CANCER EPIDEMIOLOGY, BIOMARKERS & PREVENTION: PREVALENCE AND REVIEW OF MAJOR MODIFIABLE CANCER RISK FACTORS
ABSTRACT
The study analyzes the national and state-level prevalence of major modifiable cancer risk factors, HPV vaccination status, and cancer screenings among US adults during and post-COVID-19 pandemic, comparing with pre-pandemic years.
Key Findings:
Smoking prevalence decreased from 14.2% in 2019 to 11% in 2023, higher among certain demographics:
American Indian/Alaska Native individuals
Black males
Lower-educated individuals
Bisexual females
36.3% of adult smokers used menthol-flavored cigarettes, notably higher at 75.6% among Black individuals.
Adult obesity rates (40.4%) and overweight (31.8%) remained stable from 2021 to 2023 compared to earlier periods.
51.5% of adults did not meet recommended levels of aerobic activity; 6.4% reported heavy alcohol use in 2022.
HPV vaccination rates remained flat at 61.4% for ages 13-17 years from 2021 to 2023.
Breast cancer screening rates increased to 79.9% and colorectal cancer screenings to 60.4% by 2023, rebounding from pandemic declines.
Ongoing surveillance is vital for tracking progress and informing cancer prevention initiatives.
INTRODUCTION
Cancer Attribution to Risk Factors:
40% of cancer cases in the United States are linked to modifiable risk factors, potentially preventable.
Benefits of routine vaccination against HPV and regular cancer screenings for early detection and reduced mortality.
Estimated 4.75 million cancer deaths averted in the U.S. from 1975 to 2020 due to prevention strategies and screenings.
Importance of accurate, population-representative data to understand and address cancer burden effectively.
MATERIALS AND METHODS
Surveys Used:
National Health Interview Survey (NHIS)
Estimates prevalence of smoking, cessation, physical activity, and cancer screenings.
Behavioral Risk Factor Surveillance System (BRFSS)
Estimates state-level prevalence of smoking, obesity, physical activity, and cancer screening.
National Health and Nutrition Examination Survey (NHANES)
Data on obesity estimation from August 2021 to August 2023.
Definitions of Main Variables:
Cigarette Smoking: Proportion of adults who smoked at least 100 cigarettes and currently smoke on some days or every day.
Menthol Smoking: Among current smokers, those who usually smoke menthol cigarettes.
Quit Ratio: Proportion of former smokers who have stopped entirely.
Physical Inactivity: <150 min of moderate-intensity or <75 min of vigorous-intensity exercise/week.
Heavy Alcohol Consumption: >14 drinks/week for males; >7 drinks/week for females.
Obesity & Overweight: BMI categories defined as follows:
Overweight: $25 ext{ to } <30 kg/m^2$
Obesity: $≥30 kg/m^2$
Severe Obesity: $≥40 kg/m^2$
HPV Vaccination: Up-to-date status defined as two doses separated by 5 months for certain adolescents, and appropriate dosing for others.
Cancer Screening Variables Defined as follows:
Breast Cancer Screening: % of women aged 50 to 74 who had a mammogram in the past two years.
Cervical Cancer Screening: % of women aged 21 to 65 who received Pap testing or cotesting depending on age.
Colorectal Screening: Multiple modalities, including colonoscopy and stool tests, over various timeframes as per USPSTF recommendations.
STATISTICAL ANALYSIS
Assessments of national and state-level prevalence based on demographic characteristics such as age, sex, race, education, and insurance status.
Prevalence data adjusted to the year 2000 US population for comparability.
Adjusted prevalence ratios (aPRs) compared data from COVID-19 years with prepandemic years.
aPRs estimate relative change in outcomes as percentages.
All estimates weighted for representativeness; confidence intervals calculated using SAS-callable SUDAAN.
RESULTS
TOBACCO USE
Cigarette Smoking
Linked to risk in at least 12 cancers (e.g., lung, bladder, oral cancers).
Smoking accounted for 29% of all cancer deaths in the U.S. in 2019.
2023 Prevalence Data:
Overall: 11% (Males: 12.8%, Females: 9.3%), lower than in 2019 (14.2%).
High prevalence in:
American Indian/Alaska Native (15.2% vs. 5.2% Asian)
Low education levels (e.g., 27.4% in males without a diploma).
By State: Lowest in Utah (6.2%), highest in West Virginia (21.9%).
Menthol-Flavored Cigarette Smoking
Linked to higher initiation and dependence.
In 2023, 36.3% of current smokers used menthol cigarettes,
Highest among Black Americans (75.6%), bisexual individuals (62.7%).
Smoking Cessation
Associated with reduced cancer risks; significant health gains observed across all ages.
2023 Quit Ratio: 64.7% overall, with lower ratios among Black individuals and low-education demographics.
Quitting smoking often requires multiple attempts; however, only 9.6% had sustained cessation for more than six months.
Cigar Smoking
Certain demographics showed higher rates of cigar usage; overall usage unchanged from 2019.
Smokeless Tobacco
2023 prevalence at 2.2%, higher among males and racial/ethnic minorities, stable from 2019 figures.
Electronic Cigarettes (E-Cigarettes)
Addictive and potential initiate combustible tobacco use among youths; prevalence increased from 4.8% in 2019 to 7.1% in 2023.
Significant increase among younger adults (ages 18-24).
EXCESS BODY WEIGHT
Further linked to increased cancer risks for 13 cancer types. The total prevalence of high body weight was 72.2% in adults aged ≥20 years (31.8% overweight, 40.4% obese).
Obesity remained high, particularly among specific racial and ethnic groups.
PHYSICAL ACTIVITY
Regular physical activity reduces cancer risk; however, 51.5% of US adults did not meet recommended levels in 2022.
Space for gaps exist, particularly among low-income individuals and certain racial groups.
DIET
Approximately 4% of cancer cases attributable to dietary factors; healthy eating correlates with better health outcomes.
ALCOHOL CONSUMPTION
Strong connection to various cancers; 6.4% of adults reported heavy drinking in 2022.
HPV VACCINATION
For 2023, 61.4% of adolescents are fully vaccinated against HPV; uneven coverage exists across states.
CANCER SCREENING
Screening rates revived post-pandemic, with notable increases in breast and colorectal cancer screenings.
Disparities in screening prevalence exist based on insurance and socio-economic status.
DISCUSSION
The need for comprehensive interventions to address the rising trends in modifiable risk factors and disparities in health outcomes is outlined, emphasizing the collaboration between public health and healthcare systems to tackle these ongoing challenges.