Iowa has the fastest growing rates of cancer in the U.S. What’s being done to fight it?

Jordan Hauck felt a lump in his armpit.

The healthy, active, then-single 27-year-old at first dismissed it as benign. But the lump continued to grow.

He was diagnosed in 2013 with stage 4 metastatic melanoma. A biopsy revealed the cancer had spread to his lungs and liver. The Huxley resident said there was talk of removing a lung and possibly amputating his right arm.

At the time there were no federally-approved drugs for the treatment of melanoma. Most were still in clinical trials.

“My options were pretty limited,” Hauck, now 39, said.

He pressed for more options, and his local provider mentioned clinical trials at the University of Iowa.

On the UI campus he met with Dr. Mohammed Milhem, a clinical researcher at the University of Iowa Holden Comprehensive Cancer Center. Milhem enrolled Hauck in a clinical trial involving a combination of daily oral medication targeting the cancer’s metabolic pathway and four high-dose injections of a protein to boost his immune system’s response to attack the cancer cells. The injections required weeklong stays at a time, in intensive care, for monitoring due to the potential of severe side effects.

Within a year, Hauck was cancer-free. He has had no recurrence of cancer since 2023.

Since his cancer treatment, Hauck has married and welcomed two young daughters.

“It saved my life. Basically, a two-hour drive was the difference between me having a conversation and not being here,” he said. “… To put it simply, I wouldn’t be here without the UI.”

In 2019, he founded Crown Cover, a company that sells clothing that offers sun protection. A portion of the proceeds goes to the Holden Comprehensive Cancer Center via his nonprofit, the Cancer Bucket Foundation. Hauck said he’s donated $28,000 to the UI for skin cancer research and awareness.

Hauck is one of the approximately 172,000 cancer survivors living in Iowa.

Iowa has the second-highest and fastest-growing rate of new cancers in the United States, according to the 2025 Cancer in Iowa report. It is one of only two states with a rising rate of new cancers.

More than 20,000 people are newly diagnosed with cancer each year in the state, and more than 1 in 20 people in Iowa have had a diagnosis of cancer at some point in their lives, the report states.

That ratio will continue to rise as Iowa’s rate of new cancer rises while cancer deaths decline, the report’s authors say.

Iowa Ideas In-Depth Week Explores Cancer in Iowa

Iowa Ideas, a project of The Gazette, is hosting a free, virtual In-Depth Week series called Cancer in Iowa, May 12-16.

The week features five sessions, held 12-1 p.m. each day. Full session descriptions, including a list of panelists, and registration can be found at iowaideas.com. Here is the week’s schedule:

• Monday: Cancer in Iowa Overview: Iowa has the second-highest and fastest-growing rate of new cancers in the United States. This session will explore data and what the trends mean for Iowans’ health.

• Tuesday: Cause and Effect: What makes Iowans uniquely susceptible to cancer? Researchers explain what they’ve found and what remains unknown.

• Wednesday: Pediatric Cancer: In a state with high cancer rates, what do pediatric cancer rates tell us? We’ll explore the unique challenges that come with treating children.

• Thursday: Economic Impact: Beyond the physical and emotional impact of a cancer diagnosis, this session will explore the financial hardships the disease can cause.

• Friday: Advancements in Screening and Treatment: Researchers are making new discoveries about cancer and cancer treatments. We’ll hear about some of those breakthroughs, and the work to find a cure.

The UI’s Holden Comprehensive Cancer Center is Iowa's only National Cancer Institute-designated cancer center and one of 57 such designated centers in the nation — recognized for its leadership, resources and research in cancer medicine.

Providers at Holden see nearly 5,000 new cancer cases a year and enroll hundreds of patients in clinical research, with some 200 clinical trials underway at any one time.

“I think a lot of people outside of health care don’t realize … you’re potentially getting the latest and greatest lifesaving treatment,” Hauck said. “I don’t have the words to say how much it means.”

Public health experts in the state, though, warn proposals to slash federal spending for scientific research, and workforce layoffs at federal public health agencies pose a major threat to ongoing research and data collection efforts aimed at lowering Iowa’s high cancer rates.

“I get there’s a lot of wasteful spending in government. That’s absolutely one that is not unnecessary or wasteful,” Hauck said. “That’s lifesaving potential research and treatment. It’s going to impact people’s lives and health if we don't have needed research to support new advancements in cancer treatments.”

What research is being done in Iowa?

Researchers across the state are digging into how best to prevent, detect and treat cancer and improve the quality of life of survivors.

In Des Moines and Iowa City, researchers seek to answer fundamental questions about how cancer works through laboratory studies of cells, molecules and genes to better understand the mechanisms of cancer development, growth and spread.

Researchers are also working on translating their research findings into clinical application — applying lab discoveries to create models and preclinical studies conducted on cells, tissues or animals to evaluate the potential effectiveness and safety of new therapies or diagnostic tools before human testing.

New treatments, interventions and screening methods as well are being tested through hundreds of ongoing clinical trials across Iowa, and studies are underway to explore the causes, trends and factors that affect the delivery and outcomes of cancer care in specific areas and populations in the state.

Richard Deming is medical director of the MercyOne Cancer Center in Des Moines that bears his name. He also is the founder of Above + Beyond Cancer, a nonprofit that provides evidence-based, free programs for cancer survivors that promote recovery and prevention.

The Des Moines community cancer center has 68 clinical trials funded by the National Cancer Institute currently underway. Deming said many focus on adding immunotherapy — boosting the body's own immune system to kill cancer cells — alongside a standard treatment combination of chemotherapy, radiation and surgery for patients with breast, head-and-neck, lung and colorectal cancer.

The center also has 240 patients enrolled in a large-scale, nationwide screening trial for women with breast cancer. The randomized study seeks to compare two types of digital mammography for breast cancer screening in women. It aims to determine which type of digital mammography is better at detecting and reducing advanced breast cancer.

Other trials are assessing the value of integrating oncology and palliative care and the role a cancer survivorship program can do to enhance quality of life, as well as de-escalation cancer trials studying the effects of reducing the intensity or duration of treatment.

“We're looking at those patients who get the chemotherapy first and then go to surgery, what if at the time of surgery all the cancer is gone? Do you need then to add in the radiation?” Deming said.

The hope being that would lead to fewer side effects and complications for patients, without affecting overall survival rate.

Cancer care has made remarkable progress over the past decades, said Dr. Mark Burkard, director of the UI Holden Comprehensive Cancer Center.

New therapies, surgical and radiation innovations, diagnostic tools and prevention strategies have led to a more than 30 percent decline in cancer deaths over the last 30 years.

“Clinical trials have been a key part of this progress, and they move us forward in terms of bringing better treatments to our patients,” Burkard said during a “mini-medical school” event last week on the UI campus on the future of cancer clinical trials in Iowa.

He shared the story of a woman with a tumor in her abdomen the size of a soccer ball. The woman had a genetic test done that revealed a rare genetic change. Because of that she was able to be enrolled in a clinical trial for a drug that turned off the enzyme. Six months later, the tumor had shrunk to the size of a golf ball and five years later she remained on the drug with no visible tumor.

“So clinical research does save lives,” Burkard said.

He said cellular therapy, in particular, is revolutionizing how providers treat patients who don't respond to standard treatments.

“It's taking patient cells and teaching them to find the cancer and to target it and destroy it,” Burkard said. “We have dozens of cellular therapies, and are the only center in Iowa that offers this type of treatment.”

He said one of the college of medicine’s newest faculty members recently received a federal grant to develop a new type of treatment for patients with ovarian cancer to prevent recurrence after surgery.

The approach proposes to refine the production of small, fluid-filled sacs released by cells that carry proteins and other biologically important agents to target a type of white blood cell in tumor clusters and “change them from cancer supporting to cancer fighting,” according to the university.

Michael Petronek is a research assistant professor in radiation oncology at the University of Iowa Carver College of Medicine. Petronek and his team have been researching iron metabolism in mice and patients with brain tumors, to better understand cancer progression and develop strategies that can be translated into clinical practice to enhance patient care.

“We know that iron can be used for processes that support tumor growth, which we're still working on discovering,” Petronek said. “But another consequence is it actually can do damage to the tumor cells. So one of the therapeutic strategies is the thought that if we … exacerbate the amount of iron inside the tumor, we can kill it.”

He and others at the UI are investigating medical imaging models to evaluate iron metabolic status in brain tumors and predict clinical responses to therapy.

“There are a lot of exciting things happening in cancer today. It's complicated, but if we're thoughtful and collaborating to work together, we can make major progress,” Burkard said.

What impact will federal funding cuts have on research in Iowa?

George Weiner is the former director of the UI’s Holden Comprehensive Cancer Center. Weiner has spent his decades-long career researching cancer, including running immunotherapy trials similar to the one in which Hauck was enrolled.

“We're learning more about the immune system and more about cancer, and I have no doubt new approaches to cancer prevention and new approaches to cancer therapy are within our reach based on the continued progress of research,” Weiner said.

Progress he said is now under threat by President Donald Trump’s administration.

Uncertainty over federal funding cuts and workforce layoffs at federal health agencies have already disrupted the research pipeline by delaying research, Weiner told The Gazette.

The White House has proposed significant cuts and policy changes to federal agencies like the National Institutes of Health (NIH) as part of a broad government restructuring aimed at saving taxpayer dollars.

The Republican president has proposed a $163 billion cut to the federal budget that would sharply reduce spending in areas including health next year, while increasing spending for defense and border security.

Trump’s budget proposes a 26 percent reduction to the U.S. Department of Health and Humans Services’ $127 billion budget, most of which would come from steep cuts to the NIH and Centers for Disease Control and Prevention. That includes a 37 percent funding cut to the NIH and eliminates cancer screening and prevention programs at the CDC.

“With the President's proposed budget … there's no question that what we are going to see is a drop in cancer research,” Weiner said.

He said many cancer researchers are afraid to make major investments or hire new staff.

The U.S. Department of Health and Human Services also is planning to cut 10,000 full-time jobs as part of a larger restructuring effort, reducing its workforce from 82,000 to 62,000. Another 10,000 employees are expected to leave HHS through early retirement and voluntary separation incentives.

The NIH has said it would limit indirect funding for research projects to 15 percent, cutting funding the federal government would provide to research agencies for things like equipment, maintenance, utilities and support staff. Previously, such rates varied and were negotiated by each institution with the government, but averaged about 27 percent.

A federal judge last month issued a final judgment permanently blocking implementation, pending appeal.

Should the NIH proceed with the proposed reduction in the amount of indirect costs it covers for the research endeavors it supports, the UI could lose an estimated $33.6 million a year, according to an online calculator using NIH data.

For the state as a whole, the hit could near $37 million.

The UI’s Holden Comprehensive Cancer Center receives about $22 million annually from the National Cancer Institute, which is funded by the NIH. Overall, the university received about $130 million in NIH funding last budget year that supported 178 UI biomedical research projects.

Some cancer research has been put on hold amid funding uncertainty

More than 95 percent of cancer advances that have taken place over the past 20 years that have resulted in a 30 percent drop in cancer mortality started with federal funding, Weiner said.

“A number of grants, the funding that we're expecting just hasn't arrived yet, and we don't know why,” he said.

As a result, he said some research projects have been put on hold.

Deming said one of MercyOne’s federally-funded clinical trials focusing on the LGBTQ community was abruptly canceled earlier this year as a result of a Trump executive order.

Deming, who also is vice president of the Iowa Cancer Consortium, said one of the organization's federally-funded employees was abruptly laid off earlier this year amid a wave of probationary federal government employees let go under the new Trump administration.

Weiner also serves on the National Cancer Institute’s Board of Scientific Advisors. The group of 28 cancer experts met several times a year to advise federal officials on the most efficient use of cancer research funding. Within the past week, he said members were abruptly told the board had been terminated, without information as to how their role will be filled by others.

“We cannot burn down the house” in a broad attempt to restructure the federal government, Weiner said, noting government-funded research has helped cure people who had no options 20 years ago, and has enabled people to see their grandchildren born.

Weiner spoke to The Gazette as a research oncologist and not on behalf of the University of Iowa or the National Cancer Institute’s Board of Scientific Advisors.

“Some people will find alternative sources of funding. Others will give up and will go find something else to do,” he said. “I'm most concerned about the next generation, the young cancer researchers who aren't even going to try.”

Deming, too, worries research will shift to other countries and to pharmaceutical companies.

“If all you have are the people making the drugs doing the research themselves, you will lose some of the fairness, unbiased nature of research” untethered to profit margins, he said. “ … So we're fearful of the loss, not only of clinical trials, but the loss of researchers, if we don't continue to provide the economic engine that propels science.”

Denise Jamieson, UI vice president for medical affairs, said despite the uncertainty, she believes the “future of scientific inquiry is going to be bright.”

“What I tell the graduate students that are here is, once you're here at University of Iowa, we will take care of you, and we will ensure that you are able to have the tools you need to complete your education,” Jamieson told those gathered during last week’s “mini-medical school” event.

“What I tell faculty, there's been a lot of talk about … ‘If I lose my NIH funding, are you going to provide funds to bridge me to my next grant?’” she continued. “And what I like to say is we need to think more about building rather than bridging. We need to be strategic and thoughtful about what things are going to be important in the coming years, and what problems we need to work on and build programs based around those issues,” including cancer.

What we know and don’t know about cancer in Iowa

Kelly Wells Sittig, executive director of the Iowa Cancer Consortium, stressed the need for long-term investment and commitment to address and understand the complexity and interplay of various factors contributing to Iowa's high cancer incidence rate.

“We need additional investments and bigger cancer control work in order to turn that around,” Sittig said. “So thinking about not just funding cuts, but also cuts to the cancer control workforce and health care workforce and public health workforce certainly feels worrisome when we're thinking about trying to turn our cancer incidence rate around.”

In January, Gov. Kim Reynolds pledged $1 million to fund a team of epidemiologists who would work to understand Iowa’s growing cancer rate. State lawmakers have included the funding in budget bills working their way through the legislative process.

The Iowa Cancer Consortium, with more than 650 members, develops the Iowa Cancer Plan and supports community projects. Funded by the CDC and state agencies, the plan serves as a guidebook to reduce the burden of cancer in the state.

The consortium also collaborates with the Iowa Cancer Registry on a project to present county-specific cancer information and address community concerns in each of Iowa’s 99 counties.

Sarah Nash is director of research, analytics and dissemination with the Iowa Cancer Registry and an assistant professor of epidemiology at the University of Iowa.

Nash said the 99 Counties Project aims to visit all 99 counties in Iowa to present local data and discuss cancer rates and risk factors with the goal of providing local partners with actionable cancer data specific to their county so they can address cancer concerns and promote healthier communities.

Representatives from the project are working with county public health directors and health systems to schedule meetings for each of Iowa’s 99 counties. To date, meetings have been held in 11 counties, with nine more scheduled for May through July.

A Linn County meeting will be held Wednesday, May 28, from 4-5:30 p.m. at Linn County Public Health, 1020 Sixth St. SE, Cedar Rapids. A meeting will be held in Johnson County on June 30, from 4-5:30 p.m. at a location yet to be announced.

Breast, prostate, lung and melanoma cancers are major drivers of the state's rising cancer rates, with known risk factors including smoking, drinking, poor diet and nutrition, lack of physical activity and UV exposure, according to the Cancer Registry.

The cancer registry collects data on cancer diagnoses and treatments, but does not currently collect environmental data before cancer onset, Nash said.

To better understand environmental factors, the registry collaborates with experts like the Center for Health Effects and Environmental Contamination and the Environmental Health Sciences Research Center at the University of Iowa. The registry provides cancer data to these specialized researchers, who can then analyze potential environmental links.

While there’s reason to worry about the environment, controlling behaviors like smoking, drinking, physical activity and diet have the biggest impact in reducing cancer risk, Nash said.

Iowa's cancer incidence also varies across different geographic areas, with higher rates of breast cancer in cities, colorectal cancer in rural areas, melanoma in northern parts, lung cancer in southern parts, and prostate cancer in western parts, suggesting distinct risk factors across the state.

Nash said the UI’s Holden Comprehensive Cancer Center also plans to convene a “blue ribbon panel” this summer of international and nationally renowned cancer experts to examine Iowa's cancer rates and develop concrete research strategies, which may include more in-depth investigation of environmental contributors to cancer.

Both she and Sittig said it’s crucial to recognize that cancer is a complex disease with an interplay of multiple factors contributing to its high incidence. Addressing these factors will take time and require a multifaceted approach. Therefore, it is essential to make long-term commitments in areas such as research, prevention, early detection, treatment, quality of life and public outreach.

All of which will require a complex, long-term response with diverse resources and efforts.

While there’s a pressing sense of urgency, “We are not going to be able to figure out what's happening quickly, nor are we likely to be able to change it quickly,” Sittig said.

“So we should continue to embrace that sense of urgency and use it, but we also have to settle in for a lot the long term,” she said. “ … And there's not going to be one factor that we find that will help us turn this around.”

The Gazette’s Vanessa Miller contributed to this report.

Comments: (319) 398-8499; tom.barton@thegazette.com