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Happy Friday. And welcome back to Cornhole Champions. I'm Zachary Oren Smith. Our investigative series The Hot Spot has been hurtling closer and closer to the center of Iowa’s cancer crisis, and it’s never been clearer to me how much interest there is in this subject. We’ve seen a ton of engagement. Folks writing in wanting to know why. And I hope with the series, we’re helping answer that question while sparking other questions about how we got here.
In the weeks ahead, we’ll talk about skin cancer and radon. But I wanted us to also take a beat and talk about what you can do about your chances of getting cancer. A future issue will drill deeper into this topic, but I think it’s at the heart of some of this. I don’t want me and mine to get cancer. How do I stop it?
There is nothing you can do to rule out 100% of your cancer risk. That’s just not reality. But what I really dug about this conversation is Des Moines oncologist Dr. Richard Deming said there ARE things that you can do to greatly reduce your cancer risk.
Deming has been treating cancer patients in Iowa for four decades. He's watched treatments evolve from blunt instruments to precision medicine. He's also watched Iowa climb to the second-highest cancer rate in the country. What emerged was a conversation about mortality, meaning, and what it actually takes to reduce your cancer risk.
Here are some insights that stuck with me.
The mortality wake-up call
Deming said something that reframed how I think about cancer diagnosis. It's "like a two by four up the side of the head" because it reminds you of two things you try to forget: "you are going to die someday" and "you don't know when that's going to be."
Even with stage one cancer, where survival is likely, that brush with mortality changes people. "You have the opportunity to create the autobiography you would like to read," Deming said. "You now can get off the treadmill for a second and ask yourself, is the life I'm living the one I want?"
This isn't about cancer being a "gift" or finding silver linings in suffering. It's about how confronting our limits can clarify what matters.
The Iowa problem has two clear culprits
When you look at all the cancer risk factors Iowa tracks—smoking, obesity, diet, alcohol—we're pretty average. But two things make us an outlier.
First, radon. "We happen to be sitting on a big bed of radon," Deming said. It's a colorless, odorless radioactive gas that seeps into our homes and increases cancer risk.
Second, agricultural chemicals. Iowa uses way more chemicals per square mile than surrounding states because of how much land we have dedicated to crop production. "There's lots of evidence showing correlations between the various chemicals and cancer," Deming said. We may never sort out which specific chemicals cause which cancers, but the association is clear.
This is no more about demonizing farming as it is about demonizing the soil composition underneath our feet. But we have to acknowledge that the system we've built has consequences. We have to think about whether this system is in the service of Iowans.
The 45% solution
Here's the most striking thing Deming told me: if everyone did everything we already know works, we could reduce cancer cases by 45% and cancer deaths by 42%. No new research needed.
The list isn't sexy: don't smoke, eat real food, maintain a healthy weight, exercise, limit alcohol, protect yourself from sun exposure, get vaccinated against cancer-causing viruses like HPV, and do your screenings.
"I have a feeling that you and I would get an A plus on a written test on what's healthy to eat," Deming said. "The problem isn't the written test, it's the practical test."
The gap between knowing what to do and doing it is where most of us live. That's not a personal failing; it's a design challenge for how we structure our communities, our food systems, and our daily routines.
You wrote in
This week, I asked: If you had the power, what's one policy that you think would start helping people out tomorrow?
Lisa from Cedar Rapids: "Universal childcare. I spend $1,200 a month on daycare for my two kids. That's more than my mortgage. If we had reliable, affordable childcare, parents could actually work without going broke paying for it."
ZOS: When I tell you this is one that’s on my heart… Yes, childcare costs are out of control. And I wish I could tell you that the operators were getting fat off all this money. They’re doing poorly. We’ve also deregulated the sector, and that doesn’t appear to have done the trick either. Seems like we all agree that childcare slots are insufficient and are needed for a strong economy. If that’s true, where’s the conversation for a major public subsidy? Or publicly run slots?
Tom from Ames: "Medicare for all. I'm paying $800 a month for health insurance that doesn't even kick in until I've spent $6,000 out of pocket. My neighbor in Canada pays nothing and sees a doctor whenever he needs to."
ZOS: Healthcare costs are ALSO out of control. When people are rationing insulin or skipping preventive care because they can't afford it, we're not just hurting individuals; we're making our whole system less efficient. I always hear about concerns of long wait times, but what I think people mean is disruption in care. Which is something I buy. However, any major change will come with implementation pain. AND we agree that the current private insurance system is not making us healthier or less in debt.
Before you go, thanks to everyone who followed along with The Hot Spot series. Your emails, comments, and questions helped shape how we told this story. We’re not done. There’s more writing to come in this long conversation about health, environment, and what kind of future we want to build in Iowa.
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Cornhole Champions is a weekly podcast powered by Iowa Starting Line. This podcast is produced by me and edited by Rebecca Steinberg. Our music is by Avery Mossman and our show art is from Desirée Tapia.
Your friendly neighborhood reporter,
Zachary Oren Smith
Political correspondent
Iowa Starting Line
