A state investigation into pediatric cancers in Scott County found that the cases do not meet the definition of a cancer cluster. As part of the analysis, the state looked into several potential environmental factors that could impact community health, and reported no concerning findings.
Megan Smith, an oncology nurse and advocate for Scott County families, said the results are disappointing but not unexpected.
A two-year lag in cancer data meant that the most recent surge in cases wasn’t included in the analysis. Smith said 11 kids were diagnosed between 2024 and 2025.
“The families are extremely frustrated,” she said Wednesday. “They don’t feel like there was a proper investigation done. They feel like their kids aren’t important enough.”
Families understand that a data lag exists, she said, but struggle to understand why it takes so long for cases to be included.
Hospitals have up to six months to report new cancer diagnoses. When Virginia residents receive care in other states, officials need time to match and reconcile those records. Cancer registry staff then review, clean and verify the data before submitting it to the Centers for Disease Control and Prevention and the North American Association of Central Cancer Registries.
Investigation results
In April 2025, several families from Scott County reached out to the LENOWISCO Health District with concerns about the number of pediatric cancer cases in the area. The health district launched an initial survey that month to gather additional data. Parents living in Scott County or within 15 miles of its borders who had children age 19 or younger diagnosed with cancer in the past decade were asked to report details to the state.
Scott County community meeting
Representatives from the Virginia Cancer Registry and the LENOWISCO Health District will meet with residents at Gate City Middle School, located at 170 Vale Road in Gate City, from 6 to 8 p.m. Thursday.
Community members may attend the meeting in person or online to ask questions about the investigation process, results and ongoing investigation initiatives. To join virtually, use this link.
The panel will include representatives from the Virginia Cancer Registry, Virginia Department of Health, Office of Drinking Water, LENOWISCO Health District and the Office of Epidemiology.
The survey received 24 responses from residents in Scott, Lee and Wise counties, according to the state report. About half of the responses came from Scott County residents, and most diagnoses occurred before 2024, according to the report.
To qualify as a cancer cluster, cases must be the same cancer type or from related cancer families, or have a known shared exposure to a specific environmental or chemical factor.
Using survey responses and Virginia Cancer Registry data from 2014 to 2023, investigators identified 12 cases tied to Scott County, spanning several cancer types. These included bone and joint cancers, leukemia, non-Hodgkin’s lymphoma and endocrine cancers involving the thymus, testis and thyroid.
“It is not unusual for several people in a relatively small area to develop cancer around the same time,” according to the report.
Of the 12 cases, five matched official registry records and met the timeframe criteria. Another three cases were identified independently through the registry, bringing the total analyzed to eight cases between 2014 and 2023.
Three cases diagnosed in 2024 matched registry records but were excluded due to incomplete full-year data. Three additional survey-reported cases could not be verified. In two of those cases, families reported living in non-bordering states before diagnosis.
Four of the 12 self-reported cases included a family history of cancer, and two involved confirmed genetic findings specific to the cancers under review.
During the decade studied, Scott County’s average population of children age 19 or younger was 4,355. Most diagnoses included in the analysis occurred in children age 5 or younger.
Environmental factors
The Virginia Cancer Registry team worked with Health Department staff to look for shared environmental factors among the reported childhood cancer cases.
Smith said she plans to press state officials on whether any field testing occurred.
“I want to know exactly what they tested,” she said. “Did they come down here and test where these children have been? I want to know what they have done other than what I have already done.”
The report stated that officials would only seek assistance from federal agencies for environmental studies if data showed a cancer cluster or a strong link between a specific environmental factor and a cancer type.
State officials addressed several environmental concerns raised by residents, including radon exposure. Scott County, like much of Southwest Virginia, has historically recorded higher indoor radon levels than other parts of the state.
Radon is a radioactive gas that can build up in homes and buildings. While schools are required to test for radon, state investigators did not review school data because most cases involved children younger than school age. None of the cancers included in the analysis have a known close link with radon exposure, according to the state report.
The Health Department encouraged Scott County residents to test for radon in their homes every two to three years and emphasized the need to raise awareness of the potential risk factors linked to lung cancer.
Investigators also reviewed public drinking water systems, which are federally regulated and regularly tested for contaminants. All community water systems in Scott County currently meet state and federal standards, according to the state report.
In late 2022, one system reported an exceedance related to a disinfectant byproduct.
The contamination was an isolated incident and does not mean there is a public health risk, according to the report.
State officials also reviewed several industrial sites in Scott, Wise and Lee counties, including mines, manufacturing facilities and power plants, in coordination with the Department of Environmental Quality.
Regulators reported no environmental concerns, and initial mapping showed no link between cancer cases and nearby industrial activity. Because the available data did not suggest a health risk, officials did not recommend environmental testing at this time.
Some of the cancer cases reported using private wells for drinking water. State officials noted that private wells must meet permitting and inspection requirements before use, but ongoing water testing is up to the property owner. While not required, the Health Department encourages well owners to test their water regularly and to consider additional testing based on their specific location or concerns.
What comes next
State officials will host a town hall meeting in Scott County on Thursday evening to answer questions from residents. The event will be available to stream online as well.
Members of Smith’s newly formed Southwest Virginia Mountain Valley Coalition plan to attend. The group was created to advocate for families in Scott County impacted by pediatric cancer and other health-related issues. The coalition includes parents, local pediatricians, registered nurses and an emergency department physician.
In the report, state cancer registry officials said they plan to review 2024 and 2025 cases once the data reaches at least 90% completeness, which is expected in early 2026 and 2027.
In the meantime, Smith worries that the report’s conclusions could lead providers to dismiss future cases.
“The families have been told some things from ER physicians, just kind of being blown off. … Things like ‘You Scott County people are overreaching,’” Smith said. “Like we’re looking for something that’s not really there.”
While the investigation validated families’ concerns enough to prompt a review, Smith fears that the issue could fade now that the state has ruled out a cluster.
She is now working with Trevor’s Trek Foundation, an Idaho-based nonprofit that raises awareness about childhood cancer and advocates for more research into environmental causes.
Bringing them to Southwest Virginia will cost money, though. Smith is exploring ways to bring the organization’s work to Scott County and has begun filing paperwork to fundraise locally.