Lifestyle Habits, Risk Factors, and Cancer Screening During COVID-19 Pandemic

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Investigators discovered both favorable and unfavorable changes in major cancer risk factors, preventive behaviors and services, and screenings in the United States during the COVID-19 pandemic, according to a new study published by Star et al in Cancer Epidemiology, Biomarkers & Prevention. The new findings revealed that between 2019 and 2021, smoking rates, heavy alcohol consumption, and physical inactivity declined; whereas, human papillomavirus (HPV) vaccination and stool testing for colorectal cancer increased. In contrast, obesity prevalence increased, disparities by racial/ethnic and socioeconomic status persisted, and cervical cancer screening rates declined during the same time frame.


The investigators noted that about 45% of the 609,820 cancer deaths expected to occur in the United States in 2023 may be attributable to modifiable cancer risk factors such as smoking, alcohol consumption, excess body weight, physical inactivity, unhealthy diets, and obesity. They detailed that these risk factors may all be potentially avoidable through lifestyle changes. Cancer screenings can further prevent thousands of additional cancer incidences and deaths.

“These latest findings give us a mixed bag concerning progress in the fight to help reduce the cancer burden in [U.S.] adults,” explained co–study author Priti Bandi, PhD, Scientific Director of Cancer Risk Factors & Screening Surveillance Research in the Department of Surveillance & Health Equity Science at the American Cancer Society. “As more years of data are collected, it will be clearer whether these contrasting changes are transient or not,” she added.

Study Methods and Results

In the new study, the investigators analyzed data from the National Health Interview Survey, the Behavioral Risk Factors Surveillance System, and the National Immunization Survey to identify changes in major modifiable cancer risk factors, preventive behaviors, and screenings during the COVID-19 pandemic.

They uncovered improvements in select cancer risk factors and screenings:

  • From 2019 and 2021, smoking prevalence in adults declined from 14% to 12%—an estimated decline in the number of adults who currently smoke of 5.7 million. Further, smoking prevalence declined in 17 of the 50 states, including the District of Columbia.
  • Heavy alcohol consumption prevalence among adults declined from 7% in 2019 to 6% in 2021, an estimated decline of 1.4 million individuals.
  • During the same time frame, physical inactivity prevalence among adults declined from 26% to 23%, an estimated decline of 3.2 million individuals.
  • Further, the prevalence of home-based stool testing for colorectal cancer increased from 7% in 2019 to 10% in 2021, an estimated increase of 3.6 million individuals.

However, the investigators also reported unfavorable trends from 2019 to 2021:

  • The median obesity prevalence across the United States increased from 32% to 34%. Obesity prevalence among adults increased in 18 of the 50 states and remained unchanged in the other 32 states.
  • Recommended fruit consumption in adults declined from 30% to 29%, an estimated decline of 4.5 million individuals.
  • Between 2019 to 2021, the rate of up-to-date cervical cancer screenings also declined among eligible patients from 75% to 73%.

Additionally, disparities by racial/ethnic and socioeconomic status persisted:

  • The investigators did not find any changes in the smoking prevalence or quitting ratio of individuals with less than a high school–level education from 2019 to 2021—further entrenching persistent socioeconomic disparities in smoking. Individuals with lower levels of education have been found to be four to five times more likely to smoke than individuals with a college education in 2021.
  • Further, individuals who were uninsured may have been between 28% to 60% less likely to be up to date with recommended cancer screenings compared with individuals who were privately insured in 2021, with the largest disparities reported for colorectal cancer and breast cancer screenings. These disparities persisted at similar levels since 2019.


“Ongoing efforts to reduce modifiable risk factors and improve receipt of screenings are warranted,” emphasized senior study author Ahmedin Jemal, DVM, PhD, Senior Vice President of Surveillance & Health Equity Science at the American Cancer Society. “We also must target our interventions among individuals of racially/ethnically diverse groups and socioeconomic positions who continue to be greatly affected by cancer,” he suggested.

“The pandemic put a spotlight on [how] the criticality of maintaining health and access to free preventive services—including cancer screening, HPV vaccination, and tobacco cessation—is more important than ever,” underscored Lisa Lacasse, MBA, President of the American Cancer Society Cancer Action Network. “We urge lawmakers at all levels of government to protect and advance policies that prioritize cancer prevention,” she concluded.

Disclosure: For full disclosures of the study authors, visit

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.