Cancer Upends Iowa's Race for Governor as Water and Farming Take Center Stage

Cancer Upends Iowa's Race for Governor as Water and Farming Take Center Stage

A public-health outlier in a nation of falling rates

While cancer rates are falling across the United States, they are climbing in Iowa. The state has the second-highest rate of newly diagnosed cancers in the country and is one of only three states where the rate is still rising. What was once a politically untouchable subject has become the defining issue of Iowa's 2026 campaign season.

An open seat for the first time in two decades

Iowa will elect a new governor on Nov. 3. Republican Gov. Kim Reynolds announced she would not seek reelection, giving Iowa its first open gubernatorial race since 2006. The Democrat is Rob Sand, the state auditor and the only Democrat currently holding statewide elected office. The Republican is Zach Lahn, a self-described entrepreneur and farmer who emerged from a five-man primary.

Debates open with cancer, then turn into blame games

As debate season began, the moderator's first question set the tone: what immediate, specific steps would each candidate take against Iowa's cancer crisis? Both called it foundational to their campaigns, then accused each other of doing too little. Two weeks later the same theme resurfaced in a debate in the competitive Senate race.

The toll: 21,700 diagnoses and counties worse than Cancer Alley

About 21,700 Iowans are expected to be diagnosed with cancer this year, and about 6,400 are expected to die from it, according to the Iowa Cancer Registry. Nearly half of Iowa's counties have cancer rates higher than those of Louisiana's heavily industrialized "Cancer Alley." Iowa has ranked second in the nation for new cases for three consecutive years, and its incidence rate is rising faster than any other state's.

Nitrates in the rivers put Big Ag under scrutiny

Iowa is one of the country's top producers of corn, soybeans and hogs, and chemical fertilizers plus animal waste wash nitrates and phosphorus into its web of rivers with rain and snowmelt. Environmental advocates and some farmers point to nitrates from thousands of tons of livestock manure as a key culprit. For years the issue was taboo in state politics, lest anyone point a finger at the powerful farm industry.

A $1 million study says lifestyle explains only so much

The Iowa legislature gave the University of Iowa $1 million for the Key Drivers of Cancer in Iowa Project, whose Year 1 findings came out in late September. The research found that most — but not all — of Iowa's above-normal rates for five cancers could be explained by demographic and behavioral factors such as smoking and binge drinking. The next phase will weigh environmental factors, including nitrate levels.

Nearly $30 million in cancer ads, each side naming a villain

More than 100 campaign ads mentioning cancer have aired in Iowa this year at a cost of nearly $30 million, according to AdImpact data; in the 2022 midterms there was just one, backed by a little under $200,000. Lahn's campaign accuses Sand's "biggest donor" of getting "caught polluting your drinking water." Sand's camp attacks Lahn for backing "budget cuts that slashed cancer research funding" and "a plan that would bankrupt rural hospitals."

Behind cancer lies a wider rural unraveling

Lahn ties the crisis to keeping young families in Iowa, noting the state is losing its kids faster than 46 other states, has lost 10,000 family farms in 20 years, and has seen its schools slide from first in the nation to 27th. Sand's refrain is that Iowa suffers from "high costs, high cancer and high corruption." Beneath the cancer numbers sits a tangle of rural hospitals, water quality and depopulation.

What comes next: from campaign promises to cleaner water

Both candidates pledge cleaner water and tighter chemical rules. Sand has published a multi-pronged plan covering water quality, farm chemicals, a state task force and an end to privatized Medicaid; Lahn's platform also addresses farm chemicals and runoff while urging the state's medical and agricultural institutions to focus on local problems. After Nov. 3, the winner inherits the same rivers and the same numbers.