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Across the United States (U.S.), many communities experience disproportionate exposure to environmental health hazards due to their proximity to coal-fired power plants and associated coal ash disposal sites. These facilities release toxic heavy metals such as arsenic, mercury, and lead into the surrounding environment, posing serious public health risks. Although prior research has documented adverse health effects of coal-fired power plants, few studies have specifically examined the relationship between cancer incidence and proximity to coal ash impoundments, as well as exposure to elevated concentrations of toxic constituents in coal ash. Using complementary contingency table analyses, bivariate spatial association techniques, and spatial regression methods, this study finds consistent evidence that counties containing or adjacent to coal ash impoundments exhibit significantly higher cancer incidence rates compared to more distant counties, even after adjusting for potential confounders. Incidence rates for both total cancer and lung cancer were significantly associated with smoking, drinking, and physical inactivity, corroborating prior research on these behavioral risk factors. The lung cancer model further revealed significant positive associations between cancer incidence and PM₂.₅, arsenic concentrations, and airborne cancer risk scores, highlighting specific environmental risk factors for the disease. These findings strengthen the evidence linking coal ash exposure to adverse health outcomes and underscore the urgent need for robust enforcement and compliance measures to protect communities from coal ash contamination.