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

Early detection of cancer saves lives and reduces healthcare costs. In the U.S., 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 U.S. 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: AOR=0.66, 95%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; prostate: AOR=0.56, 95%CI: 0.42-0.74). Among males who smoke, current vaping (versus 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 appears unrelated to engagement in breast cancer screening or cervical cancer screening. However, among females who formerly smoked, current vaping (versus 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 while vaping may signal emerging differences in cancer screening adherence.