Report provides review of major modifiable cancer risk factors, HPV vaccination, and cancer screenings

A recent report presents current data on major modifiable cancer risk factors, human papillomavirus (HPV) vaccination rates, and cancer screenings in the United States among adults during and after the COVID-19 pandemic versus the years before the pandemic.¹

Getting more people to stop smoking and improving cervical cancer prevention, including screening and HPV vaccination, are two key takeaways from the American Cancer Society (ACS) report on cancer prevention and early detection.

Key findings of the report suggest that improving cancer prevention is critical to lowering the burden of cancer on individuals and society. An estimated 40% of cancers in the United States are attributed to modifiable life factors, among which tobacco use remains the leading cause of preventable death. Despite a drop in smoking prevalence to 11% in 2023, 27 million adults still smoke, with a high prevalence in specific populations: American Indians, Alaska Natives, Black males, people with a lower level of education, and bisexual females.

Of all adults who smoke, 36% reported using menthol-flavored cigarettes; this level doubles or increases even more in Black people (76%) and bisexual people (63%). The lead author of the study, Priti Bandi, PhD, scientific director of the risk factors and screening research team in the ACS Surveillance & Health Equity Science Department, underscores that menthol-flavored cigarettes can increase smoking in youth and reduce cessation success. The high level of menthol-flavored cigarette smoking in Black and bisexual people is due to the targeted marketing of these products to these communities by the tobacco industry, she says.

Flavored tobacco products are particularly attractive to and used by young people. The report also found that nearly 9 in 10 teenagers who used tobacco products preferred menthol cigarettes (42%), cigars (71%), and flavored e-cigarettes and nicotine pouches (90%). The use of e-cigarettes among young adults has grown from 9% in 2019 to 13% in 2023.

“Tobacco remains the leading cause of preventable cancer death,” Dr Bandi says. “Therefore, tobacco prevention in young people and smoking cessation, via delivery of evidence-based smoking cessation services, is key to reducing cancer risk and burden.”

Another modifiable risk factor that could prevent more disease and deaths is cancer screening. In particular, the report found that current cervical cancer screening levels remain lower than pre-pandemic levels. Dr Bandi calls this a “continuing disappointing pattern of declines in up-to-date screening in the past two decades.” She notes that the up-to-date cervical cancer screening rate in 2021 was 73%, which was below pre-pandemic levels.

The report also showed that the uptake of the HPV vaccine was flat from 2021 to 2023, with 61% of adolescents aged 13–17 years receiving the vaccine. Dr Bandi calls this an unexpected finding considering the previous increasing trends in HPV vaccination. She says that the finding potentially reflects health care disruptions during the COVID-19 pandemic.

For cancer screening overall, however, the report showed a rebound in screening that had dropped off or flattened during the pandemic. The up-to-date screening rate increased to 79.9% for breast cancer and to 63.4% for colorectal cancer between 2019 and 2023.

Another modifiable risk factor highlighted in the study is excess body fat, which remains high and was stable during the pandemic. Between August 2021 and August 2023, 72% of the US population was considered to have excess body weight, with 40% labeled as obese and 32% labeled as overweight.

The ACS provides and encourages the use of the CancerRisk360 assessment tool to help guide individuals on preventive services. The tool asks users questions in four key areas to help them assess their individual cancer risk and to help them reduce that risk. The tool can be accessed at https://www.cancer.org/cancer/risk-prevention/cancer-risk-360.html.