Iowa's leading cancer researchers released sobering numbers last week. Data from the Iowa Cancer Registry indicates that Iowa has "the second-highest overall cancer incidence of all U.S. states" and is "the only state with a significant increase in cancer incidence from 2015 to 2019."
In addition, Iowa ranks first for "rates of new cases of oral cavity and pharyngeal cancer," often known as head and neck or mouth and throat cancers. Iowa also has the country's second-highest rate for leukemia and ranks fifth and sixth for melanoma and non-Hodgkin lymphoma, respectively.
Meanwhile, Governor Kim Reynolds is forging ahead with efforts to stop requiring Iowa schools to teach junior high and high school students that a vaccine is available to prevent human papillomavirus (HPV). That virus can cause cancer in several areas of the body, including the mouth and throat.
"IT'S IMPORTANT FOR ADOLESCENTS TO GET THE VACCINE"
Cancer has long been the second-leading cause of death in Iowa, after heart disease. Researchers estimate that 6,200 Iowans will die from some form of cancer this year. University of Iowa faculty presented findings from the Cancer in Iowa 2023 report at a press briefing on February 28. Here's the full video:
Mary Charlton, a University of Iowa associate professor of epidemiology who is also director and principal investigator of the Iowa Cancer Registry, walked through some of the most important numbers.
Asked why Iowa's cancer rate is so high and rising, Charlton said, “We’ve really been trying to dig into that because it just seems so unbelievable that here in Iowa we would have the second-highest rate of new cancer cases around the country."
While "we don't have as high a lung cancer rate” as residents of Kentucky, where smoking is much more prevalent, "what we do have is a relatively high rate of just about every major cancer type across the board.” Charlton noted that Iowa's cancer rates have been "trending this way for a long time."
While Iowa's aging population may partly explain high cancer rates, we're far from the oldest state—tied with Ohio for eighteenth, according to 2020 U.S. census data.
This graph from the Cancer in Iowa report shows how the state's cancer incidence and cancer mortality are both above the national average.
Referring to Iowa's number one ranking for head and neck cancers, Charlton said some of those cases can be prevented by reducing tobacco and alcohol use, "and through use of the HPV vaccine, since almost a third of these types of cancer cases are caused by the HPV virus."
Dr. George Weiner, director of the University of Iowa's Holden Comprehensive Cancer Center, added a few minutes later,
Through basic research, we understand how the HPV virus gets into cells, how over many years it can make those cells become cancerous, and we have ways of detecting whether the [cancer] cells have been caused by HPV infection.
We've developed a vaccine that's extraordinarily safe and extraordinarily effective, if given before the HPV infection takes place, when people are younger.
What we haven't done as well as we'd like is been able to get that vaccine taken up by all the communities that really need it.
When a reporter asked whether the cancer researchers had any special recommendations for Iowa policy makers, Weiner again referred to the HPV vaccine. "It's incredibly effective. It is incredibly safe, and it's an anti-cancer vaccine." He said the message needs to "continually be put out there that it's important for adolescents to get the vaccine so they don't develop these various cancers when they get older."
According to the U.S. Centers for Disease Control, "HPV is thought to be responsible for more than 90% of anal and cervical cancers, about 70% of vaginal and vulvar cancers, and 60% of penile cancers. Cancers in the back of the throat (oropharynx) traditionally have been caused by tobacco and alcohol, but recent studies1 2 3 show that about 60% to 70% of cancers of the oropharynx may be linked to HPV."
A BILL MORE EXTREME THAN JEFF SHIPLEY'S
The CDC recommends HPV vaccination around age 11 or 12. In 2007, one year after the federal government began recommending the vaccine, the state of Iowa (then governed by a Democratic trifecta) enacted language requiring instruction in grades 7 through 12 about HPV and a vaccine to prevent the virus.
The governor's wide-ranging education bill, introduced in early February, called for striking all Iowa Code language mandating that schools inform students specifically about "HPV and the availability of a vaccine to prevent HPV, and acquired immune deficiency syndrome" (commonly known as AIDS) as part of the health curriculum at the junior high and high school level.
Republicans on the Senate Education Committee approved the governor's bill in time for last week's "funnel" deadline. The legislation is now numbered Senate File 496.
The governor's proposal goes even further than a bill introduced by Iowa's most vocal anti-vaccine legislator, State Representative Jeff Shipley. His bill would have kept HPV and AIDS in the curriculum from seventh through twelfth grade, removing only code language requiring that students be taught about "the availability of a vaccine to prevent HPV." Shipley's bill cleared a House subcommittee over objections from numerous medical or public health experts but was not taken up by the full House Education Committee before the funnel deadline.
Groups that lobbied against Shipley's proposal included the American Cancer Society Cancer Action Network, Iowa Public Health Association, Blank Children's Hospital, Iowa Chapter of the American Academy of Pediatrics, Iowa School Nurses Organization, Iowa Nurses Association, and the Iowa Nurse Practitioners Society.
Reynolds and her staff were unmoved.
When presenting what she called a "parental empowerment" bill at an Iowa Senate subcommittee on February 23, the governor's legislative liaison Molly Severn downplayed the impact of removing code references to HPV and HIV, the virus that causes AIDS. "Iowa Code currently requires teaching characteristics of communicable diseases, as well as educating students about sexually-transmitted diseases and their treatments," she said. "The governor's proposed language supports the continuation of such practices without naming in code each disease that may be included in such teaching."
The reality is that without mandatory education about HPV and the vaccine that prevents it, school districts may be influenced by anti-vaccine activists seeking to remove such material from classes in their community.
"LIBERTY" ACTIVISTS LED CHARGE AGAINST HPV VACCINE
Why did Reynolds decide Iowa schools shouldn't be required to tell students about the leading anti-cancer vaccine?
The governor's deputy communications director Kollin Crompton ignored Bleeding Heartland's inquiries on the subject over a three-week period.
Reynolds obviously didn't consult cancer experts. And it seems clear that the Iowa Department of Health and Human Services wasn't driving this train. That agency's public information officer Alex Carfrae told Bleeding Heartland last month,
Iowa HHS consistently messages about the importance of the HPV vaccine and recently completed a multi-platform educational messaging campaign for parents outlining the connection between cervical cancer and HPV and establishing the HPV vaccine as the best form of protection. These efforts also included providing comprehensive materials to our local partners to execute this messaging on their platforms at the local level.
Carfrae didn't respond to follow-up questions seeking to clarify whether the agency has tried to inform Iowans about the link between HPV and mouth or throat cancers, or whether the governor's office has recently urged HHS to change any of its messaging about the vaccine.
After encouraging Iowans to get vaccinated for COVID-19 over a period of several months in early 2021, Reynolds increasingly aligned herself with anti-vaccine activists. In May 2021, she signed a bill banning so-called "vaccine passports," which did not exist in Iowa. Later that year and in 2022, the governor's public statements and social media posts emphasized the "freedom" to refuse vaccinations. In May 2022, she signed a bill banning Iowa's child care centers, K-12 schools, and colleges from requiring COVID-19 vaccines.
Even so, it's a big step to go from validating COVID vaccine skeptics to undermining education about a proven cancer prevention tool.
While the HPV language in the governor's education bill may seem to have come out of nowhere, hearings on other bills introduced this year foreshadowed its appearance.
On January 31, an Iowa Senate subcommittee considered a bill to ban gender identity instruction in grades kindergarten through 8. Lindsay Maher was one of the speakers supporting the proposal, but suggested a "friendly amendment" to remove specific references to HPV. She described existing code language as "unnecessary" and "redundant," because the law already mentions sexually transmitted diseases. Maher further asserted that the code provides "free advertising for Merck," which manufactures the only HPV vaccine currently on the market (Gardasil).
Maher is a leading member of the anti-vaccine group Informed Choice Iowa and recently founded a political action committee to back Iowa candidates "who have led in the protection of our liberties." Last month, she spoke at a House subcommittee in favor of Shipley's bill to remove material about an HPV vaccine from Iowa's health education curriculum.
Amber Williams, who is active with Moms for Liberty, called for striking HPV code language at a February 9 subcommittee on a different Senate bill, which would have prohibited instruction about sexual orientation or gender identity from kindergarten through eighth grade.
We know like-minded activists had access to the governor because Reynolds was a featured speaker at a Moms for Liberty town hall in Des Moines on February 2. She promised there to put parents in charge of their children's education. Her education bill appeared on the legislature's website a week later. And the governor's staff continued to advocate for removing HPV from the curriculum despite strenuous objections from the public health community.
Iowa parents already can choose whether to have their children vaccinated for HPV. Schools don't administer the vaccine; health care providers do. So the only thing that part of the governor's bill will accomplish is keeping more students unaware that an anti-cancer vaccine exists. Ignorance doesn't empower anyone.
No matter: Reynolds will be long gone by the time today's unvaccinated school children develop cancers linked to HPV.
Top image: Screenshot from video of Governor Kim Reynolds speaking at a Moms for Liberty town hall in Des Moines on February 2, 2023.