Cathy Ketton, of Waterloo, Iowa, found a lump in her breast in February 2022. She had just been released from the hospital after complications from contracting COVID-19 and had read the virus can cause lumps in your breasts in rare cases.
She brought her concerns to her doctor, who agreed it could be from COVID-19. She said he told her to come back in six weeks.
Six weeks later, the lump was still there.
She told her doctor, who she said wasn’t concerned. However, Cathy knew the lump was there. She even marked it in permanent marker.
In July, she went in for a mammogram, confirming she had a peanut-sized lump in her breast. Ketton underwent a biopsy that revealed she had triple-negative breast cancer, an aggressive type of breast cancer that disproportionately impacts women of color.
In an instant, Ketton became one of over 20,000 Iowans diagnosed with cancer every year.
Iowa has the second highest rate of cancer in the U.S. and is one of two with a rising rate, according to the Iowa Cancer Registry, or ICR.
The 2025 report by the ICR, which is housed at the University of Iowa’s College of Public Health, estimated there will be 21,200 new cases of cancer in Iowa this year.
An estimated 6,300 Iowans will die of cancer in 2025.
With Iowa leading the Midwest in cancer incidence, state policymakers have been working to combat soaring cancer rates.
Iowa Gov. Kim Reynolds announced a $1 million initiative to investigate the cause of Iowa’s growing cancer rate during her Condition of State Address in January. Reynolds’ attention to the subject has sparked a legislative effort to work on cancer prevention measures.
“Every case of cancer is a tragedy. And I’m concerned by the data showing that these tragedies disproportionately affect Iowans,” Reynolds said during her annual address. “Iowans don’t need more speculation. They need answers.”
Reynolds’ initiative would investigate the root causes of why Iowa differs from other states in cancer incidence. The initiative is a collaboration between the Iowa Department of Health and Human Services and the UI; they will investigate the epidemiological cause of Iowa’s rising cancer rates.
Ketton remained positive after her diagnosis. She had founded a breast cancer support group with her two daughters, whom are also breast cancer survivors. Through her involvement in the group, she had talked to dozens of women with breast cancer about their experience and struggles. When she got the news, she knew what she wanted: a double mastectomy.
Ketton said she was terrified if she didn’t get a double mastectomy, she would be at risk for recurrence, meaning her cancer would come back. Ketton sought treatment at Mayo Clinic in Minnesota and her local cancer center in Waterloo.
During Ketton’s first treatment, a social worker visited her and said it was okay to be upset, and it was okay to cry. After that, Ketton was in better spirits.
“I just had to get it together and get my mind right so my body could be well and do what I’m told,” Ketton said. “And from there, from then on, my second, all my treatments after that were positive. I went in with the right frame of mind.”
After several rounds of chemotherapy, surgery to remove her tumor, and radiation, Ketton was declared cancer-free in February 2023.
Ever since, Ketton has been trying to live her life normally. However, she realized that is simply not possible.
According to the registry’s report, Ketton is among hundreds of thousands of Iowans living with or having survived cancer — including one of more than 37,000 breast cancer survivors estimated to be living in Iowa.
The ICR has been tracking cancer in Iowa since its inception in 1973 as part of a nationwide push to monitor and combat cancer. Every year, it creates the fullest picture of the disease’s prevalence in the state.
A look at Iowa’s cancer problem
Iowa is one of only two states with a growing rate of new cancers, which rises approximately 0.7 percent every year.
The Hawkeye state is also second in the nation for total cancer incidence, with 491 of every 100,000 Iowans expected to receive a cancer diagnosis in 2025, according to the Iowa Cancer Registry’s 2025 Cancer in Iowa report.
The top three deadliest cancers in Iowa in 2025 will be lung, colon and rectum, and pancreatic cancers, the report states, making up nearly 40 percent of cancer deaths, with lung cancer causing 22 percent of total deaths alone.
The report finds that 152 of every 100,000 Iowans will die of cancer in 2025.
While Iowa cancer rates continue to soar, the cause has yet to be determined. A number of factors contribute to Iowa’s consistently high cancer rates, Director of Research, Analytics, and Dissemination at the Iowa Cancer Registry Sarah Nash said in an email to The Daily Iowan.
There is no one cause of cancer, Nash said. Every case of cancer in Iowa is the combination of a number of genetic, lifestyle, environmental, and other factors.
However, several known risk factors contribute to Iowa’s climbing cancer rates, including the state’s smoking rate, the state’s rate of binge drinking, the state’s exposure to ultraviolet radiation, and the state’s radon exposure.
Reynolds announces collaboration to investigate rising cancer rate
Reynolds’ connection with the state’s cancer rates is personal. Her husband Kevin Reynolds, Iowa’s First Gentleman, was diagnosed with lung cancer in September 2023. Reynolds announced he was in remission during her annual Condition of the State Address this year, where she announced her initiative.
“An adverse health diagnosis can change everything in the blink of an eye,” Reynolds said in January. “One moment, you’re playing with your kids or grandkids, planning family gatherings, and doing daily life. Then, lightning strikes, and those everyday joys seem not just precious but fragile. It puts things into perspective and reminds us of what matters most.”
The program Reynolds’ initiative will launch will examine the root causes of Iowa’s growing cancer rates to help inform policymakers as they look to take action on the issue.
“There’s a lot we still don’t know, and multiple factors are likely at play,” Reynolds said. “We shouldn’t jump to conclusions, but we do need to get to the bottom of this.”
State Rep. Austin Baeth, D-Des Moines, is also a doctor. He said he was moved by the governor’s commitment to the issue he has been working on in the legislature for years. He said the governor’s commitment to the issue will go a long way in moving along other proposals to address cancer in Iowa.
“I think the most important public policy that we need to do or that we discuss is investigating the causes of cancer in Iowa,” Baeth said. “We need to do a comprehensive investigation into what else is out there that might be specifically driving our cancer rate, and because there’s no other national group that’s going to come to our help, we need to be homegrown in figuring out this question.”
Whitney Zahnd, an assistant professor of health policy and management at the UI, said the collaboration will give researchers and policymakers the chance to work on finding the cause for Iowa’s rising rates and a chance to find common ground on policy proposals to control the state’s rising cancer rates.
Zahnd said the governor’s attention on the issue also aids the effort to combat Iowa’s rising cancer rates and will bring more legislative attention to the issue.
“In some ways, there’s kind of this perfect storm of opportunity to really try to address [proposals to prevent cancer incidents],” Zahnd said. “What can we find that the common ground on — whether it’s policy changes or in financial investments — or whatever it may be that we can come to agreement on to support. Because the hardest challenge is finding that agreement.”
Lawmakers consider preventative measures
There are a number of things known to cause cancer researchers have delineated and made policy recommendations on, and a number of those proposals have been taken up by lawmakers.
RELATED: Iowa’s cancer rates continue to increase, number of survivors grows
The Iowa Cancer Consortium is a coalition of cancer experts and researchers who work to address Iowa’s gaps in cancer control and prevention. Every five years, they publish a report dubbed the Iowa Cancer Plan, which gives recommendations on policy action to help combat the state’s rising cancer rate.
Kelly Wells Sittig, the executive director of the Iowa Cancer Consortium, said while cancer is not entirely preventable, there are a number of factors that can reduce cancer risk.
“Estimates of how much cancer is preventable vary quite a bit, but there is a lot that we know. Cancer is a really complex disease, and it’s a result of a lot of different factors,” Sittig said. “So, there’s not necessarily one thing that can prevent cancer from occurring, but again, there are a lot of things that we know about how to reduce risk.”
However, many of the state’s most common cancers are linked to behavioral and environmental risk factors public policy can work to address, Sittig said.
Iowa is 12th in the incidence of lung cancer rates in the U.S., according to the National Cancer Institute, but it makes up 12 percent of new cancers in Iowa, according to the Iowa Cancer Registry’s report.
Nash said a high risk of radon exposure in most of the state and a high smoking rate among Iowans at 15 percent are contributors to the state’s high incidence.
The Iowa Cancer Plan focuses on several different risk factors. Sittig said one solution that could be the most effective is increasing Iowa’s tobacco tax. Nash said increasing the price of tobacco through taxes is the best way to decrease smoking rates.
Iowa last increased its cigarette tax in 2007, resulting in a smoking rate decrease in 91 percent of Iowa counties, Nash said.
However, no legislation has been introduced to increase the tobacco tax this legislative session.
Baeth said since he is in the minority party, he doesn’t control what policies can be passed or considered, otherwise he would look to address the issue. However, he works across the aisle on a number of other pieces of legislation that have more political momentum.
“The cigarette tax has not changed since 2007, and we know that inflation has certainly gone up since then,” Baeth said. “And the taxes on cigarettes are probably one of the most effective public policy tools that we have to reduce smoking.”
Nash said another risk factor for several cancers, including breast and prostate, is alcohol use. Iowa has a high rate of binge drinking compared to the national average, with 22 percent of the population reporting binge drinking in the last year, according to the registry’s 2024 Cancer in Iowa report, which focused on alcohol-related cancer risks.
Iowa is in the top five states for binge drinking and among the top states for alcohol-related cancers, including the highest rate in the Midwest, according to the registry.
The Iowa Cancer Plan recommends increasing the alcohol tax to decrease consumption along with public education campaigns.
“There is a clear association between alcohol and some cancers,” Sittig said. “And so it’s important to think about how we can reduce alcohol use overall and then also individually.”
Baeth and Rep. Hans Wilz, R-Ottumwa, recently introduced a bill to increase the price on the cheapest liquors. The bill, House File 830, was killed by a legislative deadline.
“The data show that when alcohol is so dang cheap, it encourages binge drinking, and that leads to downstream health effects,” Baeth said. “There’s growing data that if we increase the price of that cheapest alcohol, we can help protect a lot of folks who would otherwise abuse it.”
Tanning bed use and exposure to the sun leads to higher rates of melanoma, an aggressive skin cancer, Nash said. According to the 2025 Cancer in Iowa report, 6.7 percent of new cancers in Iowa in 2025 will be melanoma.
Wilz has led a charge to require parental consent for tanning bed use for minors and display warnings that tanning bed use might cause cancer in tanning salons.
His bill, House File 524, passed the House, 83-13, with bipartisan support for the bill.
During remarks on the bill, Wilz said the bill is just one piece of the puzzle in fighting Iowa’s rising cancer rates.
“Cancer prevention is just as important as cancer research and medical treatment,” Wilz said. “We need to attack cancer in every way to ensure Iowa cancer rates do go down. Prevention is the way to get past this, to drive our rates down in Iowa as we do research. As we look for ways to treat people that have it, be compassionate, and be caring.”
Sittig said the best way to fight cancer is a collaborative effort, and the governor’s initiative is an important step in finding and combating the reason for Iowa’s rising cancer rates.
“I really do think it comes down to collaboration, that we all have to be working together, and that the work takes resources and of all kinds,” Sittig said. “Nobody wants Iowa to be the state with the second highest incidence rate in the country. None of us want that, and so we have to all work together.”