Iowa’s great cancer mystery: Is the land making young people sick?

( Yahoo )

Mackenzie Dryden’s happiest childhood memories are of running barefoot through the sunlit corn fields of her hometown. But when she was diagnosed with cancer 2½ years ago at 18 years old, a disturbing thought began to take hold.

Could something in the land she loved have made her sick?

Dryden went to social media for answers, and stumbled upon a deeper mystery: Within just two years, four other recent graduates from her high school - home to only 500 students - had also been diagnosed with advanced cancers.

“It’s kind of insane this is happening,” the college senior said in an interview.

Dryden’s questioning taps into an unsettling shift in cancer diagnoses in America, with rates for young adults in their 20s, 30s and 40s trending up even as overall cancer rates decline - and with geography appearing to be a key characteristic in who falls ill young.

Cancer rates among young adults in the Corn Belt, a patchwork of golden fields and straight-line highways stretching across the heart of the Midwest, are rising more rapidly than in the country as a whole, a Washington Post data analysis reveals.

The six leading states for corn production - Iowa, Nebraska, Illinois, Minnesota, Indiana and Kansas - had the same cancer frequency as the rest of the nation for young adults and the overall population when state-level tracking began in 1999. In the 2000s they began to diverge, and since 2015 the states have had a significantly higher cancer rate among those ages 15 to 49. In the latest data from 2022, those states have a rate 5 percent higher for young adults and 5 percent higher for the overall population.

Young adults in those states have significantly higher rates of several cancers, the Post analysis found, especially kidney and skin cancers. The skin cancer risk for young adults in the corn-producing states is 35 percent higher for men and 66 percent higher for women than their peers in other states.

In Iowa, young cancer patients like Dryden are redefining what it means to confront the illness in the 21st century, making the small state a bellwether of a generational reckoning.

With the power of social media, this group - which includes a young mother haunted by the possibility that chemotherapy has stolen her chance for another child, a woman in her 40s who now uses a feeding tube and five young adults who attended the same high school - has turned personal crises into collective action. They are raising questions about the role of agribusiness and the water that runs through their communities, and pushing politicians to act in a region where such questions have long been taboo.

They are also confronting a health care system that’s not only failing to offer answers about why so many people are getting cancer, but also struggling to diagnose and treat those who do.

At a time when Health and Human Services Secretary Robert F. Kennedy Jr.’s “Make America Healthy Again” campaign has blamed environmental exposure and diet for chronic diseases, the activists’ similar message is starting to resonate in this red state. Iowa Gov. Kim Reynolds (R) this year announced a $1 million investment to establish a research team dedicated to investigating the underlying causes of the state’s growing cancer rates. And pesticide manufacturer Bayer recently faced a setback in the state legislature when a proposed bill - intended to protect the company from lawsuits claiming that its flagship product, Roundup, causes cancer - was defeated.

Researchers are still working to disentangle national trends from regional anomalies, and the data doesn’t yet offer a satisfying explanation for why cancer rates among the young have shot up here. The increase in cancer diagnoses among young adults may reflect broader changes: better detection, shifting environmental factors or even evolving lifestyle patterns. But the fact that some areas seem to carry a heavier burden suggests that something more specific, if still unidentified, may be at play. In this vacuum, both patients and scientists have grappled with incomplete information.

Mary Charlton, director of the Iowa Cancer Registry, said the state’s rise is unlikely to be the product of a single, identifiable cause. Instead, her work and that of other scientists points more toward complex, interwoven forces, including those potentially seeded in pregnancy and early childhood.

“What’s driving these rates is what is on everyone’s mind, including mine, all the time,” Charlton said. “The complicated thing is that it’s not risk factors now. It’s our risk factors from 10, 20, 30 years ago that are causing the cancers now.”

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Pointed questions

In the geography of American health, early-onset cancer paints a stark and uneven map - one that potentially reveals how environment, policy and access to medical expertise and resources influence health. Across the Appalachian corridor, states like West Virginia and Tennessee bear a disproportionate burden - with high rates of both diagnosis and mortality. In contrast, the West Coast and Mountain West have low rates of incidence and death. Then there is Iowa, where young adults are being diagnosed with cancer at high rates yet dying at a rate typical for the country.

At the turn of the century, Iowa ranked 18th in the nation for cancer rates among adults under 50. Today, it’s fifth.

In its yearly cancer report to the public, the Iowa Cancer Registry - part of the National Institutes of Health’s surveillance program - has flagged ultraviolet exposure (due to so many residents being involved in farming and being outdoors) and high rates of binge drinking (the state is often among the top three in the nation, according to surveys) as among the potential causes of Iowa’s high overall cancer rates at all ages.

But in a report last year, the University of Iowa’s Environmental Health Sciences Research Center focused on the land itself, casting Iowa as a “hotspot for environmental exposures to cancer-causing agents.”

The assessment noted that the state’s soil harbors some of the nation’s highest natural radon levels, while its groundwater carries the country’s highest average nitrate pollution, largely due to decades of fertilizer use. Radon, a colorless, odorless, radioactive gas, is considered a key risk factor for lung cancer and multiple studies have linked nitrate in drinking water to cancer in the stomach area.

“We are a place where a lot of agrochemicals are used, both historically and currently,” said Hans-Joachim Lehmler, director of the center. “That raises concerns about exposures.”

Mounting scientific evidence has linked long-term exposure to fertilizers, pesticides and herbicides with heightened cancer risks - most notably non-Hodgkin’s lymphoma, leukemia and prostate cancer. Studies suggest these chemicals may damage DNA, disrupt hormone function, increase inflammation, suppress the immune system and trigger oxidative stress - a condition that can harm cells over time.

While the data points to dangers for farmworkers and those entering fields shortly after spraying, questions have begun to extend to nearby communities and consumers. A 2024 analysis of population-level data in the journal Frontiers in Cancer Control and Society looked at countywide agricultural pesticide data along with cancer incidence and potentially confounding factors such as prevalence of smoking. The analysis concluded that “the impact of pesticide use on cancer incidence may rival that of smoking.” The authors noted that states with “higher agricultural productivity, such as the leading corn-producing states of the Midwest, also have increased cancer risk.”

At the center of the controversy is glyphosate, the active ingredient in Roundup and the most widely used herbicide on the planet. In 2015, the International Agency for Research on Cancer, a branch of the World Health Organization, deemed it “probably carcinogenic to humans.” The Environmental Protection Agency disagreed and as recently as 2020 reaffirmed its belief that glyphosate is “not likely to be carcinogenic” - a split that has fueled ongoing scientific and regulatory discord.

The EPA said in response to questions that it is currently updating its evaluation of the carcinogenic potential of glyphosate and plans to release its findings in 2026. However, the agency said, the “underlying scientific findings regarding glyphosate, including its finding that glyphosate is not likely to be carcinogenic to humans, remain the same.”

Although considered less acutely toxic than some other agricultural chemicals, the U.S. Agency for Toxic Substances and Disease Registry (ATSDR) notes that glyphosate can have a range of potential effects beyond cancer, including respiratory problems, hormonal disruption and possible impacts on gut health.

Thousands of cancer patients have sued Bayer, which makes glyphosate-based products. Although verdicts have varied, recent massive jury awards - for example, $2.1 billion in Georgia in March and $2 billion in California in 2019 - could lead to billions in payouts. Bayer is asking the U.S. Supreme Court to intervene, asserting that federal EPA approval of Roundup’s labeling - without requiring a cancer warning - should preempt state-based failure-to-warn claims. The company eliminated glyphosate from its residential Roundup products in 2023 in the United States to reduce litigation risks, but the commercial formulation with the chemical continues to be widely used by farmers.

Bayer declined to comment about the litigation and Iowa, but said in a statement that the company “stands behind the safety of our glyphosate-based products which have been tested extensively, approved by regulators and used around the globe for 50 years.”

Glyphosate, despite its notoriety, is just one piece of a larger puzzle. Safety tests often assess chemicals in isolation, but people are exposed over time to complex mixtures - through soil, water, air and food.

Reynolds, the governor of Iowa, said the research group she launched would look holistically at potential behavioral, genetic and environmental factors, but that “we shouldn’t jump to conclusions.”

Doctor and Democratic state Rep. Austin Baeth, 41, was among a group of lawmakers who this year helped defeat a bill sought by chemical makers including Bayer that would shield them from lawsuits claiming that it failed to tell customers that a pesticide could increase cancer risk. Similar bills passed this spring in two other states - North Dakota and Georgia.

Earlier this year, after a particularly brutal shift at his internal medicine clinic, Baeth turned to TikTok to talk about two young adults - “healthy people who live clean lives” whom he diagnosed with cancer that day.

“I can’t stop thinking about how stories like this are unfolding all across Iowa, every single day,” he said, the glow of his phone illuminating a face heavy with frustration.

His post garnered a half-million views and thousands of comments in which many Iowans shared their own or a loved one’s cancer diagnosis at a young age: 21, 29, 36, 20, 23, 21, 21, 34 ...

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A system that wasn’t built for them

Beatrice Abang-Ntuen was 25 and working double shifts as a waitress in West Des Moines when she found the lump - pea-size and tucked in her left breast. Doctors dismissed her concerns again and again - she was “too young” for anything serious, they said. The shadow on her scans was brushed off as a harmless cyst. It took multiple appointments, and her own insistence, before the truth emerged: Stage 3 breast cancer.

Across the country, young people are being diagnosed with cancer at a later stage than their older counterparts. In breast cancer - the most frequent diagnosis among young women - nearly 40 percent of patients under 50 are diagnosed at a later stage, compared with 29 percent of women over 50, according to the Post analysis.

It is not just bad luck or biology, but a reflection of a system that wasn’t built for them.

Modern cancer care was shaped around the bodies - and timelines - of older adults. The median age of diagnosis in the United States is 66, and diagnosis and treatment protocols have largely followed suit.

Younger patients may endure aggressive therapies better in the short term, but their long-term risks are greater as they are more likely to survive past the five- or 10-year mark than their older counterparts. A body with decades ahead of it must live longer with the consequences: heart damage from chemotherapy, hormone disruptions, secondary cancers and infertility.

Of all these, survivors say, the infertility can be the most personally devastating.

Mom to an 8-year-old, Abang-Ntuen said she and her longtime boyfriend hope to grow their family, but her cancer medication jeopardizes that. Because Abang-Ntuen couldn’t afford to freeze her eggs, doctors instead gave her a shot to put her ovaries in a dormant state - which only works about 40 percent of the time to preserve fertility.

“Talking about infertility - it sends me into panic attacks,” said Abang-Ntuen, who is now a nursing student.

A bill introduced in the Iowa legislature aimed to ensure insurance coverage for newly-diagnosed cancer patients to preserve their fertility, but it stalled over cost concerns. (Egg freezing can cost about $10,000, while sperm preservation can be $500 and up.) Abang-Ntuen has argued on social media that fertility preservation should not be treated as a privilege but rather a fundamental part of patient care.

A former high school gymnast and basketball player, Abang-Ntuen still carries the poise of her athletic youth. But after six surgeries, six months of chemotherapy and six weeks of radiation, she lives with relentless hot flashes and fatigue. Her left arm swells painfully if she lifts it too high. She can’t wear heels because her feet go numb. Chemotherapy turned her toenails black, and her doctor has recommended removing them permanently.

“I’m 29,” she said, “but I feel 78 inside.”

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The paradox of survival

Emily Hoffman, who lives in West Des Moines, was 30 when she was diagnosed with cervical cancer. The physical toll was immediate, but the emotional weight settled in more slowly. Surveys consistently show that younger adults experience higher levels of psychological distress than both children and older adults - a paradox of their survival that the medical system has yet to fully address.

Hoffman’s digestive system never recovered. Eating became painful and unpredictable; she felt sick every time she tried. Once thriving in a physically demanding job in corn fields for a biotech seed company, she eventually had to move to a desk job as her strength faded.

For eight years, doctors tried everything. “I spent my 30s sick in bed,” she said. Nothing helped - until they implanted a port in her chest, connected to a backpack that delivers liquid nutrition around-the-clock, a system called total parenteral nutrition, or TPN.

Hoffman jokes about it now: “I admit it. I’m sleeping with my TPN.”

When she emerged from treatment, Hoffman was looking for someone to talk to - about being young, sick and still expected to build a life - but found few resources. Now 42, she’s helped launch a program for young survivors at Above + Beyond Cancer, a Des Moines nonprofit founded by a former National Cancer Institute researcher where she’s on the board. Its bike rides, art classes and yoga sessions reflect a simple but radical idea: that survivorship deserves as much care as treatment - not just to live, but to live well with an illness.

On a brisk April evening, Hoffman joined half a dozen friends - all diagnosed with cancer in their 20s or 30s - for a dance class at Ballet Des Moines. As they swayed and stumbled through the choreography, their laughter filled the studio.

“Are we caring? Are we kind?” the instructor with flame-red hair called out.

“Yeah!” they shouted back.

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The Madison County crew

Madison County, Iowa, spans 562 square miles of neatly planted corn and soybean fields that roll toward the horizon. Beyond its farming roots, the area is famous for its red covered bridges, etched in popular culture by a best-selling book and the subsequent 1995 Clint Eastwood-Meryl Streep romantic drama “The Bridges of Madison County.”

Cancer has long been a part of life in the county seat of Winterset, as in many places. But two springs ago, a wave of cancer diagnoses among young people began to emerge, prompting a more urgent and unsettling confrontation with the disease.

Three of the five had blood-related cancers, and two cancers related to the testes.

Dryden, now 21, was among the first to be diagnosed in March 2023.

She was in college at the University of Miami and snapchatting a friend when she saw herself in her camera and noticed that her right eye was half closed. She went to four different doctors before the last one sent her to the ER. Imaging revealed a tumor almost 6 inches wide in her chest, crushing her left lung. She had Hodgkin’s lymphoma - a blood-based cancer - Stage 2 “bulky,” meaning it was still early stage and hadn’t spread to the lymph nodes below her diaphragm. But because one of the tumors was so large, it required more aggressive treatment.

Since her diagnosis, Dryden has been posting on social media about her worries about glyphosate that was - and still is - sprayed every year on her family’s farm and others in her hometown. All of the five young people had been healthy - four played high school sports - before their cancer diagnosis.

Growing up, she said, “I didn’t think much of the chemicals. It was the norm here. People would spray whatever and it was what it was.”

Marshall Engnell, 20, had been a senior at Winterset Senior High School in spring 2023 when he noticed a golf-ball-size lump in his left armpit and had horrendous itching for months before that. He learned he had Hodgkin’s lymphoma, Stage 3-4 - advanced cancer that has spread beyond its point of origin.

Jack West, 23, a wrestler and golfer in high school, was in his last year of college in September 2023 when he had trouble breathing and doctors found a softball-size mass in his chest. Further testing revealed it to be an extremely rare form of cancer that is believed to have originated in the testes. Stage 4.

Mikaela Hunter, 24, Engnell’s sister and a cross-country teammate of Dryden’s, was diagnosed in March of this year with non-Hodgkin’s lymphoma, a different type of blood-based cancer than her brother. She had tumors in her breast, pelvis and chest. Stage 4.

Cole Seiler was diagnosed in April at age 28 with a type of testicular cancer - Stage 4 - and which was diffused through his body, including his back, liver, kidneys and around a major vein that supplies blood to his legs.

His body’s first warning came in the form of aches in his back. Doctors chalked it up to weightlifting - routine strain, nothing serious. He consulted a chiropractor, a physical therapist and a handful of other specialists. Many recommended heat. But his need was so persistent and intense that some nights he fell asleep on an electric heating pad, scorching his back.

Seiler has been in and out of the hospital since his diagnosis and started a concentrated round of chemotherapy in late May that has dramatically shrunken his tumors. He has gradually regained his strength - returning to work virtually in early October and taking longer walks - but the future weighs heavily on him. Too ill at the time to freeze his sperm, he’s aware of other men left infertile by treatment, and he now wonders if he will be able to have a family.

Seiler often finds his mind looping through the past, searching for answers. He’d always been strong and fit - playing football, baseball, running track. At home, his family ate well, but on his own he had indulged sometimes: gas station snacks, fast food stops, red meat. Could it be his diet or even drinking out of the water hose and playing outside? He wonders now: Was it a lifetime of little exposures adding up?

“I think about why a lot,” Seiler said.