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ACS Report: More Effort Needed to Reduce Cancer Risk in the US

A new report from the American Cancer Society says cancer death rates could fall more quickly – if more people had the resources they needed to adopt lifestyle behaviors that reduce risk. These behaviors include avoiding tobaccostaying at a healthy weighteating a healthy dietlimiting alcoholgetting enough physical activity, and getting recommended screenings and vaccinations. The greatest areas for improvement are among lower socio-economic populations.

Every 2 years, researchers from the American Cancer Society analyze data for cancer risk factors and screening from the Centers for Disease Control and Prevention (CDC) to strengthen cancer prevention and early detection efforts. This year the findings are published in the journal Cancer Epidemiology, Biomarkers & Prevention and in the report Cancer Prevention & Early Detection Facts & Figures 2019-2020.

Cancer death rates in the US have dropped 27% between 1991 and 2016. But 607,000 people are still expected to die of cancer in 2019, and about 45% of the deaths are linked with lifestyle behaviors that can be changed. Cigarette smoking alone accounts for about 29% of all cancer deaths.

Some highlights from this year’s report:

Tobacco use

  • According to the 2014 Surgeon General’s Report, smoking increases the risk of cancers of the mouth and throat, larynx, lung, esophagus, pancreas, cervix, kidney, bladder, stomach, colon and rectum, and liver, as well as acute myeloid leukemia. It’s also linked to fatal prostate cancer and a rare type of ovarian cancer.
  • An estimated 14.1% of adults (16% of men; 12.3% of women) were cigarette smokers in 2017. Smoking rates are higher in some populations than others. For example, 30.1% of men without a high school diploma smoke, compared with 5% of women who graduated college. Among ethnic groups, American Indian/Alaska Natives have the highest smoking rates and Asians have the lowest.
  • Smoking prevalence in 2017 was lowest among those with a graduate degree (4%) and highest among adults with a general equivalency high school diploma known as GED (36%).
  • The use of other forms of combustible tobacco, including cigars and waterpipes (hookahs), has gone up in recent years, and they increase the risk of some of the same cancers as smoking regular cigarettes.
  • The proportion of adults who have tried e-cigarettes increased dramatically between 2010 and 2017. The long-term risks of e-cigarettes are unknown. 
  • Fewer young people are smoking cigarettes, but their use of other tobacco products, including e-cigarettes and hookahs, has increased dramatically. Adolescent and young adult e-cigarette users may be 2 to 4 times more likely than non-users to begin using cigarettes and other combustible tobacco products.

Body weight, alcohol, diet, and exercise

  • About 16% of cancer deaths in the US are linked to a combination of overweight and obesity, too much alcohol, unhealthy eating habits, and lack of physical activity.
  • Overweight and obesity increase the risk of cancers of the endometrium, esophagus, liver, stomach, kidney, brain, pancreas, colon and rectum, gallbladder, ovary, breast (in post- menopausal women), and thyroid, as well as multiple myeloma. It may also be linked to non-Hodgkin lymphoma, breast cancer in men, and fatal prostate cancer.
  • During 2015-2016, 36.5% of men and 26.9% of women were overweight; 37.9% of men and 41.1% of women were obese. More than half of black and Hispanic women were obese, compared with 38% of white women.
  • In 2014, 5.3% of adults drank more than what is recommended by the American Cancer Society: 1 drink a day or less for women and 2 drinks a day or less for men. Heavier drinking was higher among whites than other ethnicities.
  • In 2017, only 16% of adults said they ate at least 3 servings of vegetables and about 1/3 said they ate at least 2 servings of fruits daily. Blacks and Hispanics ate less vegetables and fruits than people of other ethnicities.
  • In 2017, 26.2% of adults reported getting no leisure-time physical activity. This was more likely for people with less education. Almost half (48.7%) of people without a high school diploma reported no leisure-time activity compared with 14.4% of college graduates.

Ultraviolet radiation and skin cancer

  • Exposure to ultraviolet (UV) rays from the sun and manmade sources such as tanning beds cause about 1.5% of cancer deaths. Melanoma accounts for only 1% of all skin cancer cases but most skin cancer deaths.
  • In 2015, 35.4% of adults said they had a sunburn in the past year. Those with less education were less likely to report having had a sunburn.
  • Indoor tanning use declined among adults from 5.5% in 2010 to 3.6% in 2015.
  • In 2015, about 2/3 of men and ¾ of women said they typically take at least one action to protect themselves when in the sun, such as wearing a wide-brimmed hat, long pants, or long sleeves; using sunscreen with SPF 30+; or staying in the shade.

Screenings and vaccinations

  • Getting recommended screenings and vaccinations can prevent some types of cancer. Screening can also help find some cancers at an earlier stage when they’re more likely to be easier to treat. However, many Americans don’t get all the screenings they should, especially those who are uninsured or under-insured, recent immigrants, and those with less education and low socioeconomic status.
  • Although more people are getting the human papillomavirus (HPV) vaccine, which helps protect against cervical and some other cancers, vaccination rates remain low in the US. Research has shown many missed opportunities for children to be vaccinated. In 2017, only 53.1% of adolescent girls and 44.3% of adolescent boys were up-to-date with HPV vaccinations.
  • Breast, cervical and colon cancer screening increased in the past several decades, contributing to falling death rates in these cancers.
  • In 2015, about 68% of women age 45 and older reported having a mammogram in the past 2 years. Rates were lower among women with less education: 55% without a high school diploma reported having a mammogram in the past 2 years compared with 77.5% of college graduates.
  • In 2015, 83.2% of women ages 21 to 65 were up-to-date with cervical cancer screening. Rates were lower among women with less education, without health insurance, and recent immigrants.
  • Colon cancer screening for recommended populations increased rapidly since the 2000’s (from 38.6% in 2000 to 62.6% in 2015), mostly through increased use of colonoscopy. Screening is lowest among the uninsured (25%), recent immigrants (34%), and those without a high school diploma (47%).
  • Lung cancer screening is recommended for those at high risk, but in 2015 only 3.2% of current heavy smokers and 4.6% of former smokers were screened within the past year.


Authors of the report say reducing cancer risk factors and improving screening will take a major effort on a national, state, local, and individual level. They say government, community, and social strategies work, but have not been adopted widely enough – especially among lower socio-economic populations.

Examples include:

  • Taxing tobacco products
  • Making healthy food and beverages less expensive and more available
  • Insuring more people by expanding Medicaid eligibility

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.


Current Prevalence of Major Cancer Risk Factors 4 and Screening Test Use in the United States: 5 Q2 Disparities by Education and Race/Ethnicity. Published April 3, 2019 in Cancer Epidemiology, Biomarkers & Prevention. First author: Ann Goding Sauer, MSPH, American Cancer Society, Atlanta, Ga.

Cancer Prevention & Early Detection Facts & Figures 2019-2020. Published April 3, 2019. American Cancer Society, Atlanta, Ga.