The ACS Cancer Prevention and Early Detection Report, released 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.
