1. RAISING AWARENESS OF BONE AND JOINT CANCER THROUGH A
COLLABORATION OF WAUKEE APEX AND DMU
Aldijana Dizdarevic1, May Moreland1, Josh Waltman1, Holly Showalter1, and Elitsa Ananieva2
1Waukee APEX, Waukee High School, Waukee, IA; 2Des Moines University
Abstract
Introduction
Waukee Aspiring Professional Experience (APEX) teamed up with Dr. Elitsa
Ananieva, an Assistant Professor of Biochemistry and Nutrition at Des Moines
University who conducts research on bone cancer in Iowa. APEX is a program
through Waukee High School where students explore health sciences and
medicine alongside business professionals, while learning the fundamentals of
medicine, project management, and professional skills. This is the first project
that a researcher from DMU has collaborated with Waukee students. It is aimed
at raising awareness about bone cancer among the public, scientific community,
and funding agencies in Iowa so that more public involvement and research
efforts are devoted to benefit bone cancer patients. This project was initiated by
comparing bone and joint cancer incidence rates along with mortality rates.
Research was gathered on bone and joint cancer cases between males and
females in Iowa and other states in the Midwest. With the information collected,
the APEX students made tables and graphs that included counts of cases, age
adjusted rates, and standard errors. Next, bone cancer mortality was compared
to those from more common cancers such as breast, prostate, and lung cancer
in Iowa. Along with the information learned about cancer in Iowa, APEX students
learned professional skills such as servant leadership, communication, data
analysis, and productivity.
Methods
Results
Conclusion
References
Objectives
 Raise awareness and research funding for bone and joint cancer
 Demonstrate critical thinking, communication, creativity, and collaboration by gaining positive
feedback from conference attendees
 Show understanding of how bone cancer has impacted the population of Iowa by comparing data
collected from 2008 to 2012
1. Age-Adjusted Invasive Cancer Incidence Rates by County in Iowa, 2008 - 2012. Based on data released August 2015. Cancer-
Rates.info. Accessed on Mar 31, 2016. Iowa Cancer Registry.
2.
"Image Gallery, "USA Regions Map with Four Major Regions (NorthEast, South, West and Midwest)in High Resolution. A Related Pdf
File Can Be Downloaded for Printing." Picture & Photo Collection for PC, Mobile & IPad - Picturemic.com." USA Regions Map with
Four Major Regions (NorthEast, South, West and Midwest)in High Resolution. A Related Pdf File Can Be Downloaded for Printing.
Photo & Picture Gallery. N.p., n.d. Web. 31 Mar. 2016.
3.
The North American Association of Central Cancer Registries. Average-annual Registry-specific Cancer Incidence by Race, Ethnicity
and Sex Age-adjusted to the 2000 U.S. and World Population Standards 2008-2012.
Dr. Elitsa Ananeiva is a researcher at Des Moines
University interested in studying rare cancers such as
bone sarcomas. Rare cancers receive disproportionally
lower public attention because they affect a small
population. As a result less research funding and clinical
trials are undertaken to address rare cancers. A cancer
diagnosis is devastating for every cancer patient
regardless of how common the cancer type is. Dr.
Ananeiva’s long term goal is to raise awareness of bone
cancer. For this purpose, Dr. Ananieva formed a
collaboration with Holly Showalter, the teacher of the
Exploration of Health Sciences and Medicine APEX group
at Waukee High School. Three students from her class
were selected to perform internet based research on bone
cancer in Midwest, West , North-East, and South regions
of U.S.
 Background information on bone cancer such as bone cancer types, different treatment options,
incidents and mortality rates were researched by using internet available recourses as cited in
the references.
 Bone cancer incidence rates for both males and females in Midwest were compared using the
age adjusted rate (AAR). Rates were per 100,000 population and were age-adjusted by five-year
age groups to the 2000 U.S. standard population based on single years of age. Next, AAR of
Midwest was compared to AARs of West , North-East, and South regions of U.S.
 Mortality rates and percentage of cancer survivors for the top 8 cancers in Iowa were compared
to those for bone and joint cancer in Iowa.
Midwest
• Males
• Iowa had the highest (1.3), while South Dakota had the lowest (0.8) age adjusted incidence rate of bone
and joint cancer.
• Females
• Kansas and Iowa reported the highest (0.9), while South Dakota reported the lowest (0.5) age adjusted
incidence rate of bone and joint cancer.
North East
• Males
• New Jersey and Connecticut owned the highest age adjusted bone cancer incidence rates, while Rhode
Island (0.8) had the lowest.
• Females
• Bone cancer incidence rates were highest for New Hampshire (1.4) and lowest for the Rhode Island
(0.6). Rhode Island reported the lowest rates for both males and females.
West
• Males
• Utah reported the highest bone cancer incidence rate (1.7) not only as compared to other West states
but also as compared to all regions studied. Montana had the lowest (0.7).
• Females
• Wyoming had the highest (1.1), while California (0.7) and New Mexico (0.7) had the lowest age adjusted
bone cancer incidence rates amongst females.
South
• Males
• Texas (1.2) and Florida (1.2) reported the highest, while Delaware (0.8) reported the lowest rates
amongst males.
• Females
• The leaders of female bone cancer were Texas (1.0) and Oklahoma (1.0), while Delaware showed the
lowest rates of bone cancer. Delaware reported the lowest possible rates amongst females as
compared to all regions.
Cancer Mortality Rates and Cancer Survivors in Iowa
• Bone and Joint cancer mortality rate is only 0.5 compared to the 8 most common cancers in Iowa. This is
due to the fact that bone cancer is a rare cancer that affects only a small population. In contrast cancers
such as lung, prostate, colon and breast cancers, have high mortality rates in Iowa as normalized to
100,000 people and they reached 47.5, 20.7, 16.6, and 11.4 AARs, respectively.
• Despite the fact that bone and joint cancer mortality rate is just 0.5, the percentage of bone cancer survivors
in Iowa is 55% which is the second worst cancer survival rate after lung cancer (27%). Prostate, colon, and
breast cancer have 85%, 64%, and 82 % survival rates for a 5 year period.
State in Midwest Males AAR S.E. Females AAR S.E.
Iowa 101 1.3 0.1 76 0.9 0.1
Illinois 289 0.9 0.1 239 0.7 0.1
Indiana 161 1.0 0.1 137 0.8 0.1
Kansas 79 1.1 0.1 65 0.9 0.1
Michigan 278 1.1 0.1 225 0.8 0.1
Minnesota 157 1.2 0.1 110 0.8 0.1
Missouri 155 1.0 0.1 124 0.8 0.1
Nebraska 52 1.1 0.2 30 0.6 0.1
North Dakota 19 1.1 0.3 12 0.6 0.2
Ohio 296 1.1 0.1 219 0.7 0.1
South Dakota 17 0.8 0.2 10 0.5 0.2
Wisconsin 155 1.1 0.1 120 0.8 0.1
0.0
0.5
1.0
1.5
2.0
Ageadj.rates
Males
Females
Bone and Joint Cancer Incidence Rates among Males and Females in Midwest
for the Period 2008-2012
Bone and Joint Cancer Incidence Rates among Males and Females in North-
East for the Period 2008-2012
State in North-East Males AAR S.E. Females AAR S.E.
Pennsylvania 364 1.1 0.1 287 0.8 0.1
New Jersey 261 1.2 0.1 213 0.9 0.1
Conneticut 103 1.2 0.1 81 0.8 0.1
Rhode Island 20 0.8 0.2 17 0.6 0.1
New York 533 1.1 0.1 459 0.9 0.0
Massachussetts 158 1.0 0.1 158 0.9 0.1
Vermont 16 1.0 0.3 13 0.7 0.2
New Hampshire 32 0.9 0.2 45 1.4 0.2
Maine 42 1.3 0.2 29 0.8 0.2
0.0
0.5
1.0
1.5
2.0
Ageadj.rates
Males
Females
Bone and Joint Cancer Incidence Rates among Males and Females in West for
the Period 2008-2012
State in West Males AAR S.E. Females AAR S.E.
Washington 173 1.0 0.1 40 0.8 0.1
Oregon 99 1.0 0.1 99 1.0 0.1
California 963 1.1 0.0 701 0.7 0.0
Arizona 151 1.0 0.1 145 0.9 0.1
Utah 111 1.7 0.2 54 0.8 0.1
Idaho 44 1.1 0.2 39 1.0 0.2
Montana 16 0.7 0.2 26 0.9 0.2
Wyoming 16 1.1 0.3 15 1.1 0.3
Colorado 116 1.0 0.1 97 0.8 0.1
New Mexico 57 1.1 0.2 41 0.7 0.1
0.0
0.5
1.0
1.5
2.0
Ageadj.rates
Males
Females
Bone and Joint Cancer Incidence Rates among Males and Females in South for
the Period 2008-2012
0.0
0.5
1.0
1.5
2.0
Ageadj.rates
Males
Females
0.5
47.5
20.7
16.6
11.4
4.6 4.5 2.9
0.5
0
10
20
30
40
50
Ageadj.rates
55
27
85
64
82
73
79
92 96
0
25
50
75
100
Percentage(%)
Comparison of Bone and Joint Cancer with the 8 Most Common Cancers
in Iowa for the Period 2008-2012
Mortality Rates (All gender) Cancer Survivors (All gender)
Results
Abbreviations: AAR- Age adjusted rates (cancer incidence rates); S.E., standard error
State in South Males AAR S.E. Females AAR S.E.
Texas 695 1.2 0.1 606 1.0 0.0
Oklahoma 107 1.1 0.1 91 1.0 0.1
Arkansas 67 0.9 0.1 58 0.8 0.1
Louisiana 100 0.9 0.1 97 0.8 0.1
Mississippi 78 1.1 0.1 69 0.9 0.1
Alabama 115 1.0 0.1 108 0.8 0.1
Tenessee 164 1.1 0.1 147 0.9 0.1
Kentucky 106 1.0 0.1 94 0.8 0.1
Georgia 232 1.0 0.1 185 0.7 0.1
Florida 599 1.2 0.1 477 0.9 0.0
South Carolina 121 1.1 0.1 87 0.7 0.1
North Carolina 246 1.1 0.1 199 0.8 0.1
Virginia 168 0.9 0.1 127 0.6 0.1
West Virginia 54 1.1 0.2 31 0.6 0.1
Maryland 138 1 0.1 115 0.8 0.1
Delaware 19 0.8 0.2 10 0.4 0.1