Do the Amish Get Cancer? A Look at the Research

The Amish do get cancer, but at rates substantially lower than the general American population. A study tracking cancer cases in Ohio’s Amish communities found that their overall cancer incidence was roughly 60% of the rate among other Ohio adults, a gap that held even after accounting for age differences.¹ That difference is real and significant, but the story doesn’t end with good news. The Amish relationship with cancer is shaped by lifestyle factors that protect them, screening gaps that leave them vulnerable, and treatment decisions that can cost them when cancer does strike.

How Much Lower Are Amish Cancer Rates

The most detailed data comes from a study that assembled cancer records for the Ohio Amish population and compared them against statewide cancer registries. The age-adjusted cancer incidence rate among Amish adults was about 390 per 100,000 person-years, compared to roughly 647 per 100,000 for Ohio adults overall. That means the Amish were developing cancer at about 60% of the rate seen in the surrounding population.¹ A separate study confirmed the pattern, finding that Amish adults living in Ohio Appalachia had lower cancer incidence than their non-Amish neighbors in the same region.²

This is not a minor gap. A 40% reduction in overall cancer incidence is large enough that it demands explanation, and the answer isn’t one single thing. The Amish differ from mainstream Americans in tobacco use, physical activity levels, diet, reproductive patterns, and exposure to certain environmental factors. Each of these contributes a piece of the picture.

The Tobacco Factor

The biggest single driver of the cancer gap is tobacco. Most Amish communities strongly discourage smoking, and some prohibit it entirely. The effect on cancer rates is dramatic. The Ohio study found that Amish rates of tobacco-related cancers were just 37% of the Ohio average. Among Amish men specifically, the rate dropped to 32% of what was seen in other Ohio men.¹

Tobacco-related cancers include lung, throat, mouth, esophageal, bladder, kidney, stomach, and pancreatic cancers, among others. In the general U.S. population, these make up a large share of all cancer diagnoses and an even larger share of cancer deaths. When you remove most of those cases from a population’s cancer burden, it has an outsized effect on the overall numbers.

But here’s the part that often gets overlooked in popular accounts: the Amish advantage isn’t purely a tobacco story. Even when researchers looked only at non-tobacco-related cancers, the Amish still had lower rates than the general Ohio population, at about 72% of the statewide rate. Amish women showed a particularly notable difference, with non-tobacco cancer rates at roughly 67% of what was expected.¹ So tobacco avoidance explains a large part of the gap, but something else is going on too.

Physical Activity and Body Weight

The Amish way of life demands physical labor in a way that modern American life simply does not. Many Amish men are farmers, carpenters, or tradesmen; many women manage large households without modern appliances like dishwashers, dryers, or even electric mixers. This translates directly into measurable activity levels. In one study comparing Amish and non-Amish adults in Ohio Appalachia, Amish men walked an average of about 11,450 steps per day compared to roughly 7,600 for non-Amish men. Amish men also spent significantly more time in moderate physical activity and considerably less time sitting.³

Among Amish women, the pattern was similar in direction but more modest in magnitude. Amish women tended to walk more steps per day and spent significantly more time in moderate activity and less time sitting than their non-Amish counterparts.³ Physical activity is a well-established protective factor against several cancers, including breast and colon cancer, so this is a plausible contributor to the lower non-tobacco cancer rates.

The farming lifestyle pushes the numbers even further. Amish men who reported being farmers walked an average of about 15,280 steps daily, compared to around 10,740 for Amish men in other occupations. Those Amish farmers also had significantly lower body mass indexes than non-farming Amish men.³

That said, the relationship between Amish life and body weight isn’t as uniformly favorable as you might expect. A narrative review of Amish health research found that while some communities report very low obesity rates (as low as 4% in one Ontario settlement), the picture varies by age and community. In Holmes County, Ohio, younger Amish adults had lower obesity rates than non-Amish peers, but among older adults the differences shrank or even reversed. Adult Amish women in that community had obesity rates comparable to or higher than non-Amish women.⁴ Amish diets, while homemade, tend to be calorie-dense, heavy on baked goods, casseroles, and starches. Physical labor keeps many community members lean, but it doesn’t make everyone immune to weight gain, particularly as people age and slow down.

Other Lifestyle Differences That May Play a Role

Beyond tobacco avoidance and physical activity, several other aspects of traditional Amish life could contribute to lower cancer rates, though the research on each individual factor is less definitive.

Amish women tend to have their first pregnancies at younger ages and have larger families. Both early first pregnancy and higher number of pregnancies are associated with lower lifetime risk of breast cancer. This is likely one reason that breast cancer incidence among Amish women appears lower than in the general population.⁵ The extended breastfeeding common in large Amish families may add to this protective effect.

Amish communities also have virtually no alcohol culture. Alcohol consumption is a known risk factor for cancers of the breast, liver, esophagus, and colon. Like tobacco, the near-absence of this risk factor across a whole population would be expected to chip away at cancer rates.

Environmental exposures are harder to quantify. Amish communities are largely rural, which may mean less exposure to certain industrial pollutants. On the other hand, Amish farmers can be exposed to agricultural chemicals, and the absence of modern HVAC systems may mean more exposure to things like wood smoke and dust. The net environmental effect is unclear and hasn’t been rigorously studied.

The Screening Gap and What Happens When Cancer Does Strike

Here is where the Amish cancer story takes a darker turn. While Amish communities develop cancer less often, those who do get cancer face worse outcomes in some cases, partly because of lower rates of preventive screening. Amish women have lower rates of mammography than the general population.⁵ This means that when breast cancer does develop, it is more likely to be caught at a later stage, when treatment is harder and survival rates are lower.

The consequence is stark: while Amish women don’t appear to get breast cancer more frequently, they face significantly higher mortality rates among those who are diagnosed.⁵ Getting cancer less often is cold comfort if the cancers that do appear are more likely to kill you.

Several factors drive this screening gap. Many Amish families lack conventional health insurance, paying for medical care out of pocket or through community mutual-aid funds. The cost of routine screening can be a deterrent. Transportation to clinics is another barrier, since most Amish do not drive cars. Cultural attitudes also play a role. A large study surveying hundreds of Amish and Mennonite women across dozens of Ohio communities found that Amish women had significantly lower breast cancer knowledge scores and were more likely to believe in myths about what causes breast cancer and what its symptoms look like.⁵ If you believe certain myths about cancer causation, you’re less likely to pursue screening that could catch real cancers early.

This pattern likely extends beyond breast cancer. The same barriers of cost, transportation, health literacy, and cultural attitudes toward modern medicine apply to colon cancer screening, cervical cancer screening, and skin cancer checks. Researchers studying cancer screening in Ohio Appalachian communities documented that Amish adults had lower rates of preventive cancer screening compared to non-Amish adults in the same region.²

Treatment Decisions and Alternative Medicine

When Amish individuals are diagnosed with cancer, their treatment choices sometimes diverge from mainstream medical recommendations. The Amish are not opposed to modern medicine on principle, and many do pursue conventional cancer treatment including surgery, chemotherapy, and radiation. But the community also has a strong tradition of using complementary and alternative approaches. One study of Amish women found that about 36% reported using at least one form of complementary or alternative medicine, with the most common approaches being diet and nutrition programs, herbal therapies, and chiropractic care.⁶

For general health complaints, herbal remedies and nutritional approaches may be harmless or even helpful. But when it comes to cancer, the concern is that some patients delay or decline proven treatments in favor of alternative therapies that lack evidence of effectiveness against tumors. Anecdotally, certain Amish communities have been drawn to alternative cancer clinics in Mexico and elsewhere, though systematic data on how often this happens is sparse. The financial burden of conventional cancer care, combined with cultural preferences and limited health literacy about cancer treatment options, can push families toward cheaper or more accessible alternatives.

It’s worth stressing that the Amish are not monolithic on this point. There are over 350,000 Amish people in North America living in communities that vary widely in their conservatism, their relationship with modern technology, and their comfort with mainstream medicine. Some communities have developed strong working relationships with local hospitals and cancer centers. Others remain more insular. Generalizing about “the Amish” on treatment decisions is a bit like generalizing about any group of several hundred thousand people.

Genetics and the Founder Effect

Any discussion of Amish health inevitably raises the question of genetics. The Amish descend from a small number of European founders who emigrated in the 18th and 19th centuries, and their communities have remained relatively genetically isolated ever since due to the practice of marrying within the faith. This “founder effect” means that certain genetic variants are far more common in the Amish than in the general population, while others are far rarer.

This genetic bottleneck is well documented for conditions like certain metabolic disorders that are more common among the Amish. Could the same phenomenon work in reverse for cancer, meaning the founding population happened to carry fewer cancer-predisposing gene variants? It’s theoretically possible, but the research hasn’t established this. The Ohio cancer study’s authors were careful to note that the lower cancer rates could be explained largely by behavioral and lifestyle differences rather than requiring a genetic explanation.¹ Tobacco avoidance alone accounts for a huge chunk of the gap, and when you add physical activity, low alcohol use, and reproductive patterns, there may not be much gap left that needs a genetic explanation.

That said, the genetic angle hasn’t been thoroughly studied for most cancer types. It remains an open question, and one that researchers working with Amish communities may eventually be able to answer more definitively, since the relative genetic homogeneity of the Amish makes certain kinds of gene-disease association studies easier to conduct.

What the Amish Cancer Story Does and Doesn’t Tell Us

The Amish cancer data are sometimes held up in popular health media as proof that a “natural lifestyle” prevents cancer. The reality is more nuanced. The Amish advantages that are most clearly linked to lower cancer rates, particularly not smoking and being physically active, are entirely available to anyone. You don’t need to reject electricity or drive a horse and buggy. You need to not smoke and to move your body regularly. Those two things alone would dramatically reduce cancer rates in the general population.

At the same time, the Amish experience also illustrates the limits of prevention. They still get cancer, just less of it. Cancers of the breast, colon, prostate, and other sites still appear in Amish communities. And when those cancers do appear, the community’s lower screening rates and sometimes delayed treatment-seeking can turn what might have been a survivable diagnosis into a fatal one.

For public health researchers and clinicians working with Amish communities, the priority has increasingly shifted toward improving cancer screening access while remaining culturally sensitive. Mobile health clinics, community health workers who understand Amish culture, and educational programs delivered through trusted community channels like women’s health clinics have all been tried with varying success.⁵ The challenge is reaching communities that value self-sufficiency and may be skeptical of outside institutions, without being paternalistic about it.

How Amish Cancer Research Gets Conducted

Studying health outcomes in Amish communities presents unique methodological challenges that are worth understanding if you want to evaluate the research fairly. The Amish generally don’t participate in centralized health insurance databases, electronic medical records systems, or population registries in the way most Americans do. Researchers have had to get creative, using church directories to estimate population sizes, partnering with local physicians who serve Amish patients, cross-referencing state cancer registries with known Amish surnames and geographic areas, and conducting in-person surveys at community events.

These methods introduce potential gaps. An Amish person who develops cancer but never seeks conventional diagnosis won’t show up in a cancer registry. If screening rates are lower, some cancers may simply never be formally diagnosed, meaning the true incidence could be somewhat higher than what registries capture. Researchers have acknowledged this limitation, though the size of the gap between Amish and non-Amish rates is large enough that undetected cases are unlikely to explain the entire difference.

The geographic concentration of Amish communities also shapes the research. Most of what we know comes from Ohio and Pennsylvania, where the largest Amish populations live. Amish communities in Indiana, Wisconsin, New York, and other states have been less thoroughly studied, and lifestyle and health patterns can differ between settlements. The research base is growing, but it still draws from a limited number of communities, and extrapolating to all Amish people requires some caution.

1
PubMed Central. Low cancer incidence rates in Ohio Amish
2
PubMed Central. Cancer screening practices among Amish and non-Amish adults living in Ohio Appalachia
3
PubMed Central. Physical Activity Among Amish and Non-Amish Adults Living in Ohio Appalachia
4
PubMed Central. Physical Health Conditions of the Amish and Intervening Social Mechanisms: An Exhaustive Narrative Review
5
PubMed Central. Breast Cancer Knowledge Among Amish and Mennonite Women
6
Complementary Therapies in Medicine. Complementary and alternative medicine use in the Amish