Purpose <p>Engaging in COVID-19 preventive behaviors (e.g., wearing masks) can be particularly important for cancer survivors to avoid infectious disease. This cross-sectional study aimed to examine preventive behaviors of Black and White cancer survivors residing in North Carolina during the COVID-19 pandemic.</p> Methods <p>From February through September 2022, we recruited 548 cancer survivors from the University of North Carolina Health Registry/Cancer Survivorship Cohort. Participants completed a retrospective survey about their COVID-preventive behaviors between March 2020 and December 2020 (Time 1) and within the last 30&#xa0;days (Time 2). We examined differences and changes over time in the prevalence of behaviors by race.</p> Results <p>At Time 1, Black cancer survivors had a higher prevalence of wearing gloves (adjusted prevalence ratio [aPR], 2.99; 95% CI 1.33–6.75), limiting visitors inside their homes (aPR, 1.22; 95% CI, 1.06–1.39), and avoiding public spaces, gatherings, and crowds (aPR, 1.13; 95% CI, 1.01–1.26) compared to White cancer survivors. While both Black and White cancer survivors decreased the prevalence of preventive behaviors at Time 2, White cancer survivors decreased their preventive behaviors at a greater rate than Black cancer survivors.</p> Conclusions <p>Black cancer survivors took more behavioral precautions and continued them over time at a higher rate than White cancer survivors. Despite the use of individual-level COVID-related preventive measures, inequities in COVID-related morbidity and mortality persist, underscoring the need for more multi-level interventions to address COVID-related inequities.</p> Implications for Cancer Survivors <p>State and local prioritization of equitable resource allocation to cancer survivors may improve&#xa0;long-term survivorship care and well-being.</p>