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Background
As illustrated in the present section, many cancer survivors continue to smoke after their cancer diagnosis. This increases their risk for chronic health conditions, second primary cancers related to smoking, and premature death. To enhance the length and health-related quality of their lives, efforts are needed to identify these individuals and provide them with evidence-based interventions to help them quit smoking and remain tobacco free.
As the population of cancer survivors increases and their expected time of survival lengthens, the health behaviors of these individuals are becoming an important focus of attention. Behavioral risk factors, such as smoking, affect the length and quality of life after diagnosis. Tracking these behaviors permits evaluation of how well cancer control efforts are working to reduce preventable disability and death among those with a history of cancer.
Measure
Rates of smoking among cancer survivors are based on the self-reporting of individuals with a cancer history who are interviewed as part of the annual population-based National Health Interview Survey (NHIS). Participants who had smoked at least 100 cigarettes in their lifetime and who, at the time of the interview, reported smoking every day or some days were considered to be currently smoking.
Healthy People 2030 Target
- There is no Healthy People 2030 target for smoking rates among cancer survivors, though Healthy People does include a national objective to increase the mental and physical health-related quality of life of cancer survivors; however, the goal for the general population is to decrease to 5 percent the proportion of people who currently smoke cigarettes.
- Healthy People 2030 Targets are developed and based on the general population and do not account for differences in the age distribution of cancer survivors compared to the general population. Cancer survivors are typically older than those in the general population who have not had cancer.
Healthy People 2030 is a set of goals set forth by the Department of Health and Human Services.
Note: Goals are indicated as blue line on Detailed Trend Graphs.
Data Source
Centers for Disease Control and Prevention, National Center for Health Statistics. National Health Interview Survey, 1992–2021.
In 2019 the NHIS questionnaire was redesigned to increase relevance, enhance data quality, and minimize respondent burden. In addition, the COVID-19 pandemic created challenges conducting in-person interviews for the 2020 NHIS, requiring changes to field procedures to conduct most surveys by telephone, which impacted survey response rates. For details related to the potential impacts of these issues, please refer to Potential Impact of NHIS Redesign and COVID-19 on the Cancer Trends Progress Report.
Trends and Most Recent Estimates
By Sex
| Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2021) | |
|---|---|---|---|
| Percent of cancer survivors | 95% Confidence Interval | ||
|
Both Sexes
|
11.4 | 10.1 - 12.9 |
Male
|
11.5 | 9.5 - 13.9 | |
Female
|
11.0 | 9.4 - 12.8 | |
By Age
| Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2021) | |
|---|---|---|---|
| Percent of cancer survivors | 95% Confidence Interval | ||
|
Ages 18-44
|
15.0 | 10.1 - 21.8 |
Ages 45-64
|
17.9 | 15.1 - 21.3 | |
Ages 65 and older
|
7.0 | 5.9 - 8.3 | |
By Time Since Cancer Diagnosis
| Overview Graph | Detailed Trend Graphs | Most Recent Estimates (2021) | |
|---|---|---|---|
| Percent of cancer survivors | 95% Confidence Interval | ||
|
5 years or less since diagnosis
|
10.8 | 8.8 - 13.1 |
6+ years since diagnosis
|
12.1 | 10.4 - 14.1 | |
Compared to Remaining U.S. Population
| Overview graph | Age Group | Cancer Survivor | Remaining U.S. Population | ||
|---|---|---|---|---|---|
| Percent of population | Confidence Interval | Percent of population | Confidence Interval | ||
|
Ages 18-44 | 18.3 | 15.1 - 22.1 | 13.3 | 12.8 - 13.8 |
| Ages 45-64 | 17.9 | 16.4 - 19.5 | 15.7 | 15.1 - 16.3 | |
| Ages 65 and older | 7.4 | 6.7 - 8.1 | 8.7 | 8.3 - 9.1 | |
Additional Information on Cancer Survivors and Smoking
- Smokefree.gov. National Cancer Institute.
- SmokefreeTXT. National Cancer Institute.
- Smokefree Women. National Cancer Institute.
- Tobacco. National Cancer Institute.
- Quit Smoking. Springboard Beyond Cancer.
- Cancer Center Cessation Initiative. National Cancer Institute.
- Monograph 23: Treating Smoking in Cancer Patients: An Essential Component of Cancer Care. National Cancer Institute.
- Tobacco Control Evidence-Based Programs Listing. National Cancer Institute.
- Tobacco Cessation Tools & Resources. American Society of Clinical Oncology.
- 2014 Surgeon General’s Report - The Health Consequences of Smoking: 50 Years of Progress. Centers for Disease Control and Prevention.
- Caring for Cancer Survivors Who Use Tobacco. Centers for Disease Control and Prevention.
- Smoking Cessation, Version 1.2016, NCCN Clinical Practice Guidelines in Oncology. Shields PG, Herbst RS, Arenberg D, et al. J Natl Compre Canc Netw 2016;14(11):1430- 1468.
- Tobacco Smoking Cessation in Adults, Including Pregnant Women: Behavioral and Pharmacotherapy Interventions. U.S. Preventive Services Task Force.
- Correlates of continued smoking versus cessation among survivors of smoking-related cancers. Berg CJ, Thomas AN, Mertens AC, et al. Psycho-Oncology 2013;22:799–806.
- Introduction to the Cancer Center Cessation Initiative Working Groups: Improving Oncology Care and Outcomes by Including Tobacco Treatment. The Cancer Center Cessation Initiative Coordinating Center and Expert Advisory Panel. JNCCN. 2021 Nov; 19(Suppl_1).
- Smoking Cessation: A Report of the Surgeon General. Centers for Disease Control and Prevention. 2020.
- Association of a Comprehensive Smoking Cessation Program With Smoking Abstinence Among Patients With Cancer. Cinciripini PM, Karam-Hage M, Kypriotakis G, et al. JAMA Netw Open. 2019 Sep 4;2(9):e1912251.
- Addressing a Core Gap in Cancer Care - The NCI Moonshot Program to Help Oncology Patients Stop Smoking. Croyle RT, Morgan GD, Fiore MC. N Engl J Med 2019; 380:512-515.
- Tobacco use in the oncology setting: advancing clinical practice and research. Gritz ER, Toll BA, Warren GW. Cancer Epidemiol Biomarkers Prev. 2014;23(1):3-9.
- 21st-century hazards of smoking and benefits of cessation in the United States. Jha P, Ramasundarahettige C, Landsman V, et al. N Engl J Med. 2013;368(4):341–50.
- Tobacco use and cessation for cancer survivors: an overview for clinicians. Karam-Hage M, Cinciripini PM, Gritz ER. CA Cancer J Clin. 2014 Jul-Aug;64(4):272-90.
- Cigarette smoking, comorbidity, and general health among survivors of adolescent and young adult cancer. Kaul S, Veeranki SP, Rodriguez AM, Kuo YF. Cancer. 2016 Sep 15;122(18):2895-905.
- Research priorities, measures, and recommendations for assessment of tobacco use in clinical cancer research. Land SR, Toll BA, Moinpour CM, et al. Clin Cancer Res. 2016;22(8):1907-13.
- Smoking and all-cause mortality in older adults: results from the CHANCES Consortium. Müezzinler A, Mons U, Gellert C, et al. Am J Prev Med. 2015;49(5): e53–e63.
- Effect of Sustained Smoking Cessation Counseling and Provision of Medication vs Shorter-term Counseling and Medication Advice on Smoking Abstinence in Patients Recently Diagnosed With Cancer: A Randomized Clinical Trial. Park ER, Perez GK, Regan S, et al. JAMA. 2020 Oct 13;324(14):1406-1418.
- Cigarette smoking before and after breast cancer diagnosis: mortality from breast cancer and smoking-related diseases.. Passarelli MN, Newcomb PA, Hampton JM, et. al. Journal of Clinical Oncology 2016;34(12):1315–22.
- Lung cancer risk by years since quitting in 30+ pack year smokers.. Pinsky PF, Zhu CS, Kramer BS. J Med Screen. 2015;22(3):151–7.
- The 21st century hazards of smoking and benefits of stopping: a prospective study of one million women in the UK. Pirie K, Peto R, Reeves GK, et al. Lancet. 2013;381(9861):133–41.
- Use of electronic cigarettes among cancer survivors in the U.S.. Salloum RG, Getz KR, Tan ASL, et al. Am J Prev Med. 2016 Nov;51(5):762-766.
- Postdiagnosis Smoking Cessation and Reduced Risk for Lung Cancer Progression and Mortality: A Prospective Cohort Study. Sheikh M, Mukeriya A, Shangina O, et al. Ann Intern Med. 2021 Sep;174(9):1232-1239.
- Deaths due to cigarette smoking for 12 smoking-related cancers in the United States. Siegel RL, Jacobs EJ, Newton CC, et al. JAMA Intern Med. 2015;175(9):1574–6.
- Cancer Center Cessation Initiative Special Issue. Journal of the National Comprehensive Cancer Network, Volume 19: Issue Suppl_1, Online Publication Date: Nov 2021.
- Tobacco smoking and the risk of subsequent primary cancer among cancer survivors: a retrospective cohort study. Tabuchi T, Ito Y, Ioka A, et al. Ann Oncol 2013;24(1):2699–2704.
- Impact of postdiagnosis smoking on long-term survival of cancer patients: the Shanghai cohort study.. Tao L, Wang R, Gao YT, Yuan JM. Cancer Epidemiology, Biomarkers and Prevention 2013;22(12):2404–11.
- 50-year trends in smoking-related mortality in the United States. Thun MJ, Carter BD, Feskanich D, et al. N Eng J Med. 2013;368(4):351–64.
- Smoking-related mortality in the United States. Thun MJ, Lopez AD, Hartge P. N Eng J Med. 2013;368(18):1753.
- Assessing tobacco use by cancer patients and facilitataing cessation: an American Association for Cancer Research policy statement. Toll B, Brandon T, Gritz E, et al. Clin Cancer Res. 2013;19(8):1941-8.
- The biological and clinical effects of smoking by patients with cancer and strategies to implement evidence-based tobacco cessation support. Warren GW, Sobus S, Gritz ER. Lancet Oncol. 2014;15(12): e568–e80.
- Active smoking and mortality among colorectal cancer survivors: the Cancer Prevention Study II nutrition cohort. Yang B, Jacobs EJ, Gapstur SM, et al. J Clin Oncol. 2015;33(8):885–93.