The 10 states with the highest cancer rates
Industry Buzz
If there are specific population studies from your state that are better representations of the people from that state, it is important to understand the environmental factors that can affect cancer development.
—Catherine Perrault, MD
Cancer rates continue to climb across much of the United States, but a handful of states stand out. Iowa has drawn particular attention after recent reports showed some of the highest cancer incidence rates in the country, prompting questions from physicians, researchers, and patients alike about what is driving the trend. []
According to the latest NCI and CDC State Cancer Profiles data, which tracks age-adjusted cancer incidence from 2018 to 2022, Kentucky has the highest overall cancer rate in the nation, followed by Iowa and West Virginia. These figures reflect new cancer diagnoses, not cancer deaths, and they do not identify the underlying causes. []
Related: New study links accelerating cancer rates in young adults with cannabis useThe current top 10
Kentucky reports 519.0 new cancer cases per 100,000 people, compared with 498.8 in Iowa and 498.1 in West Virginia. Louisiana, Minnesota, Maine, North Carolina, New Jersey, Connecticut, and Arkansas round out the top 10. The national rate is 448.6 cases per 100,000. []
Two states in the top three, Iowa and West Virginia, also show rising recent incidence trends in the same federal table. Kentucky remains stable, although at a higher baseline. []
Why is Iowa different?
Iowa is drawing attention because incidence is high and rising. The Iowa Cancer Registry estimates 21,700 new invasive cancers and 6,400 cancer deaths in 2026. Prostate, breast, and lung cancers make up more than 40% of projected diagnoses. []
Mary Charlton, PhD, director of the Iowa Cancer Registry, told Iowa Public Radio, “It’s kind of same story, different year.” She also said Iowa has “different types of cancer with different sets of risk factors.” []
So, when a state ranks high for cancer incidence, what should physicians take from that clinically? According to Catherine Perrault, DO, a board-certified family physician and Chief Medical Officer at The Mesothelioma Center, doctors need to be well-versed about the public health differences in their state compared to national trends.
“When we see certain states that rank high in cancer incidence, of course, you should be screening all your patients according to the national guidelines," Dr. Perrault says. "But if there are specific population studies from your state that are better representations of the people from that state, it is important to understand the environmental factors that can affect cancer development.”
Agriculture is under study
The 2026 Iowa report focuses on farming populations through the Agricultural Health Study. [] More than 89,000 farmers and spouses in Iowa and North Carolina were enrolled in the mid-1990s.
Iowa farmers in the cohort had 13% fewer cancers overall than expected compared with the general Iowa population, but higher prostate and lip cancer. Spouses had 10% fewer cancers overall, but higher melanoma and thyroid cancer.
Richard Deming, MD, medical director at MercyOne Cancer Center, told Investigate Midwest that “Iowa doesn’t really stand out dramatically” on typical risk factors, but then he pointed to “environmental exposure to agricultural chemicals” as something that distinguishes Iowa from other states. []
“In Iowa specifically, patients should be questioned about their exposures in the environment as well as their profession, which will tailor the risks of certain exposures such as pesticides, asbestos, or radon," Dr. Perrault adds.
Related: Cancer rates are on the rise in younger populations; here’s whyCumulative exposure
According to Manu Sehgal, MD, an internal medicine and geriatrics physician and senior medical contributor at Medical Tourism Corporation, cumulative exposure must receive more attention.
“Elderly patients often live in the same house they grew up in, work at the same job, drink from the same well for years and decades," Dr. Sehgal says. "When evaluating risk in states like Iowa, we regularly assess each patient's occupational history, use of private wells, if their home has been tested for radon, farming practices, exposure to diesel exhausts, and their exposure to various environmental toxins for extended periods of time. Oftentimes, the combined effects will carry greater weight than any individual cause.”
Discussing the need for better screening in high-risk states, Dr. Perrault has some recommendations.
“At a minimum, patients should be screened according to the USPSTF guidelines, which dictate national screenings for various cancers," Dr. Perrault says. "This means that patients should get a colonoscopy at 45, and if they meet the criteria, a low-dose CT for lung cancer screening, and women should get pap smears and mammograms. But these are the bare minimum that should be done. There needs to be a high level of involvement in the community to understand the individual risks of the patients in that community and tailor the screenings accordingly.”