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Healthy nutrition and physical lifestyle choices lower cancer mortality risk for survivors

In 2022, ACS updated its nutrition and activity guidelines for cancer survivors, recommending they avoid obesity, stay physically active, eat a healthy diet, and limit alcohol intake. New research by ACS scientists shows that a lifestyle aligned with these guidelines is associated with a lower mortality risk among non-smoking survivors of obesity-related cancers in the United States. Survivors who maintained a healthy lifestyle both before and after their diagnosis — or those who improved their habits after diagnosis — also had a lower mortality risk. The study was published in the Journal of the National Cancer Institute (JNCI).

“A cancer diagnosis often motivates people to think about how they can live healthier lives. Many survivors want to know what lifestyle changes they can make to improve their chances of living longer,” said Dr. Ying Wang, senior principal scientist, epidemiology research, and lead author of the study. “These findings underscore how making the right lifestyle choices truly affects cancer survival.”

Other ACS researchers contributing to this study include Christina Newton, Dr. Marjorie McCullough, Dr. Lauren TerasDr. Clara BodelonDr. Erika Rees-PuniaDr. Caroline UmDr. Laura Makaroff, and senior author Dr. Alpa Patel.

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  • Medicaid expansion associated with slower increase in mortality during COVID-19 pandemic

    ​Despite a nationwide rise in mortality rates during the COVID-19 pandemic, adults in Medicaid expansion states experienced a slower increase in deaths than non-expansion states, according to a study led by ACS researchers. These findings suggest a protective effect of Medicaid expansion on population health in the United States during the public health emergency. The findings are published in the American Journal of Public Health (AJPH). 

    “This research is important because many people experienced employment disruptions during the pandemic, which, in addition to loss of household income, also led to loss of employment-based health insurance coverage,” said Dr. Xuesong Han, scientific director, health services research, and lead author of the study. “Medicaid expansion under the Affordable Care Act could improve access to care and reduce health disparities during the public health emergency.”

    “With 10 states having yet to expand Medicaid eligibility, our findings add to the growing body of evidence for the benefits of Medicaid expansion,” Dr. Han added. “Additionally, findings highlight the importance of maintaining support for existing Medicaid coverage in 40 states and the District of Columbia. These data also highlight the importance of monitoring lasting effects of the COVID-19 pandemic on access to care and population health, especially as millions of people have lost coverage during post-pandemic Medicaid unwinding throughout 2023-2024.”

    “This study reinforces the well-established evidence that Medicaid expansion improves health outcomes and reduces health disparities,” said Lisa A. Lacasse, president of ACS CAN. “Ensuring individuals have access to quality, affordable health insurance through Medicaid is critical to the fiscal and physical health of our country. With Medicaid on the federal chopping block, it’s imperative that Congress recognize the indisputable value of this health insurance program and protect it from any form of cuts.”

    Other ACS researchers contributing to this study include Kewei Sylvia ShiDr. Qinjin FanDr. Parichoy Pal Choudhury, Dr. Xin Hu, and senior author Dr. Robin Yabroff.

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  • Dual-use of cigarettes and e-cigarettes exposes adults to same cancer and health risks as cigarette use only

    A new study led by ACS shows adults in the United States using combustible cigarettes and electronic cigarettes (e-cigarettes), commonly referred to as dual-use, experienced the same tobacco-related nicotine and toxicant exposure compared to using cigarettes alone at the same intensity. This exposure indicates potential for cancer, cardiovascular, reproductive/developmental, and respiratory harms. The findings were published in the journal Nicotine and Tobacco Research (NTR).

    “In the U.S., dual-use of combustible cigarettes and e-cigarettes is the most common multiple tobacco-use behavior. Some individuals try to cut back on cigarettes or work toward quitting cigarettes this way,” said Zheng (Ashley) Xue, senior associate scientist, tobacco control research, and lead author of the study. “However, our results highlight that dual-use is not an effective way to safeguard health and more evidence that tobacco use is harmful.”

    “Clinicians and public health practitioners should increase awareness that dual use of cigarettes and e-cigarettes is not safe and may present similar risks as continuing to smoke cigarettes, especially if one does not reduce the number of cigarettes smoked,” Xue added. 

    "It's essential that we continue to advocate for policies that have been proven to reduce tobacco usage," said Lisa A. Lacasse, president of ACS CAN. “We will continue to work with federal, state, and local lawmakers to pass strong laws and implement critical regulations that will increase access to barrier-free, culturally competent proven cessation services, end the sale of all flavored tobacco products, substantially increase tobacco taxes, and implement comprehensive smoke-free policies. These fact-based tobacco prevention and cessation programs are critical to help those addicted to quit and prevent anyone, especially youth, from ever starting. Additionally, the FDA must use the full weight of its authority to regulate all tobacco products, including removing the thousands of illegal products on the market that have not been shown to benefit the public health.” 

    Other ACS researchers contributing to the study include Eva OrrDr. Nigar NargisDr. Minal Patel, and senior author Dr. Tyler Nighbor.  

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  • ACS to showcase cutting-edge research at AACR meeting

    ​From April 25 – 30, ACS will participate in the American Association for Cancer Research (AACR) Annual Meeting in Chicago, IL. The meeting is the focal point of the cancer research community, where scientists, clinicians, other health care professionals, survivors, patients, and advocates gather to share the latest advances in cancer science and medicine. ACS team members will be there to discuss the latest breakthroughs, make connections, and forge collaborations. 

    Four team members will be sharing poster presentations:

    • Global burden and trends in cancer incidence and mortality among young adults – Kieran Patrick Kelly
    • Associations of smoking with the risk of second primary cancer in adults with a history of various cancer types – Hyuna Sung
    • Use of large language models for clinical data abstraction from oncologic medical records – Jillian Nelson
    • Differences in complete screening adherence across age, income, and education groups – Kierstin Faw

    In addition, ACS on Tuesday, April 29, will recognize Loic Le Marchand, MD, PhD, associate director for population sciences at the University of Hawai’i Cancer Center, as this year’s AACR/ACS award winner for outstanding research in cancer epidemiology and prevention. The AACR and ACS established the award in 1992 to honor outstanding research accomplishments in cancer epidemiology, biomarkers, and prevention.

  • ACS releases Cancer Prevention and Early Detection Report

    ​The ACS Cancer Prevention and Early Detection Reportreleased April 23, shows mixed progress in major cancer risk factors, preventive behaviors, and screenings in a post-COVID-19 pandemic period among adults in the US. Smoking rates continued a long-term declining trend during the COVID-19 pandemic, but 27 million adults still smoked in 2023. Breast and colorectal cancer (CRC) screening rebounded after decreasing or stalling during the pandemic. However, past-year cervical cancer screening remained lower than pre-pandemic levels, continuing a disappointing pattern in up-to-date screening in the past two decades. Additionally, HPV (human papillomavirus) vaccination uptake was flat from 2021 to 2023, departing from prior years. 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 findings were released in the journal Cancer Epidemiology, Biomarkers & Prevention, a publication of the American Association for Cancer Research (AACR), as well as in the biennial ACS report Cancer Prevention and Early Detection Facts & Figures, 2025-2026.

    “Cancer prevention and early detection are central to the American Cancer Society’s goal to ensure everyone has an opportunity to prevent, detect, treat, and survive cancer,” said Dr. Priti Bandi scientific director, cancer risk factors & screening surveillance research, and lead author of the study. “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.”

    An estimated 40% of cancer cases in the U.S. are attributable to modifiable risk factors, including cigarette smoking, excess body weight, dietary factors, physical inactivity, ultraviolet radiation exposure, and seven cancer-causing infections, like HPV. Cancer screening tests can further prevent thousands of additional cancer cases and deaths.

    Report highlights in select cancer risk factors and screenings include:

    Tobacco
    Cigarette smoking declined to 11% in 2023. However, high smoking prevalence remains in American Indian/Alaska Native individuals, Black males, individuals with lower education, and bisexual females. 

    Menthol-flavored cigarettes, which can increase smoking uptake and reduce cessation success, were used by 36% of all adults who smoked in 2023; this level is double or more in Black individuals (76%) and bisexual individuals (63%).

    Flavors make tobacco products more appealing to youth. Close to 9-in-10 high school students who reported currently using tobacco products used a flavored product, from 90% for e-cigarettes and nicotine pouches, 71% for cigars, to 42% for cigarettes (menthol).

    Cancer Screening
    Up-to-date breast cancer screening rebounded and exceeded pre-pandemic levels in 2023 (80%) after declining during the COVID-19 pandemic. 
     
    CRC screening also increased in 2023 (60% overall; for colonoscopy: 54%; for stool testing: 11%) after stalling during the pandemic. 

    Up-to-date cervical cancer screening in 2021 (73%) remained below pre-pandemic levels, continuing a longer-term trend of declining since the early 2000s.

    HPV Vaccination
    Diverging from previously increasing trends, up-to-date HPV vaccination prevalence in adolescents 13-17 years of age remained flat between 2021 and 2023 (61%), largely reflecting pandemic-related disruptions.

    Excess Body Weight
    Excess body weight in adults remained high and stable during the COVID-19 pandemic, with approximately 72% classified as obese (40%) or overweight (32%) during August 2021 to August 2023.

    Physical Activity
    Remaining unchanged from 2020, less than half of adults (48%) met recommended physical activity levels, and an estimated one-third (27%) reported no leisure-time physical activity in 2022. 

    Alcohol
    Heavy alcohol use in adults was 6% in 2022, similar to levels in 2020, but is disproportionately higher in middle age, particularly for females who are of higher socioeconomic status, White, and bisexual. 

    “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,” said Dr. Ahmedin Jemal, senior vice president, surveillance and health equity science at the American Cancer Society and senior author of the report. “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.” 

    “These findings only further prove how investments in tobacco control have helped reduce the number of people 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,” said Lisa A. Lacasse, president of the American Cancer Society 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 (SCREENS) for Cancer Act, which would reauthorize the NBCCEDP and expand its reach to more people who may not otherwise be screened. We urge Congress to take this meaningful step towards reducing cancer disparities, saving lives, and lowering long-term health care costs.” 

    A first step to guide individuals to prevent and detect cancer is the ACS CancerRisk360 risk assessment tool. Individuals can answer questions in four key areas and receive personalized tips to help reduce their risk of cancer. Visit acscancerrisk360.cancer.org to access this important tool.

    In addition to ACS CancerRisk360, ACS continues to promote its “I Love You Get Screened” campaign, encouraging people to discuss cancer screening with their loved ones.

    Other ACS researchers contributing to the study include Jessica Star, Natalia Mazzitelli, Dr. Nigar Nargis, Dr. Farhad Islami, Rebecca Siegel, and Dr. Robin Yabroff.  

  • Chemotherapy and endocrine therapy have different long-term effects on physical health decline for breast cancer survivors

    A new study led by ACS investigators shows breast cancer survivors in the United States receiving chemotherapy or endocrine therapy (without chemotherapy) had different long-lasting physical health decline compared to women who were cancer-free. Physical health is the body’s ability to function normally and includes factors like being able to carry out activities, daily living, fatigue, or pain. The findings are published Feb. 28 in the Journal of the American Medical Association (JAMA) Network Open.

    “Patients with breast cancer suffer from an abundance of long-term and late health effects and are at risk of earlier onset disease and higher incidence of chronic health conditions,” said Dr. Clara Bodelon, senior principal scientist, survivorship research at ACS and lead author of the report. “These findings are important because understanding factors related to their physical health decline could lead to interventions to improve their health outcomes.”

    “This is encouraging news for breast cancer survivors. If they do not receive chemotherapy, it is unlikely that they will have long-lasting physical health decline,” Bodelon added. “However, further studies are needed to confirm these results and to better understand the health consequences of these treatments.”

    Dr. Lauren Teras is the senior author of the study. Other ACS researchers who contributed to the report include Matthew Masters, Den E Bloodworth, Peter BriggsDr. Erika Rees-PuniaDr. Lauren McCullough, and Dr. Alpa Patel.

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  • Early palliative care remains underused among patients with advanced cancer

    ​Despite a decade of growth, only 10% of Medicare beneficiaries with distant-stage cancer received early palliative care in 2019, according to new research led by ACS investigators. The study also finds differences between individual doctors and hospitals accounted for 30% - 50% of the variation in early palliative care billing, suggesting where patients receive care plays a major role in whether they get guideline-recommended palliative care. The study was published March 7 in the Journal of Clinical Oncology (JCO). 

    “These findings are disappointing as strong evidence and clinical guidelines support the benefits of early palliative care for these patients,” said Dr. Xuesong Han, scientific director, health services research at ACS and senior author of the study. “Palliative care improves quality of life, reduces suffering, and can even extend survival, yet most patients who would benefit are not receiving it.”

    “One of the most striking findings from our study is who treats you and where you receive care may influence access to early palliative care more than a patient’s clinical condition,” added Dr. Xin Hu, a visiting scientist at ACS and lead author of the study. “This underscores the need to minimize systemic and structural barriers, so access to this important treatment is not limited. Fighting cancer should also mean fighting unnecessary suffering.”

    Other ACS researchers contributing to this study include Kewei Sylvia ShiDr. Zhiyuan Zheng, Dr. Jingxuan Zhao, and Dr. Robin Yabroff.

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  • New ACS-led study finds wildfires pose challenges to cancer care

    ​Due to the physical, psychological, and socioeconomic consequences of a cancer diagnosis and treatment, people with cancer are especially vulnerable during extreme weather events like hurricanes, tornadoes, and wildfires, which are becoming more common and damaging with climate change. A new national study led by ACS and Harvard T.H. Chan School of Public Health researchers finds patients whose facility was impacted by a wildfire disaster during recovery from lung cancer surgery had longer length of stay (LOS) than similar patients treated at the same facility, but at times when no disaster occurred. The findings were published March 11 in the Journal of the National Cancer Institute (JNCI).

    “These data are critical as there are currently no guidelines for protecting the health and safety of patients recovering from lung cancer surgery during wildfires in the United States,” said Dr. Leticia Nogueira, scientific director, health services research, and lead author of the study. “In the absence of guidelines, clinicians might resort to improvisational strategies, such as extending post-operative length of stay to support surgical recovery and better protect the health and safety of patients during wildfires.”

    “Future studies should evaluate whether extended hospital stay improves surgical care outcomes during disasters,” Nogueira added. “Also, these findings should be considered for disaster preparedness guidelines tailored to vulnerable patient populations and contextual adjustments to quality care metrics.”

    ACS researcher Dr. Robin Yabroff also contributed to the study.

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  • Short-term limited duration insurance plans associated with advanced cancer diagnoses

    Short-term limited duration (STLD) insurance plans do not provide comprehensive coverage and can leave patients who are diagnosed with a serious disease like cancer with catastrophic costs. In a new,​ large national study published March 18 in the Journal of the American Medical Association (JAMA) Network Open, ACS researchers found the 2018 federal policy loosening restrictions on STLD insurance plans was associated with an increase in late-stage cancer diagnoses in states without or with inadequate additional STLD plan regulatory protections. 

    “This research underscores the importance of state and federal policies banning or significantly restricting short-term limited duration insurance plans,” said Nova Yang, MSPH, associate scientist, health services research, and lead author of the study. “Most of these STLD plans do not cover essential health services, such as cancer screenings, which may delay cancer diagnoses, resulting in later stage disease, where treatment is more intensive, and the prognosis is worse.”  

    Other ACS researchers contributing to the study include Dr. Jingxuan ZhaoDr. Robin Yabroff, and senior author Dr. Xuesong Han.

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