Lung cancer is one of the most common types of disease in the U.S., with a five year survival rate of just over 18 percent. In contrast, prostate cancer has a five year survival rate of over 98 percent. Lung cancer is caused by abnormal cells in either lung that are growing out of control. There are two types of lung cancer, small cell and non-small cell. While smoking and exposure to secondhand smoke and radon gas are the leading risk factors for lung cancer development, certain environmental factors (i.e., inhaling toxic chemicals, air quality, etc.) can contribute to lung cancer symptoms.

The following U.S. cities have the highest rates of lung cancer for these reasons:

1. St. Petersburg, Florida

Living in the sunshine state of Florida is the dream for many people. However, St. Petersburg is one of the most dangerous cities in the U.S. for cancer patients. The high rate of skin cancer and the aging population of St. Petersburg makes the city a perfect location for lung cancer. Additionally, a history of smoking among a population of retirees aged between 55 and 74 adds to the number of lung cancer patients passing through the city’s medical centers.

2. Sioux Falls, South Dakota

Sioux Falls in South Dakota ranks above the national average for diagnosed lung cancer cases. The national lung cancer rate is 59.5 people per 100,000 residents. Sioux Falls is an active city, with its numerous outdoor activities helping to keep its residents healthy. Despite the number of outdoor activities available, the residents of Sioux Falls rank among the lowest for consuming fresh produce. This lack of antioxidants and vitamins is what contributes to the high rate of cancer in South Dakota.

3. Tulsa, Oklahoma

A rate of 93 lung cancer cases per 100,000 residents shows the reason for concern among city officials about lung cancer. At nearly double the national incidence rate, Tulsa, Oklahoma is a hub for lung cancer cases. One of the main reasons for the high rate of lung cancer is the high number of smokers in Tulsa. The city ranks ninth for the most smokers in the nation. Smoking remains an issue the state needs to address, with lung cancer accounting for the majority of new cancer cases in Oklahoma.

4. El Paso, Texas

El Paso stands as a microcosm of the smoking problems in the Lone Star State. El Paso, Texas has one of the highest smoking rates in the U.S., ranking sixth in the nation for smokers and former smokers. Lung cancer has become an issue in Texas as a whole, with the state recording almost 10,000 deaths in 2017. Smoking remains the leading cause of lung cancer in the residents of El Paso.

5. Miami, Florida

The number of smokers and former smokers remains high in Florida. The number of retirees in the Sunshine State continues to rise, leaving the number of native Floridians aged between 55 and 74 at just 8 percent. The number of deaths from lung cancer have been falling throughout the 21st century, but the aging population keeps Miami in the charts as having one of the highest lung cancer rates in the U.S.