Smoking Rates Hit New Low, But Cervical Cancer Screening Still Lags: 2025 ACS Report
While smoking in the US continues to decline, the American Cancer Society reports mixed progress in major cancer risk factors, prevention, and screening.
Smoking rates among US adults fell to a record low in 2023, continuing a decades-long trend, according to a new report from the American Cancer Society (ACS). Despite this progress, however, the ACS reports that 27 million Americans still smoked in 2023. The report data show that screening for both breast and cervical cancer ticked up after the significant backslide during the COVID-19 pandemic but the ACS warns that past-year screening for cervical cancer is still lower than before the pandemic shut down and HPV vaccination rates were flat between 2021 and 2023.
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The ACS estimates that 40% of US cancer cases can be attributed to modifiable risk factors, including smoking, obesity, and physical activity. Screening for many types of cancer can prevent thousands more cases of cancer and related deaths, the society said.
ACS researchers analyzed cancer risk factors, preventive behaviors, and screenings between 2021 and 2023. The findings, published in Cancer Epidemiology, Biomarkers & Prevention, reflect national and state-level data analyzed 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.
Tobacco, other nicotine products
The national adult cigarette smoking rate dropped to 11% in 2023, down significantly from previous years. But ACS researchers caution that disparities persist. Smoking prevalence remains highest among American Indian/Alaska Native individuals, Black men, people with lower education levels, and bisexual females. Menthol cigarette use was reported by 36% of adult smokers overall but was significantly higher among Black individuals (76%) and bisexual individuals (63%).
Flavored tobacco use continues to appeal to younger populations, with nearly 90% of high school students who use tobacco products reporting use of flavored versions of e- cigarettes and nicotine pouches, 71% for cigars, and 42% for cigarettes (menthol).
Screening
Cancer screening rates rebounded post-pandemic in some areas, according to the report. Up-to-date breast cancer screening surpassed pre-COVID levels, reaching 80% in 2023. Colorectal cancer screening also had a post-pandemic rise to 60% overall—54% for colonoscopy and 11% for stool-based tests. However, cervical cancer screening continued to lag, with rates remaining below pre-pandemic levels. In 2021, only 73% of women were up to date on screening, continuing a trend of decline that began in the early 2000s, authors wrote.
“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,” Priti Bandi, PhD, scientific director in the surveillance and health equity science department at ACS and lead author of the study, said in an ACS statement.
HPV Vaccination
HPV vaccination rates among adolescents aged 13–17 also remained flat at 61% between 2021 and 2023, a departure from the upward trajectory observed in prior years. The report links the lack of progress to pandemic-related disruptions in routine preventive care. Combined with falling cervical screening rates, the data highlight significant vulnerabilities in efforts to prevent HPV-related cancers.
The report also addressed other major cancer risk factors. Excess body weight remained prevalent, with 72% of adults categorized as overweight or obese from August 2021 to August 2023. Physical activity levels remained suboptimal; fewer than half (48%) of adults met national activity guidelines in 2022, and 27% reported no leisure-time physical activity at all. Heavy alcohol use remained steady at 6%, but was notably higher among White, higher-income, and bisexual women in middle age.
“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,” Ahmedin Jemal, DVM, PhD, senior vice president of surveillance and health equity science at ACS, said in the ACS statement. “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.”
