Table 1.

Prevalence of factors that modify the risk of cancer in the United States along with relevant cancer preventive actions at the personal and population levels

Average national prevalenceStates with highest and lowest prevalenceRelated evidence-based personal actionsaRelated USPSTF/ACIP recommendationRelated evidence-based cancer control actionsb
Risk modifierHighestLowestFor the communityFor the clinic
Cigarette smokingAvoid or eliminate tobacco useClinicians ask about tobacco use, advise to stop, & provide behavioral interventions & FDA-approved pharmacotherapy for cessation (the 5A's model)Increasing the unit price of tobacco productsProvider reminders when used alone or with provider education (cessation)
Adult15.1 (2014)West Virginia, 26.7Utah, 9.7Primary care clinicians provide interventions, including education or brief counseling, to prevent initiation of tobacco use among school-aged children & adolescentsMass media campaigns when combined with other interventions
Youth (high school students)10.8 (2014)West Virginia, 18.8Utah, 4.4Smoke-free policies
Mass-reach health communication interventions (cessation)
Mobile phone-based interventions (cessation)
Quitline interventions
Reducing client out-of-pocket costs for cessation therapies
Community mobilization with additional interventions (restricting minors’ access)
Incentives & competitions to increase smoking cessation combined with additional interventions (among workers)
Heavy drinking
Adult5.9 (2015)D.C., 9.1West Virginia, 3.5Men: No more than 2 drinks per dayClinicians screen adults ≥18 & provide behavioral counseling interventions for alcohol misuseIncreasing alcohol taxesElectronic screening and brief interventions (may be used in various community settings as well)
Youth (high school students)17.7 (2015)Montana, 20.7Virginia, 11.0Women: No more than 1 drink per dayDram shop liability
Regulation of alcohol outlet density
Maintaining limits on days & hours of sale
Enhanced enforcement of laws prohibiting sales to minors
Privatization of retail alcohol sales (recommended against)
BMI ≥ 30
Adult29.8 (2014)Louisiana, 36.2Colorado, 20.2Be as lean as possible throughout life without being underweightClinicians screen adults & children ≥6 for obesity & offer or refer to intensive, multicomponent behavioral interventionsBehavioral interventions to reduce recreational, sedentary screen time (children ≤13 years old)
Youth (high school students)13.9 (2015)Mississippi, 13.910.3, MontanaAvoid excess weight gain at all agesWorksite programs
For those who are overweight or obese, losing even a small amount of weight has health benefits and is a good place to startMulticomponent coaching/counseling interventions to reduce weight & to maintain weight loss
Get regular physical activity and limit intake of high-calorie foods and drinks as keys to help maintain a healthy weightMulticomponent interventions to increase availability of healthier foods and beverages in schools
Meal and fruit and vegetable snack interventions to increase healthier foods and beverages provided by schools
Lack of physical activity22.1 (2014)Mississippi, 31.4Colorado, 16.4Adults: at least 150 min of moderate intensity or 75 min of vigorous intensity activity/wkFamily-based interventions
Children: at least 1 hr of moderate or vigorous- intensity activity/d, with vigorous activity on at least 3 d/wkHealth communication and social marketing: campaigns that include mass media and health-related product distribution
Limit sedentary behavior such as sitting, lying down, watching TV, and other forms of screen-based entertainmentCommunity-wide campaigns
Doing some physical activity above usual activities, no matter what one's level of activity, can have many health benefitsIndividually adapted health behavior change programs
Social support interventions in community settings
Enhanced school-based physical education
Community-scale urban design and land use policies
Built environments
Creating or improving places for physical activity
Point-of-decision prompts to encourage use of stairs
Fruit intake (≥2 cups/d)13.1 (2013)California, 17.7Tennessee, 7.5Eat a healthy diet, with an emphasis on plant-based foods
Moore et al, MMWR 2015:64:709-25Eat at least 2½ cups of fruit and vegetables each day
Limit how much red & processed meat you eat
Choose whole grains instead of refined grain products
Vegetable intake (2.5-3 cups/d)8.9 (2013)California, 13.0Mississippi, 5.5Eat a healthy diet, with an emphasis on plant-based foods
Moore et al, MMWR 2015:64:709-25Eat at least 2½ cups of fruit and vegetables each day
Limit how much red & processed meat you eat
Choose whole grains instead of refined grain products
≥1 sunburn in previous year (high school students)55.8 (2015)N/AN/AAvoid excessive UV exposureClinicians counsel children, adolescents, & young adults aged 10 to 24 who have fair skin about minimizing UV exposureEducation & policy approaches in primary & middle school settings and in outdoor recreational & occupational settings
Multicomponent community-wide interventions
Use of indoor tanning bed (high school students)7.3 (2015)N/AN/ADo not use tanning bedsClinicians counsel children, adolescents, & young adults aged 10 to 24 who have fair skin about minimizing UV exposure
Screening for colon cancer66.4 (2014)Massachusetts, 76.5Wyoming, 56.9Know your family historyScreening for colorectal cancer starting at age 50 & continuing until age 75Multicomponent interventionsProvider assessment & feedback
Mammography73.0 (2014)Massachusetts, 88.0Idaho, 62.5Follow a cancer screening programBiennial mammography for women ages 50 to 74Client remindersProvider reminder & recall systems
Pap test82.6 (2014)Massachusetts, 88.0Idaho, 76.2Screening for cervical cancer in women ages 21 to 65 with Pap smear every 3 years or, for women ages 30 to 65 who want to lengthen the screening interval, screening with a combo of Pap smear & HPV testing every 5 yearsSmall media
One-on-one education
Group education (breast only)
Reducing client out-of-pocket costs (breast only)
Reducing structural barriers (breast & colon only)
HPV vaccinationGirls: 41.9Girls: Rhode Island, 68.0Girls: Mississippi, 24.4Use preventive medicines & vaccinesVaccination at 11 or 12 years old, can begin as early as 9 years oldHome visits to increase vaccination ratesHealth care system-based interventions implemented in combination
Reagan-Steiner et al, MMWR 2016;65:850–58Boys: 28.1 (2015)Boys: Rhode Island, 58.1Boys: Tennessee, 16.02 doses 6 mo apart for those aged <15Reducing client out-of-pocket costsImmunization information systems
3 doses at 0, 1-2 mo, 6 mo for those aged ≥15Vaccination programs in schools & organized child care centersProvider assessment & feedback
HBV vaccinationHill et al, MMWR2015;64:889–9672.4 (2014)North Dakota, 88.4Vermont, 48.4Use preventive medicines & vaccinesUniversal vaccination of infants; vaccination is recommended for all children & adolescents aged <19Vaccination programs in WIC settingsProvider reminders
Hepatitis B vaccination is recommended for all unvaccinated adults at risk for HBV infection & for all adults requesting protection from HBV infectionClient or family incentive rewardsStanding orders when used alone
Screen for HBV infection in persons at high risk for infection & at the first prenatal visit for pregnant womenClient reminder & recall systems
Vaccination requirements for child care, school, & college attendance
Community-based interventions implemented in combination
Hepatitis C (reported cases of acute infection)0.7 per 100,0000.1, Missouri, Nebraska & South CarolinaWest Virginia, 3.4Use preventive medicines & vaccinesScreen for HCV infection in persons at elevated risk for infection & offer one-time screening to adults born 1945-1965
  • NOTE. All data from the CDC's 2015 National Health Interview Survey, Behavioral Risk Factor Surveillance System, Youth Risk Behavior Surveillance System, or their Division of Viral Hepatitis Statistics and Surveillance System, unless otherwise noted.

  • Abbreviations: ACIP, Advisory Committee on Immunization Practices; USPSTF, United States Preventive Services Task Force; UV, ultraviolet.

  • aOn the basis of established cancer prevention recommendations from the American Cancer Society and the American Institute for Cancer Research/World Cancer Research Fund.

  • bActions taken from the Guide to Community Preventive Services (the Community Guide) https://www.thecommunityguide.org/.

  • Modified from refs. 2, 4.