At 13 years old, Maggie Schebel ’28 walked into the hospital for a doctor’s appointment and walked out with a life-changing cancer diagnosis. But Schebel is not alone — more than one in 20 Iowans can relate to her experience. 

According to the Iowa Cancer Registry, Iowa has the second-highest cancer incidence rate in the United States, surpassed only by Kentucky. While national cancer rates are steadily falling, Iowa’s rate is still increasing, with an estimated 21,200 Iowans diagnosed with cancer in 2025, followed by an estimated 6,300 fatalities. Dr. John Buatti, a professor of radiation oncology at the University of Iowa, explains that Iowa’s increase in cancer rates is driven by a range of factors, including environmental conditions and an aging population.

“Iowa has an older population. Cancer is a disease of aging, so the older you are, the more likely you are to have a higher incidence of cancer,” Buatti said. “There are also unique things about the ground here. 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. The passage of Iowa House File 2297 this March aims to reduce this issue by requiring all newly built homes to adopt radon mitigation systems.

Additionally, 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 West who, similarly to Schebel, has been diagnosed with cancer, expresses 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,” Long said. “It’s not a political issue. It’s not Republican or Democratic. We have a problem here in Iowa.”

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, which strives to lower the cost of fertilizers for Iowan farmers — an action that could increase usage, and consequently, cancer rates. 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. How do you test for the potential of a given fertilizer to cause cancer?” Buatti 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.”

Age, radon exposure and fertilizer use are not the only risk factors. According to the Cleveland Clinic, 5% of Americans have genetic susceptibility to cancer, regardless of lifestyle or family history. Additionally, over 67,000 cancer cases in the United States have no identified cause, including Schebel’s diagnosis. In April 2023, Schebel was diagnosed with B-cell acute lymphoblastic leukemia, an aggressive blood and bone marrow cancer. Although she maintained a rigorous schedule packed with classes and extracurriculars, she suspected something was wrong when she felt more exhausted than usual.

“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.”

In the days following her diagnosis, Schebel experienced a wide range of emotions, including frustration at her diagnosis and disappointment in the changes it would make to her schedule.

“It was definitely scary at first. I didn’t really know what to feel, because that’s not something that happens every day,” Schebel said. “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. I was also really annoyed at the situation. It was a weird mix of emotions.”

Soon after her diagnosis, Schebel began chemotherapy, a systemic cancer treatment that uses powerful drugs to stop cancer cell growth. While this method is widely used — with around one million Americans receiving chemotherapy annually — the treatment comes with many side effects. Throughout her two years of chemotherapy, Schebel experienced a severe decline in her physical and mental health.

“It almost took the life out of me. Obviously, 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 University of 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, daily habits can also influence cancer risk. Buatti stresses the importance of implementing healthy lifestyle choices, such as attending regular medical appointments and exercising often to help prevent cancer.

“I don’t think there’s an easy way to eliminate cancer, but you can do things that mitigate [its effects],” Buatti said. “[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. 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.”

In 2024, around 49% of adults did not have a routine medical appointment or designated cancer screening, including around 44% of Iowans. By contrast, those who received a cancer screening saw a prolonged life expectancy of over 100 days for some types of cancer. Skin cancer — the most common form of cancer — often goes unnoticed until later stages. Long, who was diagnosed with basal cell carcinoma in her early 30s, echoes Buatti, emphasizing the importance of preventative habits against skin cancer, particularly through limiting sun exposure.

“[Basal cell carcinoma] is sun-related. We all accumulate risk every time we’re out in the sun,” Long said. “Wear sunscreen. It really is [important], if you look at skin cancer data.”

The Skin Cancer Foundation reports that regular sunscreen use decreases the risk of some skin cancers by 40-50%, blocking cancer-causing ultraviolet radiation from the sun. After having several cancerous moles surgically removed, Long now makes it a habit to apply sunscreen and stay mindful of her sun exposure. However, while basal cell carcinoma can recur, she is currently cancer-free. Despite not having any current tumors, Long still has to go in for biannual appointments and try different cancer-prevention treatments — although not all of them are successful.

“I get checked every six months and sometimes they find [cancerous moles],” Long said. “I don’t seem to respond well to chemical treatments. I tried topical for a while — it’s like a cream chemotherapy that triggers your immune system — but it didn’t do a thing, so they had to cut [the moles] out.”

Similarly, as of May 2023, Schebel has been cancer-free. Despite no longer having leukemia, she continued chemotherapy for nearly two years to ensure the complete termination of the cancer. She still grapples with the long-term effects of her treatment, including taking medication to prevent a rediagnosis.

“It took me a couple of years to fully get back to where I was, which I don’t really know if there’s a ‘fully back to where I was,’” Schebel said. “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.”

Buatti has also witnessed his patients struggle with long-term complications from cancer, adding that losing patients is one of the most challenging parts of his job.

“If you’re having a discussion with the patient about a disease that’s likely to cause them to die, and it doesn’t affect you, then there’s something wrong with you,” Buatti said. “Over the years, I’ve had lots of patients, like a young mother with breast cancer who had horrible metastatic disease, and she was just trying to get a little bit more time to spend with her kids. If you’re an oncologist and think you live a normal life, it’s not true. I live in a very interesting world where I definitely see miracles — people that [statistically] shouldn’t be here, that are here — and I see people who statistically should be here, and they aren’t.”

While fighting terminal illness, a stable support system can make all the difference. Schebel expresses gratitude for the friends and family who stuck by her side throughout her cancer battle.

“I remember getting diagnosed, and my friends were amazing. They would all send me cards in the hospital or ask to come see me. My entire track team sent me a card. My dance studio sent me a humongous gift; it was so nice. My mom and dad [were] there every day, and they took me to every appointment,” Schebel said. “Knowing I have a good support system really helped. I wanted to keep pushing and fighting for them.”

Although Schebel received support from close friends and family, not every relationship stayed the same after her diagnosis. According to the American Cancer Society, more than half of cancer patients report feeling socially isolated or lonely at least some of the time. Schebel falls in the majority, noticing some friends becoming more distant after her diagnosis.

“When I first got diagnosed, I had a hard time [because] people didn’t know if I was allowed to go to things, so they would just not invite me. And it’s like, ‘I’m still the same person,’” Schebel said. “The person who has cancer is still human; they are still their old self.”

Reflecting on life before her diagnosis, Schebel emphasizes the importance of not taking daily tasks for granted.

“Before I was diagnosed, I went through life thinking my problems were so hard, when really it was just like, ‘Oh, I have math homework.’ I feel like I overestimated my problems. Then I got diagnosed, and I was like, ‘Wow. This is huge. This is going to be hard.’ Now, simple things feel like a privilege,” Schebel said. “I’m glad I get to do my math homework every day. I’m glad I get to go on this field trip. I’m glad I get to do normal, everyday things instead of being in a hospital bed all day.”

Outside of his work in cancer research, Buatti has also known people in his personal life who have passed away from cancer. Witnessing them suffer inspired him to enter radiation oncology and dedicate himself to improving patients’ lives.

“For everyone battling cancer, you’ve always been my motivation to try and help make things better. Continue to fight,” Buatti said.

Schebel echoes Buatti, 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.

As a science teacher, as well as someone who has experienced basal cell carcinoma, Long encourages everyone — even those without a predisposition to cancer — to remain informed about the state of cancer in Iowa.

“Learn about cancer and be as informed as you can. There’s so many different levels and stages,” Long said. “Be aware. Ask questions. Take preventative [action]. The earlier you find it, the way easier it is to treat.”

This story was originally published on West Side Story on April 23, 2026.