How Well Is Your State Protecting You From Cancer?
Your state can help protect you from cancer with policies, programs, and campaigns to reduce risk factors and support cancer screening.
- Cancer Risk Factors: States With the Least & Most Protection
- Smoking Cigarettes
- Drinking Alcohol
- Excess Body Weight
- No Physical Activity
- HPV Vaccination (Ages 13 to 17)
- Screening: States with the Most and Least Cancer Protection
- Breast Cancer Screening
- Cervical Cancer Screening
- Colorectal Cancer Screening
- Lung Cancer Screening
- Prostate Cancer Screening
- See How Well Your State Is Protecting You
Protection from cancer includes taking preventive actions that decrease your risk of developing cancer, such as avoiding tobacco and alcohol, maintaining a healthy body weight and eating patterns, being physically active, avoiding excessive ultraviolet radiation exposure, and getting vaccinated against cancer-causing infections.
Getting screened for cancer at the recommended times is another protective action because screening helps find cancer at an earlier stage, which may mean less complicated treatments and a lower risk of dying prematurely from cancer. The procedures for screening for cervical cancer and colorectal cancer can even prevent you from getting cancer in the first place.
You can take actions to help protect yourself from cancer—补苍诲 your state can too with systematic interventions, such as policies, programs, and educational campaigns, to reduce cancer risk factors and to support the use of cancer screening.
Every year, the 黑料大湿Posts Cancer Society (ACS) provides data on how well your state is protecting you from cancer. Our Cancer Prevention & Early Detection Facts & Figures (CPED) report is one of the only US sources that looks from both the national and state levels at the major modifiable cancer risk factors in addition to HPV vaccination and the use of cancer screening tests.
The tables below show states with the most vs. least levels of protection from cancer risk factors and cancer screening uptake.
- States with a lower prevalence of (proportion of people with) cancer risk factors, like smoking cigarettes or having excess body weight, typically have better protection from the burden (the number of new cases and deaths) for cancers linked to those risk factors. Conversely, states with higher prevalence of people with cancer risk factors generally have a higher cancer burden for those cancers linked to the risk factors.
- Similarly, higher screening is tied to better protection against death from the cancer being screened
For information about your state specifically, use the dropdown list at the bottom of this article to see some of your state's data from the CPED Facts & Figures report on the website.
Cancer Risk Factors: States With the Least & Most Protection
Smoking Cigarettes
Smoking Cigarettes (High School Students)
Effect of Smoking
Almost 90% of adults who smoke regularly started before they were 18, which is why reducing the number of youth who start smoking is critical.
Proven strategies that states and communities can use:
Increasing the cost of cigarettes with excise taxes, as well as setting and enforcing regulations about tobacco advertising and bans on menthol and other tobacco flavors.
National Midpoint*
4% of high school students smoke cigarettes
States with the Lowest Proportion
- Utah (1%)
- 2% in:
- Delaware
- Michigan
- Nebraska
- New York (excluding New York City)
- Puerto Rico
- Virginia
States with the Highest Proportion
- 7% in:
- Alaska
- Arkansas
- Montana
- West Virginia
* Midpoint means a statistical median across states. Statistics are from 2023.
Smoking Cigarettes (18 and Older)
Relationship with Cancer
Smoking can cause cancer almost anywhere in the body and increases the risk of developing these types of cancer:
- Acute myeloid leukemia (AML)
And, from head to toe, cancer in the:
- Mouth, throat (pharynx), and voice box (larynx)
- Esophagus
- Liver
- Lung
- Pancreas
- Stomach
- Bladder
- Cervix
- Colon/rectum
Proven strategies that states and communities can use:
- Increasing the cost of cigarettes by adding a significant excise tax.
- Increasing the number of smokefree polices in workplaces, restaurants, bars, and casinos.
- Using culturally and linguistically appropriate protocols, channels, and quitting messages to reach groups affected by disparities.
- Ensuring all policies are linked to comprehensive smoking cessation services.
National Midpoint*
12% of adults 18 and older smoke cigarettes
States with the Lowest Proportion
- Utah (6%)
- 8% in:
- California
- Hawaii
- Maryland
- Washington
States with Highest Proportion
- West Virginia (22%)
- Kentucky (18%)
- Arkansas (17%)
* Midpoint means a statistical median across states. Statistics are from 2024.
Cigarette Excise Tax per Pack
Relationship with Cancer
85% of deaths from lung cancer are attributable to cigarette smoking.
The single most effective and proven way states can reduce the number of people who smoke:
Increase the cost of cigarettes with a higher tobacco excise tax.
In states with higher taxes, fewer kids start to smoke and more adults quit smoking.
National Midpoint*
$2.11 excise tax added to the cost of a package of cigarettes
States with the Highest Excise Taxes
- New York ($5.35)
- Puerto Rico ($5.10)
- Maryland ($5.00)
States with the Lowest Excise Taxes
- Missouri ($0.17)
- Georgia ($0.37)
- North Dakota ($0.44)
* Midpoint means a statistical median across states. Statistics are from 2026.
Drinking Alcohol
Drinking Any Amount of Alcohol (High School Students)
Relationship with Cancer
Drinking alcohol is the 3rd most common potentially avoidable cause of cancer, after cigarette smoking and excess body weight.
One proven strategy for states and communities to use:
Enhancing the enforcement of laws that prohibit selling alcohol to people younger than 21.
National Midpoint*
21% high school students currently drink alcohol
States with the Lowest Proportion
- Utah (6%)
- Nebraska (11%)
- District of Columbia (15%)
- New Mexico (15%)
States with the Highest Proportion
- West Virginia (28%)
- New Jersey (27%)
- Vermont (27%)
* Midpoint means a statistical median across states. Statistics are from 2023.
Drinking Heavy Amounts of Alcohol (18 and Older)
Relationship with Cancer
Heavy alcohol use has been linked with an increased risk of developing these cancers:
- Breast (Drinking even small amounts of alcohol increases the risk of breast cancer in women.)
- Colon and rectum
- Esophagus
- Liver
- Mouth, throat (pharynx), and voice box (larynx) (Drinking alcohol and smoking cigarettes together raises the risk for these cancers many times more than drinking or smoking alone.)
- Stomach
Proven strategies for states and communities to use to prevent excessive alcohol use:
Set and enforce limits on the number of places that sell alcohol and the distance between them, as well as on the days and hours people can buy alcohol. Raise taxes on alcohol.
National Midpoint*
6% of adults drink heavy amounts of alcohol
States with the Lowest Proportion
- Pennsylvania (3%)
- 4% in:
- Maryland
- New Jersey
- North Carolina
- Utah
- Puerto Rico
States with the Highest Proportion
- Montana (10%)
- Alaska (9%)
- Vermont (9%)
* Midpoint means a statistical median across states. Statistics are from 2024.
Excess Body Weight
Overweight (High School Students)
Relationship with Cancer
Children with overweight and obesity often become adults with one of the same conditions, and in adulthood, both overweight and obesity are linked with an increased risk of several types of cancer as well as other serious health conditions, like heart disease.
For those reasons, the 黑料大湿Posts Cancer Society recommends that people try to get to and stay at a healthy weight throughout their lives.
State efforts to help:
report recommends that state and local governments:
- Let schools keep the flexibility to expand access to nutrition for students—second-chance breakfasts, breakfast-on-the-go, and breakfasts in classrooms.
- Reduce unhealthy food marketing to children at the local level: Prohibit coupons, sales, and advertising around schools, and ban sugary drink brands as sponsors of youth sporting events.
- Expand the Every Kid Outdoors program for 4th graders—a free-entry to federal park pass—to more grades and to state-managed parks.
National Midpoint*
15% of high school students have overweight
States with the Lowest Proportion
- 13% in:
- Nebraska
- New Hampshire
- Ohio
- South Dakota
States with the Highest Proportion
- Mississippi (19%)
- 17% in:
- Delaware
- District of Columbia
- Missouri
- Nevada
- New Jersey
- New Mexico
- Oklahoma
- Tennessee
- West Virginia
* Midpoint means a statistical median across states. Statistics are from 2023.
Overweight (18 and Older)
Relationship with Cancer
According to research from the 黑料大湿Posts Cancer Society, in the United States, about 5% of cancers in men and about 11% of cancers in women are linked to having excess body weight (overweight or obesity). Excess body weight is also linked with about 7% of all cancer deaths.
State efforts to help:
report recommends state and local governments:
- Implement a living wage policy to meet needs for food, childcare, health insurance, housing, transportation, while maintaining self-sufficiency.
- Ensure access to evidence-based comprehensive obesity prevention and treatment programs by reversing cuts to Medicaid and health insurance marketplace subsidies.
- Use waivers or state plan amendments to allow Medicaid or managed care organizations to reimburse community-based organizations for chronic disease prevention activities, such as fruit and vegetable prescriptions.
National Midpoint*
34% of adults have overweight
States with the Lowest Proportion
- South Dakota (31%)
- 32% in:
- District of Columbia
- Louisiana
- Michigan
- Mississippi
- West Virginia
- Wisconsin
States with the Highest Proportion
- 37% in:
- Colorado
- New Hampshire
- New Jersey
- New Mexico
* Midpoint means a statistical median across states. Statistics are from 2024.
Obesity (High School Students)
Relationship with Cancer
Some research suggests that female teens who have excess weight may have a higher risk for developing ovarian cancer before menopause.
State efforts to help:
report recommends that state and local governments:
Cover pediatric weight management and obesity-related services in Medicaid and expand those services to include:
- Obesity medications
- Bariatric surgery
- Obesity and nutritional counseling from registered dietitians and other professionals
National Midpoint*
16% of high school students have obesity
States with the Lowest Proportion
- New Jersey (12%)
- 13% in:
- Massachusetts
- New Hampshire
- Utah
States with the Highest Proportion
- Arkansas (22%)
- Kentucky (22%)
- Mississippi (21%)
* Midpoint means a statistical median across states. Statistics are from 2023.
Obesity in Adults (18 and Older)
Relationship with Cancer
Excess body weight is linked with an increased risk of developing cancer in the:
- Breast (in women past menopause)
- Colon and rectal
- Endometrium (the inside lining of the uterus)
- Esophagus
- Gallbladder
- Kidney
- Liver
- Ovarian
- Pancreas
- Stomach
- Thyroid
Excess weight also increases the risk of:
- Meningioma (a tumor in the lining of the brain and spinal cord)
- Multiple myeloma (a blood cancer that starts in bone marrow.)
State efforts to help reduce obesity:
report, recommendations for state and local governments specific to youth include:
Covering adult weight management and obesity-related services in Medicaid and expand those services to include:
- Obesity medications
- Bariatric surgery
- Obesity and nutritional counseling from registered dietitians and other professionals
- Family-Based Behavioral Treatment programs
National Midpoint*
34% of adults have obesity
States with the Lowest Proportion
- Colorado (25%)
- District of Columbia (26%)
- Massachusetts (27%)
States with the Highest Proportion
- West Virginia (42%)
- Mississippi (41%)
- 40% in:
- Alabama
- Arkansas
- Louisiana
* Midpoint means a statistical median across states. Statistics are from 2024.
No Physical Activity
Relationship with Cancer
Regular physical activity can lower the risk of developing cancer in the:
- Bladder
- Breast
- Colon
- Esophagus
- Stomach
- Uterus
How states can help:
The recommendation for high school students is at least 60 minutes of moderate- or vigorous-intensity aerobic activity every day. Yet, each state sets its own standards for physical education in public high schools, and a majority do not require curriculums to meet that daily goal for all 4 years.
report recommends that states, consider:
- Using the Every Student Succeeds Act Title I and/or IV funding for physical education and related opportunities.
- Create shared-use agreements with schools so that recreational facilities can be open to students and community members outside of school hours.
National Midpoint*
16% of high school students aren’t physically active
States with the Lowest Proportion
- 12% in:
- Montana
- North Dakota
- South Dakota
US Places with the Highest Proportion
- Puerto Rico (31%)
- District of Columbia (26%)
- Delaware (22%)
* Midpoint means a statistical median across states. Statistics are from 2023.
Relationship with Cancer
Sitting or lying down too much while awake can raise the risk of developing cancer in the:
- Colon
- Lung
- Uterus
Strategies that state public health agencies may use:
Forming partnerships within a community's businesses, health-care organizations, and schools to create activity-friendly policies on community planning and zoning, public spaces, and transportation.
The goal: Connect safe routes for walking, biking, and using public transportation to everyday destinations like homes, worksites, schools, parks, and shops.
National Midpoint*
21% of adults aren’t physically active
States with the Lowest Proportion
- 15% in:
- Colorado
- District of Columbia
- Vermont
States with the Highest Proportion
- Puerto Rico (42%)
- Mississippi (30%)
- 27% in:
- Alabama
- Arkansas
- Kentucky
- Louisiana
- Oklahoma
- West Virginia
* Midpoint means a statistical median across states. Statistics are from 2024.
HPV Vaccination (Ages 13 to 17)
Relationship with Cancer
HPV vaccination provides nearly total protection against infections and precancers caused by cancer-related types of the human papillomavirus, including cancers in the:
- Mouth
- Throat
- Cervix
- Vagina
- Penis
- Anus
State approaches to increase HPV vaccine uptake:
- School entry requirements (SERs) for HPV vaccination specifically and for vaccinations in general, as a spillover effect. Gender-neutral policies showed better results than female-specific mandates.
- Medicaid expansion
National Midpoint*
66% of 13- to 17-year-olds in the US are up to date with HPV vaccinations
States with the Most Up-to-Date HPV Vaccinations
- Massachusetts (80%)
- Puerto Rico (77%)
- 76% in:
- District of Columbia
- Hawaii
- Rhode Island
States with the Fewest Up-to-Date HPV Vaccinations
- Mississippi (39%)
- Wyoming (47%)
- Oklahoma (50%)
* Midpoint means a statistical median across states. Statistics are from 2024.
Screening: States with the Most and Least Cancer Protection
Breast Cancer Screening
For Women 45 and Older
Benefit of Screening
Mammograms cannot keep breast cancer from developing, but regular screening can help find tumors when they are small and more treatable—补苍诲 that can lower the risk of dying from breast cancer.
State approaches to increase screening:
All 50 states have the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), which is focused on increasing screening access for women without health insurance, with low incomes, and who are part of underserved populations. States may expand the national program.
States have increased the uptake of breast cancer screening by:
- Mapping screening to target high-need areas
- Partnering with community organizations to reach non-English speakers and diverse populations
- Offering on-site screening
- Coordinating provider reminders
National Midpoint*
69% of women 45 and older are up to date with ACS breast cancer screening guidelines
States with the Highest Proportion
- 78% in:
- Connecticut
- Massachusetts
- Rhode Island
States with the Lowest Proportion
- Wyoming (60%)
- New Mexico (61%)
- Montana (63%)
* Midpoint means a statistical median across states. Statistics are from 2024.
Cervical Cancer Screening
For Eligibile Females 25 to 65
Benefit of Screening
Screening for cervical cancer can detect and remove precancers before cancer develops. Screening can also find cancer in its early stages, when it is most treatable. Half of cervical cancers are found in women who have never had a Pap test or who have not had one recently.
State approaches to increase screening:
All 50 states have the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), which is focused on increasing screening access for women without health insurance, with low incomes, and who are part of underserved populations. States may expand the national program via their state Cancer Prevention and Control Programs and Departments of Health.
States have increased the uptake of cervical cancer screening by:
- Using phone calls, letters, and texts to women to remind them about screening.
- Offering extended hours for Pap tests.
- Providing culturally sensitive education about risk factors, family history, genetic counseling, and healthy choices.
National Midpoint*
75% of women 25 to 65 are up to date with ACS cervical cancer screening guidelines
States with the Highest Proportion
- Puerto Rico (87%)
- Connecticut (80%)
- Maine (80%)
States with the Lowest Proportion
- Mississippi (67%)
- Nevada (67%)
- New Mexico (68%)
* Midpoint means a statistical median across states. Statistics are from 2024.
Colorectal Cancer Screening
For Adults 45 and Older
Benefit of Screening
Screening with colonoscopy can find precancerous polyps in the colon or rectum that can be removed before they turn into cancer.
Screening also helps find colorectal cancer at an early stage, when treatment works best. When people have screening colonoscopies, deaths from colorectal cancer are reduced by half.
State approaches to increase screening include:
- Eliminating costs for colonoscopy after a positive non-invasive screening test, such as an FOBT
- Expanding Medicaid
National Midpoint*
69% of adults 45 and older are up to date with ACS colorectal cancer screening guidelines
States with the Highest Proportion
- Rhode Island (78%)
- Connecticut (76%)
- Massachusetts (76%)
States with the Lowest Proportion
- New Mexico (59%)
- Wyoming (60%)
- Alaska
- Nevada (63%)
* Midpoint means a statistical median across states. Statistics are from 2024.
Lung Cancer Screening
For Adults 50 to 80 Who Currently or Formerly Smoked Cigarettes
Benefit of Screening
Screening for lung cancer by getting a yearly low-dose CT scans when they are recommended can detect cancer at an earlier stage when it's more treatable and reduce the risk of dying from lung cancer by about 20%.
State approaches to increase screening include:
- Not requiring people to have to pay for screening—even small copays
- Removing insurance barriers, such as requiring prior authorization, which may be accomplished by expanding Medicaid access.
- Using mobile screening units to improve access in underserved areas.
National Midpoint*
18% of eligible adults 50 to 80 are up to date with ACS lung cancer screening guidelines
States with the Highest Proportion
- 28% in:
- Connecticut
- Massachusetts
- Pennsylvania
States with the Lowest Proportion
- California (11%)
- Utah (12%)
- Alaska (13%)
- South Dakota (13%)
* Midpoint means a statistical median across states. Statistics are from 2024.
Prostate Cancer Screening
For Eligible Males 50 and Older
Recommendation
For now, the 黑料大湿Posts Cancer Society recommends that men learn as much as they can about prostate cancer screening, so they can make an informed decision about whether to get a PSA test based on available information, discussions with their health care provider, and their own views on the possible benefits, risks, and limits of screening.
State approaches to increase screening:
National Midpoint*
31% of eligibile men 50 and older without a prostate cancer diagnosis were screened for prostate cancer screening in the past year
States with the Highest Proportion
- Puerto Rico (48%)
- 37% in:
- Alabama
- North Carolina
- South Dakota
- Wyoming
States with the Lowest Proportion
- New Mexico (22%)
- Vermont (22%)
- Washington (24%)
* Midpoint means a statistical median across states. Statistics are from 2020.
See How Well Your State Is Protecting You
Select your state in the list of links below and click "Go," to review the tables and charts within the "Cancer Risk Factor and Screening Prevalence" section to see whether your state is above, below, or in line with the national midpoint.
- Helpful resources
- For researchers
Stopping Smoking Earlier in Life Reduces More Risks
Affordability and Taxation of Tobacco Products
Getting Enough Exercise Lowers Risk of 7 Cancers
Healthy Lifestyle Improves Survival from Obesity-Related Cancers
Excess Weight Before 50 Shortens Life with Breast Cancer After 50
HPV Vaccine: A Powerful Way to Help Prevent 3+ Cancers in Women
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