Cancer Screening Adherence in the United States by Smoking and Vaping Status, 2023

Early detection of cancer saves lives and reduces healthcare costs. In the United States, adherence to cancer screening recommendations is associated with many structural and individual-level factors. People who smoke cigarettes are less likely to engage in cancer screening. E-cigarette use (vaping) has become popular in the United States. We evaluated whether vaping is associated with cancer screening. Data from the 2023 National Health Interview Survey were used to identify adults who met criteria to receive preventative cancer screening for colorectal (N = 14,561), breast (N = 6,572), cervical (N = 8,637), or prostate (N = 3,556) cancer. Nationally representative cancer screening adherence rates were determined for each cancer site, by smoking and vaping status. Multivariable logistic regression analyses were used to examine differences in screening adherence, controlling for social determinants of health. Smoking was associated with lower cancer screening adherence across all sites [colorectal, males: adjusted odds ratio (AOR) = 0.66, 95% confidence interval (CI), 0.55-0.79; colorectal, females: AOR = 0.60, 95% CI, 0.50-0.73; breast: AOR = 0.45, 95% CI, 0.36-0.56; cervical: AOR = 0.77, 95% CI, 0.64-0.93; and prostate: AOR = 0.56, 95% CI, 0.42-0.74]. Among males who smoke, current vaping (vs. never or former vaping) may signal greater engagement in colorectal and prostate cancer screening, a finding not observed among males who formerly smoked. Among females who smoke, vaping seems unrelated to engagement in breast cancer screening or cervical cancer screening. However, among females who formerly smoked, current vaping (vs. never or former vaping) may signal lower engagement in breast cancer screening. Smoking remains a robust target for improving cancer screening adherence across multiple cancer sites whereas vaping may signal emerging differences in cancer screening adherence.

Early detection of cancer saves lives and reduces healthcare costs. Our nationally representative findings show that cigarette smoking remains a robust target for improving cancer screening adherence across multiple cancer sites. Cessation counseling and screening advisement both present opportunities to cross-promote health behaviors.