Coming in second place for cancer risk was West Virginia with the nation’s highest rates of both smoking and obesity, which are critical cancer risk factors. The state also has the largest population of elderly people among the top-ranked states, creating a vulnerable demographic, said the report.

Pennsylvania ranked third with a composite score of 86, which reflected moderate risk factors across categories. Radon levels are concerning in the state, and its residents report relatively high stress levels. In addition, a high obesity rate (33.3%) and air pollution further compound cancer risks.

Ohio comes in at fourth for cancer risk with a score of 83.44. Air pollution is the highest in Ohio among all of the top states, and its smoking and obesity rates are also among the highest. With a composite score of 82.61, Kentucky ranks fifth. Although it has a lower elderly population, the state’s second-highest rate of smoking and obesity put its residents at an elevated risk for cancer.

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With the highest percentage of population over age 65 among all states studied, Maine ranks 6th in cancer risk. Residents benefit from the lowest UV radiation index among the top states, which provides some protection against skin cancer risks, the study found. A high water hardness score heightens the cancer risk for seventh-raked Iowa, which also has a higher rate of alcohol consumption and obesity among its residents.

Montana ranked eighth on Masumi’s cancer-risk ranking, thanks partly to its elevation and geographic location, which exposes its residents to the highest radiation levels among all top 10 states. Residents also have a fairly excessive rate of alcoholic consumption and are exposed to a high level of water hardness. Wisconsin ranked ninth, largely due to logging the highest excessive alcohol consumption rate of all analyzed states, making it more prone to alcohol-related cancers. Wisconsinites also have a high stress level index, creating significant psychosocial cancer risk factors, said the report.

Finally, New Hampshire rounded out the top 10, with residents reporting the highest stress levels among all states studied. Moderate alcohol consumption also contributed to the state’s cancer risk, although it had the lowest obesity and smoking rates among the top 10 states.

“While the common understanding is that lifestyle choices like smoking and drinking contribute to cancer risk, recent research emphasizes a more nuanced connection between environmental factors and health outcomes,” said a Masumi spokesperson. “For example, exposure to radon, a silent but potent carcinogen, can significantly alter cancer risk over time, particularly when compounded by other stressors like air pollution. What remains critical is an integrated approach to health, where the effects of multiple risk factors — sometimes subtle, often interrelated — are considered together rather than in isolation.”