ACS Report Highlights Mixed Results: Smoking Declines, but Cervical Cancer Prevention Continues to Lag

A recent report released from the American Cancer Society (ACS) identified mixed outcomes regarding major cancer risk factors, preventive health behaviors, and screening rates among U.S. adults during the post-COVID-19 pandemic period.

• Smoking rates maintained a long-term downward trend throughout the pandemic; however, 27 million adults were still smoking in 2023.
• Breast and colorectal cancer (CRC) screenings showed recovery after experiencing declines or stagnation during the pandemic. In contrast, past-year cervical cancer screening remained below pre-pandemic levels, continuing what researchers described as “a disappointing pattern in up-to-date screening in the past two decades.”
• HPV (human papillomavirus) vaccination uptake was flat from 2021 to 2023, marking a notable departure from previous upward trends.

Other significant cancer risk factors, including excess body weight, physical inactivity, and heavy alcohol use, remained largely unchanged during the pandemic period but were still characterized as less than optimal.

The findings were released 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 at the American Cancer Society 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.

ACS researchers analyzed national or state-representative data from the National Health Interview Survey (NHIS), the Behavioral Risk Factors Surveillance System (BRFSS), the National Health and Nutrition Examination Survey (NHANES), and the National Immunization Survey-Teen (NIS-TEEN). The report highlights findings in select cancer risk factors and screenings including:

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.”