Amish communities do get cancer, but their overall rates appear to be substantially lower than those of the general American population. A study of Ohio’s Amish found their age-adjusted cancer incidence was roughly 60 percent of the statewide rate, with the gap widest for cancers tied to tobacco use. The picture is more complicated than a single number suggests, though, because low screening rates in Amish communities may mean some cancers simply go undetected, and the genetic isolation that protects against certain diseases can raise risk for others.
How Much Lower Are the Rates?
The most detailed look at Amish cancer incidence comes from a study that tracked diagnoses in the Ohio Amish community and compared them to the broader Ohio population. The overall cancer rate among Amish adults came in at about 390 per 100,000, compared to roughly 647 per 100,000 for Ohio adults as a whole. That works out to the Amish rate being about 60 percent of the state average. When the researchers broke cancers into tobacco-related and non-tobacco-related categories, the split was striking: tobacco-related cancers among the Amish ran at just 37 percent of the Ohio rate, while non-tobacco-related cancers were 72 percent of the state rate.1PubMed Central. Low cancer incidence rates in Ohio Amish
An earlier mortality study found a similar pattern, but with an important wrinkle: the benefit was concentrated in men. Amish males between 40 and 69 had a cancer mortality ratio of just 0.44 compared to the general population, meaning they were dying of cancer at less than half the expected rate. Amish women, by contrast, showed no statistically significant difference in overall cancer mortality.2American Journal of Epidemiology. Patterns of Mortality in the Old Order Amish: I. Background and Major Causes of Death That gap between men and women is worth sitting with. It suggests that whatever is protecting Amish communities from cancer is not doing so equally across sexes, and the likeliest explanation involves lifestyle factors that differ more sharply between Amish men and men in the general population than between the two groups of women.
The Tobacco Factor
The single biggest reason Amish cancer rates are lower is straightforward: almost nobody in these communities smokes. Tobacco use is culturally prohibited or heavily discouraged across Amish settlements, and a review of cancer rates in four religious groups with near-zero smoking found that lung cancer was strikingly low in all of them. Cancers of the mouth, throat, and esophagus were also well below population averages.3Social Science & Medicine. Review of cancer among 4 religious sects: Evidence that life-styles are distinctive sets of risk factors
This matters more than it might seem at first glance. Lung cancer alone is the leading cause of cancer death in the United States, and tobacco is linked to cancers of the bladder, kidney, pancreas, stomach, and several other sites. When you remove tobacco from the equation, you eliminate or dramatically reduce risk for a large share of the most common cancers. The Ohio data bear this out directly: the Amish advantage over the general population was almost twice as large for tobacco-related cancers as it was for all other cancers combined.1PubMed Central. Low cancer incidence rates in Ohio Amish
It also helps explain the sex gap in cancer mortality. In the general U.S. population, men have historically smoked at higher rates than women, so the cancers most strongly linked to tobacco have hit men harder. When Amish men are compared to non-Amish men, the elimination of smoking removes a huge chunk of expected cancers. Amish women already benefit from lower baseline smoking rates in the female population at large, so the relative advantage is smaller.
Physical Activity and the Farming Life
Beyond tobacco, the Amish lifestyle involves a level of daily physical exertion that is unusual in modern America. Many Amish communities farm without modern mechanized equipment, travel by horse and buggy, and perform manual labor as a matter of daily routine. Researchers who strapped pedometers and activity monitors onto Amish and non-Amish adults in Ohio Appalachia found that Amish men averaged about 11,400 steps per day, compared to roughly 7,600 for their non-Amish neighbors. Amish farmers logged even more, averaging over 15,200 steps per day. Amish women showed a similar trend, though the gap was narrower.4PubMed Central. Physical activity among Amish and non-Amish adults living in Ohio Appalachia
A separate study of Old Order Amish physical activity levels reached a blunt conclusion: their very high activity levels likely contribute to their low rates of obesity.5PubMed. Physical activity in an Old Order Amish community Obesity is a recognized risk factor for at least a dozen types of cancer, including breast, colon, kidney, and endometrial cancers. A population that is both highly active and less likely to be obese has lower baseline risk for many of the cancers that are increasingly common in sedentary, overweight populations.
This connection is correlational rather than proven as a direct cause. Researchers studying the Amish have flagged physical activity as one behavioral factor that warrants further investigation for its potential role in lower cancer rates, but isolating its effect from the rest of the Amish lifestyle bundle is difficult. Diet, stress, alcohol consumption, and social cohesion all differ between Amish and non-Amish communities, and disentangling their individual contributions remains an open question.
Sexual Behavior and Cervical Cancer
One of the earliest and most specific findings about cancer in Amish communities involved cervical cancer. A study analyzing over 10,000 Pap smears collected in Holmes County, Ohio, from 1950 to 1966 compared results between Amish women and non-Amish rural women in the same area. Cervical cancer was considerably less common among the Amish women, even though they had higher birth rates and did not use contraceptives.6Cancer. Cancer of the cervix in an Amish population
The researchers at the time attributed this to the Amish practice of strict endogamy and lifelong monogamy, which would limit the spread of a sexually transmitted agent. We now know that agent is the human papillomavirus (HPV), which causes the vast majority of cervical cancers. In a community where both partners are expected to be sexually exclusive and marriages occur within a closed community, the virus has far fewer opportunities to circulate. This finding has held up well over time and has been cited as a classic example of how sexual behavior patterns shape cervical cancer risk at a population level.
HPV vaccination, which has become widespread in the general population, is generally not adopted in Amish communities. But the behavioral norms that limit HPV transmission appear to have achieved a similar protective effect through a different mechanism.
The Screening Paradox
Here is where the story gets less tidy. Amish communities have dramatically lower rates of cancer screening than the broader population. A comparison of Amish and non-Amish adults in Ohio Appalachia found that only about 14 percent of Amish men had undergone prostate cancer screening, compared to 63 percent of their non-Amish neighbors. Colorectal screening rates among Amish men were roughly 10 percent versus 40 percent for non-Amish men. The numbers for women showed a similar pattern: about 48 percent of Amish women had been screened for cervical cancer compared to 84 percent of non-Amish women, and breast cancer screening rates were about 25 percent versus 54 percent.7PubMed Central. Cancer screening practices among Amish and non-Amish adults living in Ohio Appalachia
These are not small gaps. When researchers asked Amish men why they had not been screened for prostate cancer, roughly 79 percent said they did not think it was necessary, compared to about 17 percent of non-Amish men who gave the same answer.7PubMed Central. Cancer screening practices among Amish and non-Amish adults living in Ohio Appalachia This reflects a broader cultural orientation in which routine medical testing is not a priority, partly because many Amish do not carry health insurance and pay for medical care out of pocket, and partly because of a philosophical disposition toward accepting outcomes as God’s will.
The screening gap creates a genuine problem for interpreting the cancer incidence data. If fewer Amish people are being screened, some cancers that exist may never be detected or formally diagnosed, which would make the reported incidence rates artificially low. A narrative review of Amish health research raised exactly this concern, questioning whether overall cancer rates are truly as low as studies have suggested and noting that under-screening may contribute to underreporting.8PubMed Central. Physical Health Conditions of the Amish and Intervening Social Mechanisms: An Exhaustive Narrative Review – Section: Cancer One proposed workaround is to analyze state death records and identify probable Amish individuals from those, which would capture fatal cancers regardless of whether they were diagnosed during life.
This does not mean the lower rates are an illusion. The reduction in tobacco-related cancers, for instance, is too large and too consistent with the near-absence of smoking to be explained by screening artifacts alone. But for cancers that are primarily caught through routine screening, like early-stage prostate, breast, and colorectal cancers, the true Amish incidence may be higher than what the data show.
What Gets Amish Women to Seek Screening
Among Amish women, the decision to get a mammogram appears to hinge heavily on whether they know screening guidelines exist at all. A study of Amish women in central Illinois found that women who were aware of mammography recommendations were more than five times as likely to have ever had a mammogram as those who were not aware. Interestingly, women who believed that nutrition or diet could cause breast cancer were also more likely to seek screening, as were women who believed physical injury could cause it.9PubMed. Mammography-Seeking Practices of Central Illinois Amish Women
The takeaway for public health outreach is that low screening rates among Amish women are not entirely a matter of religious opposition to medicine. They appear to be driven partly by a simple lack of information about what screenings are available and why they matter. This suggests that culturally sensitive health education could meaningfully increase screening rates in these communities without requiring anyone to compromise their beliefs.
Genetics and the Founder Effect
Amish communities in North America trace their ancestry to a small group of European settlers, which means their gene pool is unusually narrow. Over generations, this founder effect has amplified certain genetic variants that are rare in the general population. Some of these are harmful: Amish communities have higher rates of specific inherited conditions caused by recessive gene variants that are concentrated through centuries of intermarriage within the community.10PubMed Central. Development of a Novel Next-Generation Sequencing Assay for Carrier Screening in Old Order Amish and Mennonite Populations of Pennsylvania
When researchers used genetic sequencing to look at over 6,100 apparently healthy adults in the Lancaster, Pennsylvania, Amish settlement, they found seven variants classified as disease-causing or likely disease-causing across genes flagged as clinically important. All seven were enriched in the Amish compared to non-founder populations.11PubMed. The burden of pathogenic variants in clinically actionable genes in a founder population Some of these genes are associated with cancer predisposition syndromes. So while the Amish lifestyle may reduce exposure-driven cancers, the genetic architecture of their communities means that inherited cancer risk is not necessarily lower and could be concentrated in specific families or lineages.
On the flip side, at least one genetic variant amplified in the Amish appears to be protective. Researchers studying the Berne Amish community in Indiana found that carriers of a loss-of-function mutation in a gene called SERPINE1 had longer telomeres, lower fasting insulin levels, less diabetes, and a longer overall lifespan.12PubMed Central. A null mutation in SERPINE1 protects against biological aging in humans This variant was present in about a quarter of the extended kindred studied, and its effects on metabolism and biological aging could indirectly influence cancer risk, though the study focused on longevity and metabolic markers rather than cancer specifically. The finding is notable because it shows that the founder effect is not purely a vulnerability; it can also concentrate beneficial mutations.
Alternative Medicine and Treatment Choices
When Amish individuals do develop cancer, their approach to treatment sometimes diverges from mainstream oncology. Amish communities have a well-documented openness to complementary and alternative medicine. A survey of Amish women found that about 36 percent used at least one form of alternative therapy, with the most common being diet and nutrition programs, herbal remedies, and chiropractic care.13PubMed. Complementary and alternative medicine use in the Amish
This openness to alternative approaches extends to cancer treatment. Anecdotal and clinical reports have described Amish patients seeking out herbal clinics, dietary therapies, and other non-conventional cancer treatments, sometimes in place of surgery, chemotherapy, or radiation. The reasons are multifaceted: the cost of conventional treatment weighs heavily on a community that largely self-insures, the side effects of chemotherapy conflict with the need to maintain physical labor, and there is a cultural comfort with natural remedies that aligns with the broader Amish emphasis on simplicity and self-reliance.
This does not mean Amish people uniformly reject modern medicine for cancer. Many do pursue conventional treatment, and Amish communities have a pragmatic streak when it comes to medical care. Hospital births, surgery, and antibiotics are all accepted when deemed necessary. But the threshold for seeking aggressive treatment may be different, and the cultural weight placed on accepting God’s will can influence end-of-life decisions in ways that reduce the use of aggressive interventions for advanced cancers.
Environmental Exposures That Cut Both Ways
The Amish lifestyle removes many of the environmental cancer risks that affect the general population. Limited use of processed foods, no smoking, minimal alcohol consumption, and less exposure to urban air pollution all work in their favor. But farming introduces its own set of exposures. Pesticide and herbicide use, even in less mechanized agriculture, can put farmers in contact with chemicals that have been linked to certain cancers, particularly lymphomas and leukemias.
Water quality is another concern that has received some attention. A study of plain-sect communities found that members generally perceived their drinking water as clean and safe, but when the water was actually tested, 92 percent of samples failed to meet standard drinking water quality parameters. Community members did mention health concerns including cancer and stomach ailments, but they did not connect those concerns to their water quality.14IdeaExchange @ The University of Akron. Perceptions Regarding Drinking Water Quality and Its Effects on Human and Animal Health among Plain-Sect Community Members Most Amish homes use private wells rather than municipal water systems, which means the water is not subject to the same testing and treatment standards that protect public supplies.
Whether these agricultural and environmental exposures meaningfully offset the cancer advantages conferred by the Amish lifestyle is unclear. The overall data still point to lower cancer rates, suggesting that the protective factors outweigh the risks. But the picture is not one of universal protection, and Amish farmers may face occupational cancer risks that are simply different from, rather than lower than, those facing the general population.
Why the Evidence Is Thinner Than You Might Expect
Given the consistent finding that Amish cancer rates appear lower, you might expect a deep body of research exploring exactly why. In practice, the literature is relatively thin. The Amish are a small population, geographically dispersed across settlements that vary meaningfully in their practices. Old Order Amish in Lancaster County, Pennsylvania, live differently from Swartzentruber Amish in rural Ohio, and both differ from the Beachy Amish, who have adopted more modern technology. Lumping them all together obscures real variation.
There is also no centralized Amish health registry. Researchers typically identify Amish individuals through church directories, genealogical records, or community contacts, all of which introduce the possibility of incomplete coverage. Amish individuals who leave the community are generally lost to follow-up. And because many Amish pay for health care out of pocket and avoid the insurance-linked systems that generate the bulk of American health data, their medical encounters are harder to capture in the databases that epidemiologists rely on. The studies that do exist tend to focus on specific settlements, making it risky to generalize from Ohio Amish to all Amish everywhere.
Researchers have suggested that analyzing state death certificates and using surname-based identification methods could help fill these gaps, but these approaches have their own limitations. A death certificate records a cause of death, not a lifetime of cancer history, and surnames alone cannot reliably distinguish Amish from non-Amish individuals who share common names. The result is that the evidence base, while suggestive and largely consistent, rests on a smaller foundation than people tend to assume.