Report points to alcohol as possible factor in Iowa’s high cancer rates

John Stokes has survived cancer twice — his treatment for “voice box” cancer was successful after being diagnosed 13 years ago — and is once again cancer-free after receiving surgery to remove what doctors in 2022 identified as head and neck cancer.

Almost 169,000 Iowans are cancer survivors like Stokes, according to the 2024 Cancer in Iowa Report, but about 6,100 are expected to die from it this year, alongside an estimated 21,000 who are diagnosed with new invasive cancer cases. Health care experts discussed the report’s findings Tuesday at a news conference.

Iowa once again has the second-highest rate of new cancer cases in the U.S., according to the report, alongside the fastest-growing rate of new cancers. The state also reports the fourth-highest incidence of alcohol-related cancers in the country and the highest in the Midwest, facts which Stokes called “astounding.”

As someone who confronted his alcoholism and quit drinking a long time ago, Stokes said it might have made a difference in his life if he knew how alcohol could contribute to the chances of developing cancer.

“It’s never too late to reduce your risk of alcohol-related cancer,” Stokes said. “As a head and neck cancer survivor, I want to make sure that Iowans know that alcohol can cause cancer and if you’re thinking about making the move to drink less, reducing your chance of risk is a great motivation itself.”

Panelists at the news conference cited alcohol usage as a possible driver in Iowa’s cancer rates, and emphasized that there needs to be policies and other efforts put in place to try and lower alcohol abuse across the board.

“My main message today is to be a literal buzzkill,” said Mary Charlton, director of the Iowa Cancer Registry at the University of Iowa, at the news conference.

No one thing leads to developing cancer, Charlton said, rather it’s a group of multiple factors coming together to impact cells. These factors can include genetics, environment, behaviors and more. Alcohol can contribute to these factors, and when combined with other things like tobacco use or HPV, the risks can become even greater.

“Alcohol can result in damage of the genetic material and cells. At the same time, it reduces your body’s ability to repair that DNA, and so that’s kind of a double whammy that can lead to accumulation of mutations … the accumulation of mutations that can drive cancer,” said Michael Henry, interim director of University of Iowa Holden Comprehensive Cancer Center. “But even more than that, it can also cause inflammation and affect the function of our immune system, and that can actually cause cancers that have developed to be worse and have worse consequences.”

Risks come from how many units of alcohol are being consumed, rather than what kind of alcohol is being consumed, Charlton said, and the report stated reducing alcohol consumption at all can lead to reduced risks of developing cancer. Binge drinking poses the greatest risks, she said, and 22% of Iowans report binge drinking, compared to the 17% national average.

Across all demographics, including age, race, sex, income level and more, Iowans binge drink more than the national average.

Alcohol has been shown to heighten the risk of developing cancer in the esophagus, colon and rectum, oral cavity, pharynx and larynx, as well as female breast cancer. According to the report, Iowa ranks in the top 10 of highest rates of new cases of oral cavity and pharyngeal, esophageal, colorectal, and female breast cancers.

Charlton said breast, prostate, lung and colorectal cancers make up around half of all cancer cases in Iowa, and they top the list of expected cancers in 2024.

Only 40% of adults know that alcohol consumption increases the risk of developing cancer, according to the report.

Iowa alcohol sales continue to climb

According to state data, Iowans spent $446 million last year on liquor sales at businesses holding Class “E” liquor licenses, like grocery and convenience stores. That number has steadily climbed since 2012, when $255 million was spent, and $33 million has already been spent this year.

The report also went over possible solutions for decreasing alcohol consumption, citing the Iowa Cancer Consortium’s Iowa Cancer Plan strategies of educating the public on alcohol consumption and cancer, creating environments that reduce and prevent excessive alcohol consumption and increasing screening and treatment for excessive alcohol use.

Some ways to curb heightened drinking include controlling alcohol prices through taxes and minimum unit pricing, discouraging over-serving alcohol and encouraging better practices through laws holding businesses liable for injuries and damages caused by intoxicated patrons and other regulatory policies.

The report stated that health care providers could also help curb drinking by conducting screening and brief interventions in order to identify excessive drinking habits and have discussions with their patients about the risks involved and ways to make changes.

“Leaving it to individuals to make that choice on their own has still gotten us to the number two highest cancer rate in the country,” Charlton said. “I think it’s definitely time to look at a population level —  what are the things that we can do at a population level, whether it’s policy, legislation, programming, things like that, that make it easier to make the healthy choices and harder to make the less healthy choices.”