• Posted November 4, 2025

Tobacco Still Top Cancer Killer, Despite Falling Smoking Rates

Tobacco remains the leading preventable cause of cancer death in the U.S., despite a dramatic decline in smoking, a new American Cancer Society report says.

More than 80% of lung cancer deaths are linked to tobacco, according to data from the inaugural release of the American Heart Association’s U.S. Tobacco Atlas.

That’s even though cigarette smoking among adults cratered from 42% in 1965 to just 11% in 2023, researchers said.

Quit rates also have skyrocketed, with a record 62% of smokers trying to drop the habit in 2022, the reports says.

However, smokers are shunning the low-dose CT chest scans that are recommended for lung cancer screening, results show.

Only 18% of eligible current or former smokers were up to date with screening in 2022 — such screening can catch cancers early and improve survival odds.

“The U.S. Tobacco Atlas is a powerful tool showcasing not only the toll that tobacco has taken on the U.S., but also the immense progress public health gains have made over the past decades,” lead report editor Nigar Nargis, senior scientific director of tobacco control research at the American Cancer Society, said in a news release.

“Since the landmark 1964 U.S. Surgeon General’s report on tobacco, millions of lives have been saved by tobacco control, but the scale of the epidemic demands our continued attention and support,” Nargis added.

The ACS recommends annual lung cancer screening for adults 50 to 80 who smoke or used to smoke and have a 20-year or greater pack-year smoking history. A pack year is equal to smoking one pack per day for a year.

The new atlas maps U.S. tobacco use and control efforts at national and state levels, the ACS said.

For example, the report found that lung cancer screening rates are lowest in Southern States, where the burden of lung cancer is greatest.

The use of tobacco cessation aids also remains lowest in the South and Midwest, the report says.

“The U.S. Tobacco Atlas is more than a report — it is a call to action. It reminds us that progress is possible, but not inevitable. It requires bold leadership, equitable policies, and unwavering commitment from every sector of society,” Dr. William Dahut, chief scientific officer at the American Cancer Society, said in a news release.

Other findings include:

• About 33% of people who use tobacco also use e-cigarettes.

• More than 1.6 million youth use e-cigarettes, with 90% preferring flavored products.

• Racial minorities, people with disabilities, LGBTQ+ individuals, and those with lower income and limited education face higher tobacco-related burdens.

“While we have made significant strides in reducing smoking prevalence and expanding access to evidence-based cessation resources, we remain deeply concerned about persistent disparities in tobacco use and tobacco-related disease,” senior author Dr. Ahmedin Jemal, senior scientific vice president of surveillance, prevention and health service research at the American Cancer Society, said in a news release.

“These disparities are particularly pronounced in states with weak tobacco control policies and among populations with lower socioeconomic status, and within communities historically targeted by the tobacco industry,” Jemal said. “This report brings these inequities into sharp focus and underscores the urgent need for strengthening state and federal tobacco control policies, as well as targeted interventions.”

More information

The U.S. Centers for Disease Control and Prevention has more on cigarette smoking among U.S. adults.

SOURCE: American Cancer Society, news release, Nov. 3, 2025