Iowa faces a cancer crisis, ranking second highest in the nation for cancer rates.

The Iowa Cancer Registry’s 2025 report shows that Iowa is one of two states in the country where cancer rates are increasing every day, with an estimated 6,300 cancer-related deaths in 2025. Iowa also has the country’s fastest-rising cancer rate, with lung cancer, melanoma, breast cancer and prostate cancer leading the incidence list.

Research emphasizes that cancer is a multifactorial disease that is shaped by genetics, lifestyle choices and environmental conditions rather than a single cause.

“I don’t blame anybody for the situation that we’re in right now,” said Cody Smith, the director of climate initiatives at the Iowa Environmental Council. “It would be like blaming people that drive cars for climate change. It’s a little more complicated than that.”

The Understanding Cancer in Iowa Project is led by the Harkin Institute for Public Policy and Citizen Engagement, the Iowa Environmental Council and the Iowa Farmers Union. The initiative aims to highlight the underlying environmental causes behind the rapidly rising rates of cancer.

“It’s been a fantastic partnership,” said Smith. “We bring our environmental expertise, the Harkin Institute brings a history of wellness and nutrition and informing Iowans about policy and agricultural exposures, and the [Iowa] Farmers Union wants to advocate for farmers and help them make better choices.”

While lifestyle-related causes of cancer, such as smoking, HPV and tanning beds, have been discussed extensively in the past, the environmental and agricultural exposures remain relatively unexplored.

“The idea behind this project was to expand the conversation and address all possible causes,” said Adam Shriver, the director of wellness and nutrition at the Harkin Institute. “[The project] is about considering things that many people think might be involved, but feel like that it’s not being discussed enough in the state.”

The project combines an extensive review of existing literature on agricultural chemicals and cancer with a statewide campaign that included 15 listening sessions across different counties this summer to better understand Iowa’s position as an outlier state.

“It was an eye-opening experience,” said Shriver. “People describing how they’ve done everything right their whole life — never drank, never smoked, exercised regularly and still ended up with a tragic diagnosis.”

A public report with all the data collected from surveys at the listening sessions will be released in November, alongside video footage of Iowans describing their own experiences.

“It was a really interesting and illuminating experience for us,” said Smith. “We learned about the different perceptions of what risk factors Iowans were most concerned about, whether that was drinking water contamination, agricultural exposures or land contamination.”

Iowa’s factory farms produce 109 billion pounds of waste annually. It is also the state that applies the most synthetic pesticides and fertilizers — all of which contribute to high nitrate levels. Drinking water nitrate detection was associated with 73% higher cancer mortality.

“In Iowa for a long time, it’s always been this idea that you shouldn’t talk about different ways of doing agriculture because it might come across as anti-farmer,” said Shriver. “But when it becomes something so big that it’s threatening public health, that shifts the dynamic. It’s reached a point where people really want to talk about it. They’re ready to say that we might need to do agriculture a little differently.”

Shriver pointed to examples of environmental strain across the state — the recent lawn watering ban in Des Moines, miles long fish-kill due to a fertilizer spill in the East Nishnabotna River and weekly advisories about lakes being unsafe to swim in.

Smith described public health as inseparable from the environment, whether it’s the water Iowans drink or the land where their food is grown. When this balance is disrupted by agricultural byproducts like nitrates, it leads to a series of environmental health concerns.

Beyond highlighting the problems, the project also focused on finding solutions through community input.

“It was really important to us to give Iowans the chance to participate in this solution-making process. We want to make sure that Iowans are on the driver’s seat on how we move forward,” said Smith.

Shriver hopes that, with this project, public health will be a priority that’s discussed in conversations around environmental and agricultural policy.

Smith explained that change can start at the individual level with small actions like testing basements for radon, a known carcinogen. At the community level, Iowa Health and Human Services and the American Lung Association partnered to distribute free radon tests.

“My hope is that the report starts a conversation that leads to actual solutions — protecting the public health and wellbeing of Iowans across the state, because this is cancer we’re talking about,” said Smith.