“As Iowa goes, so goes the nation.”
Alas, when it comes to cancer, this oft-repeated political cliche happens to be dead wrong.
While the nation’s cancer rates are declining, Iowa’s cancer rates continue on a slow and steady upward climb.
Now, a historic shift has occurred during the runup to the 2026 midterm elections. The question of Iowa’s cancer problem has become a front and center political issue.
Consider a recent televised debate between candidates vying to fill the seat vacated by Sen. Joni Ernst (R-IA).
On the ballot is Republican Ashley Hinson, a U.S. Congresswoman representing Iowa’s 2nd District and former reporter, and Democrat Josh Turek, an Iowa state legislator and a two-time Paralympic gold medalist for Team USA.
The moderator’s all-important Question One:
“We’re going to begin with the topic of cancer in Iowa,” Amanda Krenz, a journalist with local TV station WHO News 13, said at the start of the debate. “Iowans need to know everything possible is being done to protect them.”
“Farmers get $14 billion a year in subsidies,” Tim Seaman, a journalist with KCAU 9 News, continued. “The question is: should those subsidies be tied to reducing fertilizer runoff and lowering the amount of nitrates in order to keep Iowans safe?”
Answered Hinson:
It is important that we get to the bottom of our cancer rates here in Iowa. Cancer does not discriminate who it affects. It’s not a Republican or Democrat that it’s affecting. It’s an American problem. It’s an Iowa problem and we need to solve it.
I think farmers are a part of the conversation. Farmers are excellent environmentalists. They know what they need to do to help make sure we have clean drinking water and all of us need to be able to turn on our faucet and know the water that we’re drinking is safe to drink.
Just last week I had the opportunity to tour a water treatment facility right here in the Des Moines area to learn about the process and what they’re doing to take out these contaminants that are in there, whether it’s nitrates or PFAS or anything else that might be concerning in our water.
We need to obviously have the investments and the infrastructure to be able to clean our water. That’s something I’m proud to have been able to deliver as a member of the U.S. House. Millions of dollars in investment in water infrastructure, as well. So farmers I think should have a part in this as well, but we also need to make sure we’re investing in the infrastructure to keep our water clean.
Answered Turek:
No, but I can tell you that we certainly have a cancer crisis that is being driven by the water quality crisis and certainly it’s something that has touched my life very deeply and personally. I lost my grandmother to pancreatic cancer. My father due to his exposure to Agent Orange has dealt with cancer and nearly the day I launched my campaign, my sister was diagnosed with stage 2 breast cancer.
I worked very hard in the Iowa legislature to expand cancer coverage to firefighters to provide some state appropriation to cancer coverage. The reality is that Rep. Henson has pulled $33 million in research due to the DOGE cuts, four times voted in favor of reducing the Clean Water Act, and taken thousands of dollars from Chinese companies and tried to provide them immunity.
I think the way that we go about this is we need more funding towards infrastructure for nitrate removal plants, but also to our farmers. Our farmers want to do the right thing and I think incentives to them for cover crops, land barriers, and to not put down fertilizer in the winter months is the best way to address this.
Maybe elevated nitrate levels in the drinking water are driving the rising cancer rates, given that fertilizer and manure runoff has left Iowa with some of the highest nitrate levels in the country.
But the Iowa Cancer Registry, run by the University of Iowa’s College of Public Health, has mentioned multiple risk factors that may be contributing to the cancer crisis: elevated rates of smoking and drinking, as well as higher exposure to radon.
While scientists may not currently have clear answers, the cost of cancer—both human and financial—is quite clear to voters in Iowa.
“I actually just voted before this [interview],” Josh Wilson, Iowa resident and senior manager of Federal Media Advocacy at the American Cancer Society Cancer Action Network, said to The Cancer Letter. “People were talking about the cancer issue in the line going into the polls.”
“This is Iowa. I mean, you can meet pretty much any president you want because they all campaign here,” Wilson said, referring to the first-in-the-nation Iowa caucus during presidential primaries. “So we’re used to going to breakfast in diners and hearing people talk about the state of education, or the economy, or gas prices. But you hear a lot more people talking about cancer now, and I think it’s telling.”
The scourge of cancer is near universal, but in Iowa, it’s on a different scale.
“Part of [the political interest] is it’s a numbers game,” Traci McCausland, president of the American Cancer Society for Iowa Board, state lead ambassador for ACS-CAN, and a breast cancer survivor, said to The Cancer Letter. “Everyone has a story of either being diagnosed, or being a caretaker, or knowing a close friend or family member who’s faced a cancer diagnosis.”
This is Iowa. I mean, you can meet pretty much any president you want because they all campaign here. So we’re used to going to breakfast in diners, and hearing people talk about the state of education, or the economy, or gas prices. But you hear a lot more people talking about cancer now, and I think it’s telling.
Josh Wilson
Researchers estimate that more than 21,000 Iowans will be diagnosed with cancer this year, and about 6,400 Iowans will die from the disease, according to the Iowa Cancer Registry’s 2026 “Cancer in Iowa Report” published in March.
“Here in Iowa, you know several people who are almost always actively undergoing cancer treatment,” Wilson added.
As a result, cancer has emerged as a major issue on the campaign trail in Iowa, a largely rural, agricultural state grappling with rising rates of incidence. The Iowa Cancer Registry has ranked Iowa second in the nation for new cancer cases for three consecutive years, and reports that its cancer incidence rate is rising faster than that of any other state.
The race has drawn national attention as Democrats seek to regain control of Congress and flip states that reliably lean red, including Iowa.
The latest polls suggest the contest is competitive. The Marist poll puts Turek three points ahead in the race, while the Emerson poll puts Hinson at two points ahead.
Iowans are also preparing to elect their next governor. Earlier in October, Democrat Rob Sand, state auditor of Iowa and the former assistant state attorney general, and Republican Zach Lahn, a businessman, sparred on the debate stage. Iowa’s growing cancer incidencewas a motif in both of their one-minute opening statements.
As the debate continued, the moderators further pressed the candidates:
“It’s been widely reported that Iowa has the second highest cancer rate in the United States and is one of a handful of states where diagnoses are rising,” Marcia Lense, an anchor at KWQC-TV6, said. “If elected, what are the immediate and specific steps that you would take to combat Iowa’s cancer crisis?”
“This is one of the foundational questions, if not the foundational question for Iowans right now,” Lahn responded. “It’s actually one of the things I launched my campaign on.”
Cancer was not as salient in previous election cycles, said Traci McCausland.
“[Cancer] is one of the points brought up in many conversations. I don’t think that that would’ve been the case five or 10 years ago—specifically [the focus on] cancer,” McCausland said.
In recent years, Iowa’s repeated ranking as No. 2 on the list of states with the worst cancer incidence has thrust the issue into the spotlight, McCausland and Wilson said.
Additionally, Iowa has seen some high-profile cancer cases, including Iowa’s First Gentleman Kevin Reynolds, who was diagnosed with lung cancer in 2023. Earlier this week, the Governor’s office announced that Reynolds’ cancer has recurred—requiring surgery to remove a tumor from his brain and radiation therapy.
Researchers have not been able to definitively identify the causes of Iowa’s rising cancer rates, but many Iowans suspect the state’s extensive agricultural industry is a contributing factor.
“There’s not one sentence that can answer what’s going on with cancer in Iowa,” McCausland said. “We obviously are an agricultural state, but we’re not the only one… Some people are quick to point their fingers at farmers in Iowa.”
The theme of this year’s cancer registry report was agriculture. The registry published some results from the Agricultural Health Study, which enrolled almost 90,000 farmers and their spouses in Iowa and North Carolina in the mid-1990s. The study found that Iowa farmers had 13% fewer cancers overall than expected compared to the general population from 1994-2015. These farmers did experience more cases than expected of prostate and lip cancers.
“Iowans are understandably concerned about environmental risk factors,” Mary Charlton, professor of epidemiology in the College of Public Health and co-author of the report, said in a statement. “Cancer is complex, and it takes multiple research studies to determine whether something causes cancer.”
“More work needs to be done to better understand other contributing factors, including the environment,” the report reads.
Drinking water is another big topic of concern in the state—in connection to cancer incidence and otherwise.
The International Agency for Research on Cancer categorized nitrate and nitrite as a Group 2A carcinogen or an agent “probably carcinogenic to humans” in 2010.
The strongest evidence linking nitrates to cancer in Iowa comes from observational studies.
The report states:
An AHS analysis showed that drinking water nitrate-nitrogen exposure at average levels >10 mg/L, the current maximum contaminant level for public water supplies, was associated with increased risk of prostate cancer, particularly aggressive disease.
Another AHS analysis suggested that risk of ovarian cancer increased with higher average nitrate levels in drinking water.
Iowa voters are also concerned about access to cancer treatment and screening.
“What’s important right now is the people who are getting cancer, making sure that they’re getting the treatment that they need and have the access to care that they need,” Wilson said. “That is a huge driver for a lot of voters in Iowa right now.”
Iowa only has one NCI-designated cancer center located in Iowa City. The state is currently expanding access to cancer care in rural areas through a hub-and-spoke model that connects community clinics to larger regional hospitals.
However, this move to expand rural health care is also happening alongside the upcoming Medicaid work requirements, slated to go into effect on Jan 1. The new paperwork requirements are expected to result in millions of Americans falling out of coverage and significant losses in income for health care facilities.
Iowa is no exception.
There’s not one sentence that can answer what’s going on with cancer in Iowa. We obviously are an agricultural state, but we’re not the only one… Some people are quick to point their fingers at farmers in Iowa.
Traci McCausland
“Some money was put back into the rural transformation funds of which our state got $209 million,” Mark Burkard, University of Iowa Holden Comprehensive Cancer Center Director, said on The Directors, a monthly podcast series by The Cancer Letter. “We had a Medicaid expansion in Iowa, and that supported what’s called the directed payment program (Medicaid State Directed Payments) and that’s being phased out over 10 years… We’re looking at, basically, over the next 10 years, a billion-dollar cut from our health system. So, we’re trying to figure out how to tighten our belts to make up for that difference as a health system.
“I think it’s going to affect rural hospitals and hospitals in underserved areas even more.” (The Cancer Letter, June 26, 2026)
Access to cutting-edge cancer treatments means access to emerging vaccine technology—including mRNA vaccines—a point of contention in the gubernatorial debates.
In January, during the Republican primary debate, Lahn committed to banning mRNA vaccines in the state, according to the Iowa Capital Dispatch. The debate was held by Moms For Liberty, a group that advocates for parental rights and opposes vaccine mandates. During this exchange, Lahn was speaking specifically about the COVID-19 mRNA vaccine.
However, for his opponent Rob Sand, the pledge raised questions about mRNA cancer vaccine technology as well, which came up at the Oct. 6 debate:
Sand: The other thing that we need to do is make sure that people who have cancer in Iowa have access to treatments. My opponent has said that he would ban all mRNA vaccines.
Lahn: No, no, no. This is a complete lie. And I get a chance to respond to this because this has been another one of the lies that Rob’s put out. The reason he’s talking like this is because he actually has no clue what he’s talking about.
So, he’s talked about me wanting to ban cancer treatments. And he’s talking about vaccines and mRNA vaccines.
There is no cancer vaccine. That doesn’t exist. There’s not any in trial. There’s not any in testing. He doesn’t know this because he doesn’t know that there’s a difference between a vaccine and a therapy. Vaccines prevent illness. Therapies treat illness. That’d be like calling chemotherapy a vaccine. He doesn’t know what he’s talking about because he’s a career politician. This is a neoantigen therapy that there might be some promise for. And I will tell you this right now, if there is promise for it, I want to make sure Iowa families have access to it.
I talked very specifically about the COVID vaccine and believing we need to pull the COVID vaccine off the market. I stand by it. During COVID, Rob Sand was locked with Anthony Fauci. He was a COVID Karen. He was mandating masks. He was wanting to lock down schools. He was wanting to lock down churches. I disagree with that completely. I believe that we need safe and effective medications. And the COVID vaccine, I believe, is one that has been proven to not be that. I want to protect the people of the state.
When it comes to this idea of a cancer vaccine, Rob, that doesn’t exist. These are therapies and they could be promising and if they are, we need to get them into the state and get people to be able to have the treatment they deserve.”
“There’s a lot of inaccurate information there,” Judd Wolchok, director of the Sandra and Edward Meyer Cancer Center at Weill Cornell Medicine and the Chief of Cancer Services at New York Presbyterian Hospital, the Weill Cornell Campus, said to The Cancer Letter in response to the debate comments. “For humans, there are experimental vaccines for cancer. There are such things as cancer vaccines. They are in clinical trials.
“I think that it’s important that the public has a clear and succinct understanding of what we’re talking about when we use the term cancer vaccine. It’s still an mRNA vaccine.”
There’s a lot of inaccurate information there. For humans, there are experimental vaccines for cancer. There are such things as cancer vaccines. They are in clinical trials.
Jedd Wolchok
Overall, Traci McCausland said she is comforted that all the major candidates have taken the issue of cancer in Iowa seriously. Most federal candidates have signed ACS-CAN’s Cancer Promise, a pledge to support investments in cancer research, prevention programs, and access to affordable health care.
“What has impressed me from some candidates is their ability to articulate multiple areas of the cancer impact. You want the best medical care, you want it to be affordable, and you want to know that there are research dollars going towards advancements,” McCausland said. One candidate I heard saying that nobody should have to start a GoFundMe when they’re diagnosed with cancer, and I really liked hearing that.
“I like it when candidates can go into more depth than just saying, ‘We need to fight for Iowans and cancer.’”
