Investigators have uncovered mixed progress in major cancer risk factors, preventive behaviors, and screenings in the post–COVID-19 pandemic period among adults in the United States, according to a new study published by Bandi et al in Cancer Epidemiology, Biomarkers & Prevention.
Background
An estimated 40% of cancer cases in the United States may be attributable to modifiable risk factors—including cigarette smoking, excess body weight, dietary factors, physical inactivity, ultraviolet radiation exposure, and seven cancer-causing infections like human papillomavirus (HPV). Cancer screening tests can further prevent thousands of additional cancer cases and deaths.
“Cancer prevention and early detection are central to the American Cancer Society’s [ACS] goal to ensure everyone has an opportunity to prevent, detect, treat, and survive cancer,” explained lead study author Priti Bandi, PhD, Scientific Director of Cancer Risk Factors & Screening Surveillance Research at the ACS.
Study Methods and Results
In the study, the investigators analyzed national and state-representative data from the National Health Interview Survey, the Behavioral Risk Factors Surveillance System, the National Health and Nutrition Examination Survey, and the National Immunization Survey-Teen.
The investigators found that although smoking rates continued a long-term declining trend during the COVID-19 pandemic, dropping by 11% in 2023. Nonetheless, 27 million adults smoked in 2023. For instance, high smoking prevalence remained among American Indian/Alaska Native individuals, Black male individuals, those with a lower education level, and female individuals who identified as bisexual.
Menthol-flavored cigarettes, which can increase smoking uptake and reduce cessation success, were used by 36% of all adults, 76% of Black individuals, and 63% of bisexual individuals who smoked in 2023. Flavors also make tobacco products more appealing to youth. Close to 90% of high school students who reported currently using tobacco products used a flavored product. These numbers ranged from 90% for e-cigarettes and nicotine pouches and 71% for cigars, to 42% for menthol cigarettes.
Up-to-date breast cancer screenings rebounded and exceeded prepandemic levels by achieving an 80% rate of uptake in 2023, following a decline or stall during the pandemic. Up-to-date colorectal cancer screenings also rose in 2023: 60% overall, 54% for colonoscopy, and 11% for stool testing. However, past-year cervical cancer screenings in 2021 (73%) remained lower compared with prepandemic levels, continuing a longer-term trend of decline since the early 2000s.
Additionally, up-to-date HPV vaccination uptake remained static from 2021 to 2023, diverging from previously increasing trends reported in prior years. For example, HPV vaccination prevalence among individuals aged 13 to 17 years remained flat between 2021 and 2023 (61%), largely reflecting pandemic-related disruptions.
Other major risk factors such as excess body weight, physical inactivity, and heavy alcohol use remained stable during the pandemic—but were largely suboptimal. The investigators detailed that excess body weight in adults remained high and stable during the COVID-19 pandemic, with approximately 72% of individuals classified as having obesity (40%) or overweight (32%) between August 2021 to August 2023. Remaining unchanged from 2020, 48% of adults met recommended physical activity levels, and 27% of them reported no leisure-time physical activity in 2022. Further, heavy alcohol use among adults was 6% in 2022, comparable to levels in 2020, but was disproportionately higher in middle age—particularly among female individuals who were of higher socioeconomic status, White, and bisexual.
Conclusions
“These latest findings are encouraging, mainly the reduction in smoking rates and screening for certain cancers, but it’s clear urgent efforts are needed to address lagging cervical cancer prevention,” Dr. Bandi indicated.
“Our report underscores the need to strengthen efforts to improve access and receipt of preventive services, including cancer screening, HPV vaccination, and counseling and treatment for tobacco dependence,” emphasized senior study author Ahmedin Jemal, DVM, PhD, Senior Vice President of Surveillance and Health Equity Science at the ACS. “We must also work to identify individuals of racially/ethnically diverse groups and socioeconomic positions who continue to be greatly affected by cancer to accelerate progress against the disease,” he continued.
“These findings only further prove how investments in tobacco control have helped reduce the number of [individuals] falling prey to Big Tobacco’s deadly products and practices. Federal agencies have played a major role in helping to drive the successful reduction of smoking rates through critical tobacco control programs and funding. We are deeply concerned that recent cuts to these important agencies will jeopardize continued progress to reduce tobacco utilization nationwide,” warned Lisa A. Lacasse, MBA, President of the ACS Cancer Action Network. “Additionally, as we continue our efforts to reduce cervical cancer mortality rates, it is vital that we expand access to life-saving screenings. The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) has long served as a crucial resource for limited-income, uninsured, and underinsured women, providing them with critical screenings and treatment. Congress now has an opportunity to pass the Screening for Communities to Receive Early and Equitable Needed Services for Cancer Act, which would reauthorize the NBCCEDP and expand its reach to more [patients] who may not otherwise be screened. We urge Congress to take this meaningful step toward reducing cancer disparities, saving lives, and lowering long-term health-care costs,” she concluded.
Disclosure: For full disclosures of the study authors, visit aacrjournals.org.
