Cigarette smoking and cancer screening underutilization by state: BRFSS 2010

To quantify the impact of current smokers' underutilization of colorectal cancer (CRC) and breast cancer screenings on overall cancer screening prevalence at the state level.

Behavioral Risk Factor Surveillance System 2010 data were used to calculate states' prevalence of screening for breast cancer and CRC overall and by current smoking status. To quantify the effect of underutilization of screening by current smokers on the overall breast cancer and CRC screening prevalence in each state, we derived a cancer screening underutilization (CSU) measure.

CRC screening rates among adults aged 50 years and older ranged from 38.3% in Oklahoma to 59.5% in Rhode Island for current smokers and from 58.0% in Idaho to 75.9% in New Hampshire for nonsmokers. Mammography rates among women aged 40 years and older ranged from 26.8% in Utah to 63.6% in the District of Columbia for current smokers and from 50.8% in Utah to 73.0% in Massachusetts for nonsmokers. As a result, CSU values ranged from 2.1% to 6.7% for CRC screening and from 0.3% to 7.9% for mammography. Most states with the largest CSU values were located in the South or Midwest, whereas those with the smallest CSU values were located in the Northeast or West.

Lower levels of CRC and mammography screening among current smokers substantially contribute to many states' lower overall screening prevalence, particularly in Southern and Midwestern states where smoking prevalence is highest. These findings underscore the potential for more concentrated efforts to promote cessation and screening among smokers as a means to achieving cancer screening goals.