Nav: Home

Comprehensive report says tobacco control must be highest priority in cancer control

October 10, 2018

The highest priority in a national cancer control plan must be expansion of tobacco control--the intervention with the largest potential health benefits--according to a new American Cancer Society report, the second in a series of articles that together inform priorities for a comprehensive cancer control plan. The report, appearing in CA: A Cancer Journal for Clinicians, says that although some cancer prevention interventions, such as increasing HPV vaccination rates, can be implemented fairly quickly, others, including promoting access to healthier living environments and addressing the social determinants of health, will require concerted and sustained efforts.

The second article in the series focuses on existing evidence about established, modifiable risk factors for cancer, the cancer burden in the United States due to each risk factor, and established primary prevention recommendations and interventions to reduce exposure to each risk factor. The report was led by Susan M. Gapstur, Ph.D., MPH, American Cancer Society Senior Vice President of Behavioral and Epidemiology Research.

The report focuses on several important modifiable risk factors:

Tobacco: More than half of the 26% decline in cancer mortality rates in the U.S. since 1991 is due to reductions in tobacco smoking. Despite this progress, tobacco smoking (active and second-hand smoke) remains the most common cause of cancers diagnosed (19.4%, n=304,880) and cancer death (29.6%, n=173,670). Moreover, the annual direct health care costs of tobacco in the U.S. are estimated to be $170 billion, and tobacco use results in $156 billion in lost productivity. There is considerable evidence that tobacco control can prevent more cancer deaths than any other primary prevention strategy.

The demographic profile of today's smoker has changed over the last half century.

Today, tobacco use is more prevalent among persons with lower educational attainment; lower income; within vulnerable populations, such as individuals with mental illness or addiction to other substances; within the Lesbian, Gay, Bisexual, Transgender (LGBT) community; and within certain racial or ethnic groups. Enhanced efforts to reach groups that are more likely to smoke are needed to further reduce the prevalence of tobacco use.

Obesity and overweight: In the U.S., approximately, 7.8% of cancer cases in 2014 were attributed to excess body fatness, second only to cigarette smoking. Its contribution was higher among women (10.9% of cases) than among men (4.8% of cases). Among women, 60.3% of uterine cancer and, among men and women combined, more than 30% of gallbladder, liver, and kidney/renal cancers as well as esophageal adenocarcinoma were attributed to excess body fatness. Despite clear evidence that excess body fatness contributes substantially to cancer risk, the full impact of the obesity epidemic on the cancer burden, including the long-term effect of obesity that begins in childhood, is yet to be completely understood.

Alcohol: Alcohol is the third most-important major modifiable contributor to cancer, associated with 6.4% of cancers in women and 4.8% of cancers in men in 2014. However, for some cancers, the attributable fraction exceeds 10%; among men and women combined, an estimated 40.9% of oral cavity/pharynx cancers, 23.2% of larynx cancers, 21.6% of liver cancers, 21% of esophageal cancers, and 12.8% of colorectal cancers were attributed to alcohol consumption. Notably, among women, alcohol intake accounted for 16.4% of all cases, or 39,060 breast cancers in 2014.

Diet: The combination of low calcium, fiber, and fruit and vegetable intake and high red and processed meat intake is estimated to cause 4.2% of cancers among men and women combined. However, there was considerable variation across specific dietary factors and types of cancer. For example, 5.4% of colorectal cancers are associated with high red meat consumption causes, 8.2% with high processed meat consumption, and 10.3% and 4.9% for low dietary fiber and calcium consumption, respectively. Low fruit and vegetable consumption was attributed to 17.6% and 17.4% of oral cavity/pharynx and larynx cancers, respectively. A lack of clear evidence about the role of early life dietary exposures as well as many other dietary hypotheses means the percentage of cancers attributable to diet may continue to rise beyond current estimates once more is known.

Physical inactivity It is estimated that 2.9% of all cancer cases in the U.S. in 2014 were attributable to low physical activity, with the contribution greater among women (4.4%) than among men (1.5%). The cancer with the highest percentage related to low physical activity was uterine cancer (26.7%), followed by colorectal cancer (6.3% among men and women combined). As additional cancer types are determined to be causally associated with low amounts of physical activity, the total number of cancer cases attributed to low physical activity will continue to rise.

In the U.S., an estimated 13.9% of cancers among men and 22.4% among women in 2014 were attributable to the combination of excess body weight, poor diet, physical inactivity, and alcohol consumption. Reversing the obesity epidemic and increasing the prevalence of healthy eating and active living hold considerable potential for reducing cancer incidence and mortality rates. Achieving this potential, write the authors, will require a comprehensive approach, including evidence-based, primary prevention interventions that target communities and individuals.

Sugar-sweetened beverage consumption has been consistently associated with weight gain, overweight, and obesity. Consistent with the effectiveness of raising tobacco taxes on reducing the use of tobacco products, the broad implementation of excise taxes on these products has the potential to reduce consumption of sugar sweetened beverages.

In the U.S., an estimated 4% of human cancers are attributed to infectious agents. For several types of cancer, infectious agents are the dominant known risk factors. The report details six of the eleven pathogens classified as being human carcinogens: H. pylori (the only bacterium), human papillomavirus (HPV), hepatitis B, hepatitis C, Epstein-Barr, and human immunodeficiency virus (HIV).

Recent estimates indicate that approximately 95% of all cutaneous melanoma cases in the U.S. may be attributable to UV radiation exposure from the sun and indoor tanning. More than 9000 men and women die each year from melanoma in the U.S. alone.

The proportion of ionizing radiation the general public is exposed to that comes from medical sources has increased significantly. In the 1980s, exposure from things like diagnostic and therapeutic procedures accounted for 15% of total radiation exposure. By 2006, that proportion had risen to 48%. The large increase has been attributed to significant increases in the number of CT procedures.

Radon exposure caused 13% (21,000) of all lung cancer deaths in the U.S. in 1995, making radon the second leading cause of lung cancer behind smoking. According to a risk assessment by the National Research Council, approximately 3% to 4% of all lung cancer deaths in the U.S. could be prevented by mitigating all homes with radon levels at or above the EPA action level.

"A comprehensive cancer control plan designed to support the implementation of evidence-based interventions, including cancer prevention interventions like those we described has enormous potential to substantially reduce the number of individuals diagnosed with and dying from cancer," said Dr. Gapstur. "It is the responsibility of government and industry as well as the public health, medical, and scientific communities to work together to invest in and implement a comprehensive cancer control plan at the national level and support and expand ongoing initiatives at the state and local levels. If we fail to do so, we will slow progress in our national efforts to reduce the burden of cancer."
-end-
Article: A Blueprint for the Primary Prevention of Cancer: Targeting Established, Modifiable Risk Factors; CA: Cancer J Clin. 2018; doi: 10.3322/caac.21496.

American Cancer Society

Related Lung Cancer Articles:

Lung cancer therapy may improve outcomes of metastatic brain cancer
A medication commonly used to treat non-small cell lung cancer that has spread, or metastasized, may have benefits for patients with metastatic brain cancers, suggests a new review and analysis led by researchers at St.
Cancer mortality continues steady decline, driven by progress against lung cancer
The cancer death rate declined by 29% from 1991 to 2017, including a 2.2% drop from 2016 to 2017, the largest single-year drop in cancer mortality ever reported.
Cancer-sniffing dogs 97% accurate in identifying lung cancer, according to study in JAOA
The next step will be to further fractionate the samples based on chemical and physical properties, presenting them back to the dogs until the specific biomarkers for each cancer are identified.
Lung transplant patients face elevated lung cancer risk
In an American Journal of Transplantation study, lung cancer risk was increased after lung transplantation, especially in the native (non-transplanted) lung of single lung transplant recipients.
Proposed cancer treatment may boost lung cancer stem cells, study warns
Epigenetic therapies -- targeting enzymes that alter what genes are turned on or off in a cell -- are of growing interest in the cancer field as a way of making a cancer less aggressive or less malignant.
Are you at risk for lung cancer?
This question isn't only for people who've smoked a lot.
Better equipped in the fight against lung cancer
Lung cancer is the third most common type of cancer in Germany and the disease affects both men and women.
New liquid biopsy-based cancer model reveals data on deadly lung cancer
Small cell lung cancer (SCLC) accounts for 14 percent of all lung cancers and is often rapidly resistant to chemotherapy resulting in poor clinical outcomes.
Cancer drug leads to 'drastic decrease' in HIV infection in lung cancer patient
Doctors in France have found the first evidence that a cancer drug may be able to eradicate HIV-infected cells in humans.
Air pollution is associated with cancer mortality beyond lung cancer
A large scale epidemiological study associates some air pollutants with kidney, bladder and colorectal cancer death.
More Lung Cancer News and Lung Cancer Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Climate Mindset
In the past few months, human beings have come together to fight a global threat. This hour, TED speakers explore how our response can be the catalyst to fight another global crisis: climate change. Guests include political strategist Tom Rivett-Carnac, diplomat Christiana Figueres, climate justice activist Xiye Bastida, and writer, illustrator, and artist Oliver Jeffers.
Now Playing: Science for the People

#562 Superbug to Bedside
By now we're all good and scared about antibiotic resistance, one of the many things coming to get us all. But there's good news, sort of. News antibiotics are coming out! How do they get tested? What does that kind of a trial look like and how does it happen? Host Bethany Brookeshire talks with Matt McCarthy, author of "Superbugs: The Race to Stop an Epidemic", about the ins and outs of testing a new antibiotic in the hospital.
Now Playing: Radiolab

Speedy Beet
There are few musical moments more well-worn than the first four notes of Beethoven's Fifth Symphony. But in this short, we find out that Beethoven might have made a last-ditch effort to keep his music from ever feeling familiar, to keep pushing his listeners to a kind of psychological limit. Big thanks to our Brooklyn Philharmonic musicians: Deborah Buck and Suzy Perelman on violin, Arash Amini on cello, and Ah Ling Neu on viola. And check out The First Four Notes, Matthew Guerrieri's book on Beethoven's Fifth. Support Radiolab today at Radiolab.org/donate.