An earlier version of this story was originally published in West Side Story, the student newspaper of Iowa City West High.
At 13 years old, Iowa City West High junior Maggie Schebel walked into the hospital for a doctor’s appointment and walked out with a life-changing cancer diagnosis. Although she maintained a rigorous schedule packed with classes and extracurriculars, she suspected something was wrong.
“About a month before, I started noticing a lot of bruising, and I was really tired. I did three sports at the time, so I thought it was normal,” Schebel said. “Then it started getting concerning, to the point where my mom noticed, and she brought me to the doctor. They immediately said I had to go to the hospital, did more testing and then diagnosed me that day.”
She’s one of the one in 20 Iowans who is in cancer remission. According to the Iowa Cancer Registry, Iowa has the second-highest cancer incidence rate in the United States for the third year running. While national cancer rates are steadily falling, Iowa’s rate is still increasing, with an estimated 21,200 residents diagnosed with cancer in 2025 and an estimated 6,300 fatalities. Experts say there’s a range of factors to blame for Iowa’s outlier status, including environmental conditions and the fact that Iowans are getting older.
John Buatti, a professor of radiation oncology at the University of Iowa, cites cancer as “a disease of aging, so the older you are, the more likely you are to have a higher incidence of cancer. There are also unique things about the ground here,” he said. “We have radon, a naturally occurring radioactive gas. Because we all have basements, radon can leach into the system. Things like lung cancer in non-smokers increased because of radon levels that existed for a long time.”
According to the Iowa Cancer Consortium, 71.6% of Iowan homes are at or above the acceptable threshold for radon, leading to around 400 deaths annually. To counter this, Iowa Gov. Kim Reynolds signed House File 2297 into law this May, requiring all newly built homes to adopt radon mitigation systems.
Intensive farming may also play a role in making Iowans sick. A 2026 report from the Iowa Environmental Council and the Harkin Institute for Public Policy cites pesticide exposure and water contamination as leading factors in 13 of 16 types of cancer. As a state heavily reliant on agriculture, Iowa ranks fourth in the nation for pesticide use, increasing the risk of environmental contamination and chemical exposure.
Sarah Long, a science teacher at Iowa City West High School and cancer survivor, expressed frustration over these environmental conditions. “I have a lot of concerns about cancer in Iowa, due to all the fertilizers. The data is there, so people are starting to realize we just need to do something about it,” she said.
Despite Iowa’s poor water quality, there are few restrictions on pesticide and fertilizer use. In 2025, Sens. Chuck Grassley, Tammy Baldwin and Joni Ernst reintroduced the Fertilizer Research Act to study and publish a report on fertilizer markets and pricing — a step they hope is a precursor to bringing down prices. Lower prices could increase usage, and with that potentially also cancer rates, given that nitrate exposure is considered a probable human carcinogen.
Genetics may also be involved; according to the Cleveland Clinic, 5% of Americans inherit susceptibility to cancer.
Still, Buatti finds it can be difficult to prove direct causation between any single factor and cancer rates. “It’s very hard to hone in and identify one agent as the cause of cancer,” he said. “It’s very hard to show causality for things like that, [but] the folks in our school of public health are doing a fabulous job in trying to study it in a very scientific way.”
Over 67,000 cancer cases in the United States have no identified cause, including Schebel, who was diagnosed in 2023 with B-cell acute lymphoblastic leukemia, an aggressive blood and bone marrow cancer. In the days after her diagnosis, Schebel felt frustrated.
“I was in shock the first couple of days, and I was sad that I had to cancel all my things — I had a dance competition that weekend, so I had to tell them I wasn’t going to be there for the rest of the season,” Schebel said. “I was also really annoyed at the situation. It was a weird mix of emotions.”
Soon after her diagnosis, Schebel began chemotherapy, a treatment that uses powerful drugs to stop cancer cell growth. While this method is widely used — with around 1 million Americans receiving chemotherapy annually — the treatment comes with side effects.
“It took away my hair, but it also took away my energy,” Schebel said. “I was very, very pale. I looked so sick. I was just so tired and defeated, almost [like I] couldn’t live life. I just sat there all day doing homework or on my phone, because I couldn’t do anything else.”
Despite their negative effects, treatments like chemotherapy have boosted the cancer survival rate. According to the Iowa Cancer Registry, around 172,000 cancer survivors currently live in the state, making up 5.4% of the population. While modern medical treatments play a role, Buatti stresses the importance of implementing healthy lifestyle choices, such as attending regular medical appointments.
“[Have] good awareness not to smoke, make sure that people exercise and stay relatively healthy [and] test people who are at high risk for cancer,” Buatti said. “Iowa has a relatively low incidence of people doing that successfully, probably due to the rural environment. If we can get more people tested early, that could help long-term outcomes.”
A 2025 study found that in the prior year, around 49% of U.S. adults didn’t have a routine medical appointment or designated cancer screening. Iowans miss key recommended cancer screenings at almost the same rate. By contrast, those who received a cancer screening saw a prolonged life expectancy of over 100 days for some types of cancer.
Since May 2023, Schebel has been cancer-free. She still grapples with the long-term effects of her treatment, including taking medication to prevent a rediagnosis. “It’s definitely a hard reminder every day, because in the mornings, I now have to take pills. I’ll have complications for the rest of my life,” Schebel said.
Reflecting on life before her diagnosis, Schebel emphasizes the importance of not taking daily tasks for granted, encouraging cancer patients to seek support from friends and family no matter the challenges they face. “Keep pushing and fighting through, and know that people are there for you and you are supported. Just keep doing the things you love,” Schebel said.