Cancer Screening Less Likely in Current Smokers Than Former, Never Smokers

man smoking a cigarette
man smoking a cigarette
Guideline-compliant prostate, colorectal, and breast cancer screening studies are less frequently administered to current smokers compared with individuals who have never smoked.

Guideline-compliant prostate, colorectal, and breast cancer screening studies are less frequently administered to current smokers compared with individuals who have never smoked, according to a study published in JAMA Network Open.  This cross-sectional study included 83,176 participants, 55.1% (n=45,851) of whom were women, and whose mean age was 47±18 years. Of this population, 61.3% (n=51,014) had never smoked, 17.9% (n=14,927) were current smokers, and 20.7% (n=17,235) were former smokers. None had a previous cancer diagnosis. Data was sourced from the 2010, 2013, and 2015 records of the National Health Interview Survey, with the study’s primary exposure being confirmation of cancer screening (mammography, prostate-specific antigen test, colonoscopy, and Papanicolaou test). The association between receipt of cancer screening and smoking status was represented by adjusted odds ratios (AORs) via multivariable logistic regression. The odds of being given a guideline-compliant test were also examined in the participants given a specific screening test.

Current smokers were less likely than never smokers to have been given a mammogram (88.8% vs 93.3%; AOR, 0.70; 95% CI, 0.57-0.87; P =.001), colonoscopy (43.8% vs 57.7%; AOR, 0.74; 95% CI, 0.68-0.82; P <.001), or antigen test for prostate (46.1% vs 60.8%; AOR, 0.76; 95% CI, 0.64-0.90; P =.001). Current smokers who had received a specific screening test were also less likely than previously tested never smokers to have received guideline-compliant colonoscopy (92.1% vs 95.1%; AOR, 0.75; 95% CI, 0.59-0.96; P =.02), Papanicolaou test (80.9% vs 90.8%; AOR, 0.61; 95% CI, 0.56-0.67; P <.001), or a mammogram (62.4% vs 79.4%; AOR, 0.52; 95% CI, 0.45-0.60; P <.001). In the previous 2 years, 77.8% of women who were former smokers and 79.5% of women who never smoked (all aged 50-74 years) had undergone a mammography, compared with 62.4% of women current smokers.

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All types of screening studies evaluated except antigen screening for prostate cancer were likelier to be given to former smokers than never smokers, with 95.7% vs 93.3% given a mammography (AOR, 1.35; 95% CI, 1.07-1.70; P =.01); 65.2% vs 57.7% (AOR, 1.20; 95% CI, 1.12-1.30; P < 001) given a colonoscopy, and 97.6% vs 91.4% (AOR, 2.51; 95% CI, 1.93-3.26; P <.001) given a Papanicolaou test.

Limitations to this study included self-reported data, a lack of differentiation between screening and diagnostic tests, the possible dependence of follow-up screening on previous examination results, a lack of focus on the correlation between smoking status and less common test types, and not taking into account changing guidelines for testing.

“Current smokers appear to be less likely to receive cancer screening in accordance with USPSTF guidelines for colorectal, prostate, and breast cancer,” the researchers concluded. “Our findings suggest physicians need to be aware of this disparity, which may affect a group of individuals with a baseline higher risk for several cancer types. We recommend a concerted effort from the medical community to identify barriers to screening among smokers to implement strategies to increase acceptance and uptake of cancer screening within this population.”


Sanford NN, Sher DJ, Butler S, et al. Cancer screening patterns among current, former, and never smokers in the United States, 2010-2015. JAMA Netw Open. 2019;2(5):e193759.