton, professor of epidemiology at the UI College of Public Health, co-author of the report. “Screening and HPV vaccine, We know how to eliminate cervical cancer. So it’s very disappointing to see the screenings up and down. “

There are many reasons why someone can’t get the recommended cancer screening.

“There may be no healthcare provider who advises on the importance of screening,” Weiner says. I’ve heard people say, “Why do you bother when you have family and friends who have been screened and developed cancer anyway?” Screening is not complete, but it helps explain how it reduces the chance of dying from cancer. People have their own reasons to avoid medical institutions. Sometimes it has to do with trust. “

Charlton says people may be nervous about certain aspects of the screening method.

“When you think of something like colonoscopy, it sounds uncomfortable and you may have to take a break from work,” says Charlton. “But one thing we’re trying to clarify in the report is that there may be multiple options depending on the type of screening. Instead of colonoscopy, a home stool test can be done. Therefore, you should actually consult your doctor about the various screening options. Some may be just as effective, but less invasive and less time consuming. “

The highlights of the 2022 Iowa Cancer Report are:

• In 2022, an estimated 20,000 Iowa people will be diagnosed with cancer. Breast cancer is the most common diagnosis of cancer, followed by prostate, lung, colon / rectum, and cutaneous melanoma.
• An estimated 6,300 Iowa people will die of cancer in 2022, making it one of the two leading causes of death in the state, along with heart disease. Lung cancer will cause almost a quarter of these deaths.
• Based on data collected between 1973 and 2017, Iowa currently has more than 159,700 cancer survivors.

The State Health Registry of Iowa has been collecting state cancer incidence and follow-up data since 1973. This project is based on the National Cancer Institute, National Institute of Health, Ministry of Health, and Human Services, contract number HHSN261201800012I.

Another potential complex factor is that there is not always an agreement on who should be screened and when.

The US Preventive Services Task Force (USPSTF) guidelines for cancer screening indicate whether people at average risk should be screened for cancer, at what age they should start screening, how often, and when. The purpose is to help you decide if you should have a medical examination in a way. However, different medical institutions have their own guidelines for specific cancers, and not all are consistent. For example, guidelines for when to start getting mammograms range from 40 to 50, depending on the recommendations of the organization you are considering.

“Here, informed decision making is very important,” says Weiner. “Healthcare professionals need to explain when the strengths and weaknesses of screening and then make decisions with the patient about what is best.”

Charlton agrees that the main point is to talk to your doctor.

“What you don’t want to do is not tell anyone about screening and you don’t get it at all,” says Charlton. “It’s important to know that it can really save your life.”

Lung cancer screening

Lung cancer is the leading cause of cancer deaths in Iowa, accounting for one-quarter of all cancer deaths. Lung cancer screening has been recommended for certain people since 2014, and the screening age was reduced to 50 in 2021. Adults aged 50 to 80 years who have smoked more than one pack a day for 20 years and are currently smoking. If you quit smoking within the last 15 years, you should do a low-dose computed tomography scan each year.

“This is a new screening with more data and better technology,” Weiner says. “When we first started screening for lung cancer, CT scans weren’t as accurate as they are these days, and they were shining more radiation. And the recommendations have become clearer. “

Lung cancer screening data will begin to be collected in Iowa in 2022, but the American Lung Association estimates that the lung cancer screening rate in Iowa is 11%. The low rate may reflect a lack of access or poor awareness and knowledge between the patient and the healthcare provider.

“Originally, we didn’t have lung cancer screening programs everywhere, so if you’re a provider of a system that doesn’t offer it, you’re probably unlikely to advertise it,” says Charlton. “But now it’s fairly available throughout the state and in the majority of counties.”

“This screening can save your life completely, so talk to your doctor.”

Genetic counseling for high-risk individuals

The 2022 Iowa Cancer Report also includes information on genetic counseling. DNA tests can detect some genetic changes, and the results may provide information that can help prevent cancer or detect it in its early stages.

“Cancer screening applies to people at average risk, but there are many who may be at high risk because of their family or personal history,” says Charlton. “This technique has exploded in that it can perform very large genetic panel tests, but you should consult a counselor. Family history before deciding to have such a test. You need to find out what a particular test tells you, what it doesn’t, and what the results mean. “

With the rise of off-the-shelf genetic testing kits, Charlton and Weiner emphasize the important role that genetic counseling plays before and after genetic testing.

“It’s important to note that the recommendations aren’t for genetic testing, they’re for genetic counseling,” Weiner says. “Determining which test is appropriate for an individual patient is not so easy. Tests like 23andMe can be dangerous because people get the information out of context. Genetic testing can be dangerous. It should be done within the framework of broader genetic counseling, which allows the results to be foreseen. “

Schmouth consulted with a genetic counselor after being diagnosed with breast cancer.

“It was my great fear to have an oncogene that could be passed on to my daughter,” says Schmouth. “My genetic counselor was great. She guided me everything, the tests I might need, how they work, and how they do things over time. I explained if I would track it. She was very kind and answered all my questions. “

Schmouth tested negative for BRCA mutations that are commonly associated with an increased risk of breast and ovarian cancer, but the results of the other two tests were not conclusive. Her doctor monitored them over time, and Schmouth says her genetic counselor helped her understand what it meant and calmed her fears.

Schmouth says he was fortunate to be able to get rid of breast cancer with surgery alone and no radiation or chemotherapy.

Now she says she feels the purpose of life to share her story and advocate early detection.

“Even if you don’t have any signs or symptoms, you should be screened and taken when the deadline is reached. Don’t delay,” says Schmouth. “Consult your doctor about when to start mammography screening. Even if your doctor’s guidelines recommend 45-50 years to start screening, if you have the option, start at 40. Consider doing, but still qualifying. If you waited until 45 instead of 40, it was probably Stage 4 and Terminal.

“Early detection saves lives. I’m an example of how to walk. I didn’t expect this to happen to me for a million years. And I screened it when I did. I am very grateful for the help. Thanks to the mammogram, I can see the children grow up. “

Cancer screening recommendations

The United States Preventive Services Task Force (USPSTF) recommends the following screening tests for people at average risk:

• Breast cancer: Mammograms for all women aged 50-74 years every two years. The decision to start at age 40 must be personal.

• Cervical cancer:
  • Papanicolaou test every 3 years for all women aged 21-29
  • Papanicolaou test every 3 years for all women aged 30-65 years, high-risk HPV (hrHPV) test every 5 years only, or hrHPV test in combination with the Papanicolaou test every 5 years
• Colorectal cancer: For all adults between the ages of 45 and 75, one of the following:
  • High-sensitivity guaiac fecal occult blood test (HSgFOBT) or fecal immunochemical test (FIT) every year
  • Fecal DNA-FIT every 1 to 3 years
  • Colon endoscopy every 10 years
  • Flexible sigmoidoscopy every 5 years
  • Flexible sigmoidoscopy every 10 years + annual FIT
  • Computed tomography colonography every 5 years
• lung cancer: Low-dose computed tomography for adults aged 50-80 years who have smoked 20 packs and are currently smoking or have quit smoking within the last 15 years.