Cancer rates vary a great deal from state to state — and many factors could be contributing to these differences.
Some states have higher rates of unhealthy behaviors that have been linked to cancer, like smoking or highly processed diets. Other factors have to do with the cost of preventative care like screening which can be prohibitive for people trying to stop living paycheck to paycheck.
Here are the 10 states that had the highest rates of new cancer cases in 2019, the last year for which full data was available from the Centers for Disease Control and Prevention (CDC).
Kentucky topped the list when it comes to new cancer cases. In 2019, 28,243 new cases were diagnosed in the state, a rate of 504.9 per 100,000 people.
Research into the high cancer rates in Kentucky indicates factors like smoking, obesity, and lack of access to cancer screening are driving forces.
Education is also a key factor when it comes to cancer prevention. Not everyone is aware of how often they should be screened or how things like Medicaid work when it comes to preventative care.
Iowa came in second place on the list, with 19,800 new cases of cancer diagnosed in 2019, translating to a rate of 494.1 cases per 100,000 residents.
While pinpointing a specific reason for high cancer rates is extremely difficult, there have been some studies that suggest several factors may be at play in Iowa.
Lung cancer rates in the state are nearly 10% higher than the national average, which could be linked to a high smoking rate.
While there are many early detection tools now available for lung cancer, residents may not know if their health insurance will cover testing or may even be unaware that it is recommended.
Iowa is also a prominent agricultural state and many farmers in the area used Roundup, a glyphosate-based weed killer that some scientists suspect is linked to cancer.
Louisiana made it into the top 3, according to the CDC’s 2019 data, with 27,529 new cases of cancer diagnosed for the year, which translates to a rate of 490 per 100,000 people.
A study that came out earlier in 2022 indicated that cancer rates in parts of rural Louisiana are much higher than the state average — particularly in heavily-polluted industrialized areas.
The pollution seems to adversely affect poor neighborhoods, with low-income areas having a higher cancer rate (502 cases per 100,000) than the rest of the state.
The Environmental Protection Agency (EPA) opened an investigation into the area earlier this year as well to examine if residents’ civil rights were violated.
Another southern state, Arkansas, made it into the top five with 18,596 new cases of cancer diagnosed in 2019. Those numbers translate to a rate of 487.6 new cases per 100,000 residents.
A 2020 report from the state’s health department focused on preventative measures to reduce the high cancer rate, including dietary factors.
According to 2018 data, 33.3% of adults in Arkansas were considered overweight and another 37.1% were considered obese. Several cancers have been linked to excess weight — including thyroid, breast, and colorectal cancers.
The report estimates 17.4% of cancers diagnosed in Arkansas adults over age 30 from 2013 to 2017 could be linked to extra weight.
New York rounds out the top five, with 118,803 new cases of cancer diagnosed in 2019, a rate of 484.9 cases per 100,000 residents. The huge number of new cases can be attributed to the state’s size since New York is the fourth most populous state in the U.S.
In a 2018 report on cancer rates, the state’s health department noted that while much of its population is concentrated in the New York City area, the state also has very large rural areas where residents may not have access to screening, and other preventative health care.
New Jersey nearly tied its neighbor, New York. In Jersey, 54,271 new cases of cancer were diagnosed in 2019, translating to a rate of 483.7 cases per 100,000 people.
According to the state’s health department, cancer rates in counties in the southern part of the state tended to be higher than those in the north, suggesting that access to care and screening could have something to do with the numbers.
Counties in south Jersey, including Monmouth, Ocean, Gloucester, Salem, and Cape May had the highest cancer rates, while Middlesex, Union, Essex, and Hudson (all closer to the New York Metro area) had lower rates.
West Virginia was next on the list with 12,188 new cases of cancer reported in 2019, which translates to about 480.5 cases per 100,000 residents. There has been speculation that several risk factors are responsible for the high number of cases in the state.
West Virginia has the highest smoking rate in the country at nearly 24%, according to CDC data. The state also has the second-highest rate of lung cancer in the nation, just behind Kentucky.
Other contributing factors could be the lack of residents taking preventative measures. The state is below the national average when it comes to getting the HPV vaccine (which can prevent several cancers) and has one of the highest obesity rates in the U.S. at 39.7.
Maine is next on the list with 9,600 new cases of cancer diagnosed in 2019, which translates to a rate of 478.1 per 100,000 residents.
A 2021 report from the Maine Cancer Registry found that the cancer incidence in the state had been steadily decreasing over 20 years, but it’s still higher than the U.S. average.
Some counties within the state — including Penobscot and Piscataquis — also have higher cancer rates than other parts of Maine. A plan laid out by the state in 2021 acknowledges that people living in rural counties have higher rates of cancer.
This is likely due to older populations that do not have equal access to healthcare and may not be able to afford to travel to doctors for regular screenings and checkups.
New Hampshire was next on the list with 8,996 new cases of cancer diagnosed in 2019, which translates to a rate of 475.9 cases per 100,000 people.
Research published earlier this year looked into why people living in the town of Merrimack had higher rates of thyroid, colon, and prostate cancers between the years 2005 and 2014.
Merrimack was studied because the town’s drinking water was found to be contaminated with industrial compounds known as PFAS. The location is home to a Saint-Gobain factory that produces PFAS-lined glass and fabrics, according to The Intercept.
However, other research has questioned the report. Proving any one chemical is linked to someone’s cancer diagnosis is also an incredibly difficult feat.
While Rhode Island has one of the smallest populations of any state in the country, it is still one of the most densely populated.
The state rounded out the top ten when it came to cancer incidence, with 6,530 new cases diagnosed in 2019. This translates to a rate of 473.7 new cases per 100,000 residents.
Rhode Island also has long had disproportionately high rates of bladder cancer. A research project launched in 2020 aims to understand the reason and is examining whether people who work in manufacturing jobs have been adversely affected.
With the information, researchers hope to be able to develop new screening guidelines and raise awareness.
In the U.S., the price of cancer care can cause devastating financial hardships. About two-thirds of adults who are carrying health-related debts due to cancer have been forced to cut spending on food, clothing, and/or other household basics.
Many others have faced incredible financial losses, like being evicted. Because cancer care is so expensive, prevention campaigns, screening, and equal access are all critically important.