We Need to Talk About Cancer Rates in Iowa

Where to Listen:

Our neighbor to the south—Iowa—has a cancer problem. In this episode, we look at a new study that paints an alarming picture of rural America… and cancer rates.

Host:

Amy Barrilleaux

Guests:

Kerri Johannsen, Senior Director of Policy and Programs with the Iowa Environmental Council

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Transcript:

Amy Hi there, this is the Defender, Wisconsin’s environmental podcast, and I’m your host, Amy Barrilleaux. The Defender is powered by Clean Wisconsin, your environmental voice since 1970. Did you know there are thousands of pesticides registered for use in Wisconsin, but less than two dozen are actually limited in our drinking water? Did you that less than half of the nitrogen fertilizer that gets applied to farm fields actually gets used by crops, leaving most of it to pollute our environment. We do know that here in Wisconsin, where many communities are surrounded by corn and soybean fields, there is growing chemical pollution coming from increasingly industrialized agriculture. But how is all of that affecting our health? In this episode, we’re not talking about Wisconsin, we are going to talk about Iowa and a new study that paints an alarming picture of rural America and cancer rates. That’s right now on The Defender. Our neighbor to the south, Iowa, has a cancer problem. According to the Iowa Cancer Registry, the Hawkeye State has the second highest rate of new cancer diagnoses in the country, and it’s one of only two states where that rate is still rising. The big question is, why? In March, the Iowa Environmental Council and the Harkin Institute for Public Policy and Citizen Engagement released a report that links those concerning cancer rates to the environment. Joining me is Kerri Johanssen, Senior Director of Policy and Programs at the Iowa Environmental Council. Thank you so much for joining me today.

Kerri Yeah. Thank you so much for having me on. I really appreciate it.

Amy So here in Wisconsin, we’re not used to talking about other states. You know, we focus that we’re clean Wisconsin. We focus on Wisconsin But I think what you’ve been looking at in Iowa is pretty hard to ignore When did it first I guess get on folks radar that Iowa’s cancer rates are? Kind of high compared to the rest of the nation. I mean, is it something everybody kind of knows or is it new information?

Kerri Yeah, so in 2023 is when Iowa jumped into the number two spot for new incidents of cancer in terms of U.S. State. And so this was a new thing for us in 2023 and definitely started a conversation there. We have a cancer registry in the state that had highlighted this for us. So there was rumblings, but… The conversation itself didn’t really start to take off until 2025, I would say, last year when there started to be a lot more conversation in the legislature about it. The work that I think that we and our partners did to bring attention to the issue and to actually go out and start to listen to what Iowans were actually experiencing, What does it mean to have the number two? Highest rate of cancer in the country for just, you know, Iowans, everyday Iowians, that I think people really started to understand just how widespread this issue is for our state.

Amy Cancer is kind of a big word. It certainly affects almost everyone in some way. We all have had loved ones who’ve had cancer. It’s such a thing that you don’t want to talk about or think about. It’s also all kinds of cancers are out there. So is there one particular type or a couple of different types that is pushing Iowa into this place that really no state wants to be?

Kerri So, um, some experts have looked at the top five cancers in the state. Those are the ones that, you know, if you, if you look at what makes up most cancers in Iowa, it’s going to be breast, prostate, lung, skin, and colorectal cancer. Those are the, the big five. But when we were doing our analysis, we also looked at where we have what we call excess cancers in Iowa. So where are there cancers that we have more of here than they do in other parts of the United States? We’re above the national average. And which cancers are increasing the fastest? We thought that was another area where it could point us towards what might be driving some of the increases in cancer rates. Obviously, like you said, cancer is… A difficult issue to talk about, it’s multifactorial in terms of, you know, usually it’s a number of different things that kind of stack on top of one another in terms of exposures or risk factors that, you know, often it’s not one single thing that will end up causing cancer, but a number of things layered, one on top of the other in addition to genetic risk factors. And so, those are, you know… Looking at the big five cancers, looking at, um, the trends of cancers in Iowa. And one of the things that’s really striking about the data here though, is that so many cancer types, Iowa is above the national average, we’re seeing an increasing trend in, in those types of cancer. So, um. So there are some that are really outliers in terms of our rank nationally. We are, you know, blood cancers, leukemia, and non-Hodgkin lymphoma are very high in Iowa. Varyngeal cancer is another one where we’re very high, but really we’re an outlier in a lot of different ways.

Amy So Iowa Environmental Council and some partners kind of, you’re looking at this information about different cancers in Iowa, Iowa’s moving in the wrong direction from where you’d like to be headed in terms of cancer rates, what made you think let’s look at environmental factors?

Kerri Well, actually we had, you know, some folks who have been, you know, in our circles and supporters of ours and just, you know, community members for a long time who came to us and said, what about the environment? We’re talking about obesity, smoking, tanning beds, all of these other factors, but you know what really makes Iowa different from every other state? Well. We brag about it a lot, you know, the amount of corn, hogs, chickens, you now, are the amount of ag products we produce are, you know, dwarf some countries in terms of the amount that we have here. So I think that it was a, it was something they brought to us and we started to look at, you know how can we start to try to understand this? Um, so that we know, is there a place for us in this conversation? And what does that look like? And that’s where we really kicked off the, the two phases that we completed in 2025 of this project, where first we went around the state and we did 15 listening sessions, um, in communities in every corner of the state where we really just helped people talk to each other about what they were seeing and experiencing when it came to cancer. Um, and sort of, um, did some like polling in the rooms and got our own, you know, data about what people were seeing. And we were, I think that summer really changed the people on our staff. Um, having those conversations and then seeing the conversation spread with us as we went around the state and seeing people start to talk about this more and more, and just the depth of how this is affecting people. And knowing that what we were doing is trying to carry that forward into a bigger conversation. Then at the same time, we were doing this literature review with an expert panel of epidemiologists, oncologists, cancer researchers, doctors, and the Harkin Institute at Drake University looking at, well, how is ION outlier? Where should we even start to look when it comes to environmental risk factors? And that’s where we landed on looking at pesticides, nitrates, PFAS, and radon as four big factors that were currently not really part of the discussion in Iowa, but could point to some areas where Iowa is an outlier. And when we put those puzzle pieces together, it became very clear to us that, of course, it’s not just one thing, but the environment and especially you know, intensive industrial agriculture is something we absolutely need to take a look at if we’re going to tackle cancer rates in our state.

Amy And I think that’s why your report is getting so much interest beyond Iowa, because, you know, there’s farming happening all over the place, places like Wisconsin. I mean, Iowa’s known for its corn. That is you think Iowa, you think corn. And here in Wisconsin, even though we’re known for cows, we have about 4 million acres of corn growing here. Have you gotten attention, more attention maybe than you expected from neighboring states saying, well, hey. What are you finding out about pesticides, for example, or this kind of mixture of chemicals and radon and the health impacts?

Kerri Yeah, I think, you know, one thing we found was that there are others, especially in academia, who have been much more quietly doing this kind of work for a long time. I would say that there’s some work that’s been going on in Nebraska that we weren’t really aware of, but around research and education on these issues, you know, Nebraska is really another row crop powerhouse. And so we found some folks that were already working on it and others, I think, you know, in the Midwest, when we look at, um, this group of states that does have intensive rural crop agriculture, and we see even if the levels aren’t the same, some of the same trends emerging and cancers across these states, we definitely have had, um questions and we’ve presented this information a couple of times, a couple of different ways in Wisconsin. In particular, but it also, I think, points to larger questions around federal policies that are impacting all of our states. Though the Farm Bill, I thing in particular is one that, you know, as a state organization, we don’t get involved in a lot of federal policy, but the way that the Farm bill impacts all of us who live in farming states, whether for positive or negative, I think. I think this conversation and talking about this together across states kind of points us in a direction of what are the answers around agriculture and public health that we need to address both at a state level and in larger federal policy conversations.

Amy When you talk about this research, this look that you and partners did at possible causes of this cancer problem in Iowa, what are some of the kind of big picture things that you discovered?

Kerri Yeah, so when we looked at the research around nitrate, this is something that we actually had published a paper in 2019 around evidence of the health impacts of nitrate levels in water. And the EPA standard for nitrate in drinking water is 10 parts per million. Even in, you know, 2019 and before that, research was finding that there were longer term health impacts. So if you were exposed over the longer run to water with nitrate in it, that we were seeing health impacts below that 10 part per million standard. The 10 parts per million was set to prevent blue baby syndrome, which is in like an acute kind of exposure that can hurt a small child really quickly, so we can’t go above that level ever. But if you’re exposed at lower levels, even down to five or two parts per million potentially over a longer span of time, that’s where we started seeing things like cancer incidents become associated. And so in our paper, we talked about the strength of the evidence for various types of cancer and what those cancers are doing in Iowa. And so there’s a lot of strong evidence that colorectal cancer is associated with nitrate in drinking water, well below 10 parts per million. And in Iowa, coloreactal cancer is both one of the top five cancers in the state and the top five fastest rising in people under the age of 50. And so we looked for these sorts of that kind of evidence, right? Of is there a link? How strong is the link? And then are Iowans more exposed than people in other states? And so for nitrate, we definitely found Iowians do have a much larger exposure to nitrate. The associated cancers are rising. This is a problem. We did a similar look for pesticides. We looked at the top three pesticides that are Acetochlor and Atrazine looked at the evidence for these substances being carcinogens and what types of cancer they were associated with, and for those three pesticides in particular, there was just an overwhelming overlap of the associated cancers and those cancers that we have more of in Iowa, unfortunately. We did similar types of analyzes for PFAS and then. For radon, this is a little bit different because radon is naturally occurring. Wisconsin also, I believe, has some radon in your geology. Iowa’s really a hotspot for this one. But it’s naturally occurring in homes. It leaks in through cracks in the walls, usually in the basement, but can occur anywhere in the home. And you can test for it. You can mitigate it and get it out of your home. But there’s a real like deficit of awareness around this problem in Iowa, even though it’s very widespread. And often what can happen is that it’s a combination of different things. Some researchers we talked with would describe it like maybe you encounter one carcinogen and it sort of is like the key that goes in the lock and there’s another factor that’s the one that turns the key, that unlocks the cancer. Um, and so I like to think of it, or I don’t like to, but one way that helps me understand it a little bit as well is that when we encounter carcinogens, they can do one of a couple of things to our bodies. They can… Um. Either increase the number of mutations as our cells are dividing, as they always do, so we end up with more mutations, or they can suppress our immune system. So normally where our immune would come in and fix the mutations, now the immune system is kind of sluggish and it’s not getting in there to fix as mutations are happening. So you can see that if you have more and more exposures Either from behavioral factors or environmental factors or both, you start to get really out of balance. And we sort of end up with a skyscraper of risk factors at a certain point. If you can start to reduce some of those, take some of the floors out of the skyscrapper, like all of that helps overall in reducing the number of exposures people have. And so that’s what gives me the energy, I guess, and the hope to say like, You know, educating people about, about radon even, or about, um, you know, if, if we, if, we really were, if were able to reduce our nitrate in the water, if we had, if you were even able to, um. Get on our trajectory with pesticides that was going down instead of up. That would make a difference. It would make it different to the exposures that people have in Iowa. So we’re, you now, that’s why we’re we’re excited to keep. Fighting on this because it’s impacting so many people and we know that changes absolutely can make a difference.

Amy You talk about the kind of trajectory that we’re on. From what I understand, Iowa started to really diverge from national trends around the year 2000, so about 25, 26 years ago. What are some of the things that, I mean, radon didn’t change. So what are some other things that have changed in that time?

Kerri So one of the first things that we always try to, you know, talk about as well is that different types of cancers have different, like, periods from exposure to onset. And so it’s okay. People are very hesitant to say like, this thing happened at this moment in time, and that is what pause this. So I think that that is something that is, there are definitely questions about still. When we were looking at, for example, like the use of different pesticides, you know, you definitely see trends of more intensive row crop agriculture following you know, a couple of farm bills that really incentivized towards like production, like produce as much as possible versus sort of a like let’s set aside some land here, farm this land here. Market controls that looked very different and resulted in more conservation where you had, you know maybe some set aside land, more diversity on the landscape. The policies that pointed us towards ethanol as a hedge also clearly had an impact on looking at more fence row to fence row kind of policies that did not prioritize conservation. And over the last decade in particular, But, um, you know, for a while we’ve been, we’ve lost some of our infrastructure in Iowa in terms of sustainable agriculture. We don’t have a soil, we don’t a public soil testing lab at any of our universities here. We have to send our soil samples to Minnesota or private companies. I can’t believe that. I really can’t. I mean, we talk about the quality of soil and how it’s our, you know, right here. Some of the best soil in the world. You know, we think that is a precious resource and one that deserves the stewardship of, you know, the farmers in Iowa and not whatever the agenda of, you know the largest industrial agribusiness of the moment is. And so we think this is really part of the conversation we’re having right now is What is the reality for the people of Iowa and Iowa farmers on the ground? Why are we using so many chemicals? Is it cost-effective even? A lot of it is not. So how do we bring the conversation back to what do we need for the People of our State to thrive and not just outside entities or CEOs or people who don’t even live here who are not experiencing the impacts of these policies.

Amy So the common thread among most of the things you’ve been talking about, nitrates, PFAS, pesticides, is that they are all applied to kind of industrial agriculture. PFAS are used in pesticide applications. Nitrates come from fertilizer applications and also from animal manure. So you’ve got this this kind of intense impact on the environment. And it almost feels like, though, when you start pointing that out, when you start saying, hey, these things are hurting people, the reaction is, well, you’re anti-farmer. Why is it that it feels like you can’t pull farming, which is the lifeblood of both of our states, away from this notion that farming has to come along with a bunch of chemicals and environmental and health harms.

Kerri I think that as people, so I grew up on a farm and my parents still farm, my brother farms, and still, right, like I’ve lived away from our farm for, you know, what I wanna say now, right? Like decades, but many people are even more, even further away from the reality of day-to-day farming and what that means, but we all have a lot of ideas. Or like idealistic ideas even, right, about what that means and looks like, which is understandable. And that like feeling of connection to that is very real. However, I think that often what that picture leaves out is, you know, we have some small, midsize, independent family farmers who become sort of the poster children. Or an agricultural industry that largely does not reflect that small independent family farmer, which is disappearing very quickly from the landscape. It benefits those big guys to pretend that that’s who they are, right? But… And there are a lot of stories of farmers struggling with the tariffs, struggling in this economy to hold onto their land that they’ve been working for a long time. So I think that there’s this idea of what a farmer is, but also like some broad brush painting on both sides. About like, what is farming today? What are the real challenges? And what are the real opportunities? And instead, it becomes sort of a head to head political conversation. Instead of a like, instead of looking at those those real barriers and having a better understanding of of that landscape from different people across all different parts of the state. So I think that’s really badly needed, like that conversation, that like. Understanding between people, urban and rural, in Iowa. And I think it’s entirely possible to have that conversation.

Amy I think, you know, it reminds me of when I found out, you know, at Clean Wisconsin, we talk a lot about neonicotinoid pesticides, which are pesticides that coat corn seeds to end up killing the pests that eat the plant. And when I find out that, you know, conventional farmers don’t have a choice. They’re not going to be able to go out and buy neonic-free corn, and it’s expensive to buy. It’s all they get. You realize farmers are kind of caught in a system. And that system is hurting a lot of people, farmers included. You mentioned the farm bill as one way to kind of break out of this. And when I think about the farm bill, I start to, huh, you know, got to take a deep breath. There’s so much going on in that thing, and it’s like so stressful to even think about all the components of that. What is, I guess, the first thing that the Farm Bill needs to have for us to start changing some of these things?

Kerri The big pieces of that bill that really drive where we end up are crop insurance and the commodity title of the bill. I think that the heart of what happens on the ground is so heavily determined by those two parts of the Bill. I also think that as state organizations, I’m so encouraged and excited about the ways that people in Iowa have worked around the system to bring people back to the idea of profit on the farm as the measurement, because I think that there’s been a lot of like, oh, yield is the measurement. And it’s like, well, not for an individual farmer to keep the lights on. And they know that, right? They have to do those calculations every single year to figure out how that’s gonna flow. But the incentives from, you know, the person selling them the seed or the chemicals or whatever, that is like, we’re going to give you an award for your bushels per acre, right? Like that’s what we’re gonna make the gold standard. Farmers are caught in these same systems. They have to make their calculations based on these same system of what to do from one year to the next or what to invest in for the long term. But there’s also definitely elements of how we safeguard and regulate pesticides that are like very inadequate in this country the way we’ve decided to do it and we we just don’t have enough safeguards in place for these products or is this even an appropriate thing to be doing. Like you said, the seed all has. Neonicotinoids on it and it’s not even counted as a pesticide when we’re accounting for pesticides Oh, I didn’t realize that tracking systems, right? It’s just that’s great. Yeah, and and that’s the thing I think that also, you know in our in our quest to educate people and to even to educate farmers about this Um is that a lot of people most people have no idea they assume there’s been a full safety vetting Yeah before these chemicals come to market and that it’s been an independent sort of like, yes, thumbs up. And the truth is it’s not that straightforward. And there’s a lot more, you know, sway and leeway and problems in the system with the manufacturers having more power than they should to bring these products to market without enough oversight.

Amy Does it make you feel differently now when you, kind of knowing what you know after this study, when you drive past a cornfield or, you know, these iconic landscapes that we think of as being so green and good and healthy when we see them out there, does it kind of change your perspective on all that?

Kerri I mean, it’s the landscape I grew up with, though not really the same, right? In 30 years, like even if you drive through, you know, parts of Iowa, when I was younger, like lots of fence rows, trees, right, like a more diverse landscape even in 30 years where so many old homesteads and fences and things have just been torn down, right to go just like. As far as the eye can see, uninterrupted corn and soybeans. And that, that makes me sad because I, there needs to be room on the land for both. And our land can only sustain so much. It is also, you know, I would say the biggest thing that that has come into my mind as I’ve been, especially as we’ve been out like traveling around lots of different communities and talking to people. You know, people will really share in their communities about issues they have with their water systems or whatnot that like are just not well known. And so I’m used to drinking city water now at this point. And I find myself like a little bit like, oh no, should I fill my water bottle here? Should I wait till the next town? Um, and it’s a, it’s really, I feel lucky that I, you know, go home to my, and I have my filtered water there. Um, but also like motivated to know that like, this is how people in rural Iowa in particular are just like, they’re getting by, um, but they deserve to have clean water they can trust as well, and not to be wondering. Should I drink this? Should I buy bottled water? What should I do? And that is a very real thing that I only really started feeling because that is what we were hearing from so many people in these communities about their own concern and anxiety about it. So that’s been probably the biggest difference for me.

Amy You know, it’s really, it is so hard to have these discussions where, you know, we’re looking at a study about cancer rates, we are talking about the use of pesticides, especially that have gone up and up and over the last 25 years, when we’re talking about chemicals that we don’t understand a lot about, like PFAS that are showing up in pesticides, in our drinking water, in our food supplies. I mean, it starts to get kind of like, ugh. I don’t wanna talk about this anymore. So what would you say to people who are worried? Like what is the first step that we need to do to start getting a handle on these things?

Kerri I mean, I’ve tried to think about it like, especially as a mom, it’s like, I wish I did not have to think about this the number of times a day it goes through my head. Oh, what did I use? Oh, is that plastic? Oh, there’s a lot of lead in it. You know, just all of the things. And I try to practice, I say I practice like good enough gardening where like it’s a mess, but there are a few flowers in there. Just like. What can I do like this day, right? That’s good enough for this day. And, you know, a really big part of all of this and living with this knowledge as well is just like, that this is, like we’re walking this road with a lot of other people. You know, I have had people in my life who have dealt with cancer, who have passed away from cancer. And You know, I do feel like the sense that like, yes, this is scary, but. That’s really all we can do is write that next right thing and reduce our own exposures as much as we can, do our research, but then to, I need to be involved in something where I feel like I’m adding my voice to a larger course of voices that are fighting for a larger change for more people. And that’s what helps me, I think, deal with some of that anxiety is doing something. And that not the same for everybody, But for me, It’s definitely like doing that thing, doing the next right thing.

Amy And I guess part of that is knowing your farmer and how what their practices are and where you’re buying your food and all of those things. Because in a sense, we’re lucky because we can know our farmers. We can get out to a farmer’s market or go to a CSA or go on farm visits and really see and support the practices that help out.

Kerri Yeah Yeah, definitely. Like we can do all of that as consumers. And I think it’s also we can also practice like hard conversations and empathy with people who maybe we don’t agree with and who are tricky to trickier to talk to about some of these issues. But I think that that’s also such an important part of this change that we need to see is like coming from a place of You know, as humans, we all, like this is affecting all of us in Iowa. And I think that that’s something different about, you know, what’s happening with the cancer crisis here. That is maybe circumventing some of this a little bit is because it is happening in every community and that is not something people can turn away from.

Amy Well, this has been some eye-opening research and a really important conversation. Carrie, thank you so much for taking the time to talk with me about all this. I really appreciate it.

Kerri Thank you so much, Amy.

Amy And thank you for listening to The Defender. We’ll have a link to that Iowa study in the show notes plus links to Wisconsin based information on some of those contaminants we talked about nitrates, PFAS, neonic pesticides. Those have all been found in the environment across Wisconsin. Or you can visit cleanwisconsin.org/podcast. I know I just laid a lot of information on you. So I do as always really appreciate you listening. If you have a question or comment on the show, please send me an email podcast at cleanwisconson.org. I’m Amy Barrilleaux, talk to you later.