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CA Cancer J Clin. 2018 Jan;68(1):31-54. doi: 10.3322/caac.21440. Epub 2017 Nov 21.

Proportion and number of cancer cases and deaths attributable to potentially modifiable risk factors in the United States.

Author information

1
Strategic Director, Cancer Surveillance Research, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA.
2
Epidemiologist, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA.
3
Strategic Director, Surveillance Information, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA.
4
Strategic Director, Risk Factors and Screening Surveillance, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA.
5
Strategic Director, Pharmacoepidemiology, Epidemiology Research Program, American Cancer Society, Atlanta, GA.
6
Strategic Director, Nutritional Epidemiology, Epidemiology Research Program, American Cancer Society, Atlanta, GA.
7
Strategic Director, Cancer Prevention Study-3, Epidemiology Research Program, American Cancer Society, Atlanta, GA.
8
Strategic Director, Cancer Interventions Surveillance, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA.
9
Scientist, Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France.
10
Professor, Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.
11
Chief Medical and Science Officer, Executive Vice President, Research, American Cancer Society, Atlanta, GA.
12
Vice President, Epidemiology Research Program, American Cancer Society, Atlanta, GA.
13
Vice President, Surveillance and Health Services Research Program, American Cancer Society, Atlanta, GA.

Abstract

Contemporary information on the fraction of cancers that potentially could be prevented is useful for priority setting in cancer prevention and control. Herein, the authors estimate the proportion and number of invasive cancer cases and deaths, overall (excluding nonmelanoma skin cancers) and for 26 cancer types, in adults aged 30 years and older in the United States in 2014, that were attributable to major, potentially modifiable exposures (cigarette smoking; secondhand smoke; excess body weight; alcohol intake; consumption of red and processed meat; low consumption of fruits/vegetables, dietary fiber, and dietary calcium; physical inactivity; ultraviolet radiation; and 6 cancer-associated infections). The numbers of cancer cases were obtained from the Centers for Disease Control and Prevention (CDC) and the National Cancer Institute; the numbers of deaths were obtained from the CDC; risk factor prevalence estimates were obtained from nationally representative surveys; and associated relative risks of cancer were obtained from published, large-scale pooled analyses or meta-analyses. In the United States in 2014, an estimated 42.0% of all incident cancers (659,640 of 1570,975 cancers, excluding nonmelanoma skin cancers) and 45.1% of cancer deaths (265,150 of 587,521 deaths) were attributable to evaluated risk factors. Cigarette smoking accounted for the highest proportion of cancer cases (19.0%; 298,970 cases) and deaths (28.8%; 169,180 deaths), followed by excess body weight (7.8% and 6.5%, respectively) and alcohol intake (5.6% and 4.0%, respectively). Lung cancer had the highest number of cancers (184,970 cases) and deaths (132,960 deaths) attributable to evaluated risk factors, followed by colorectal cancer (76,910 cases and 28,290 deaths). These results, however, may underestimate the overall proportion of cancers attributable to modifiable factors, because the impact of all established risk factors could not be quantified, and many likely modifiable risk factors are not yet firmly established as causal. Nevertheless, these findings underscore the vast potential for reducing cancer morbidity and mortality through broad and equitable implementation of known preventive measures. CA Cancer J Clin 2018;68:31-54.

KEYWORDS:

cancer; population-attributable fraction; prevention; risk factor

PMID:
29160902
DOI:
10.3322/caac.21440
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