Abstract
The purpose of the present study was to calculate the proportion of cancers in Canada attributable to tobacco smoking (ts), alcohol use (au), excess weight (ew), and physical inactivity (pia); to explore variation in the proportions of those risk factors (rfs) over time by sex and province; to estimate the economic burden of cancer attributable to the 4 rfs; and to calculate the potential reduction in cancers and economic burden if all provinces achieved rf prevalence rates equivalent to the best in Canada. We used a previously developed approach based on population-attributable fractions (pafs) to estimate the cancer-related economic burden associated with the four rfs. Sex-specific relative risk and age- and sex-specific prevalence data were used in the modelling. The economic burden was adjusted for potential double counting of cases and costs. In Canada, 27.7% of incident cancer cases [95% confidence interval (ci): 22.6% to 32.9%] in 2013 [47,000 of 170,000 (95% ci: 38,400-55,900)] were attributable to the four rfs: ts, 15.2% (95% ci: 13.7% to 16.9%); ew, 5.1% (95% ci: 3.8% to 6.4%); au, 3.9% (95% ci: 2.4% to 5.3%); and pia, 3.5% (95% ci: 2.7% to 4.3%). The annual economic burden attributable to the 47,000 total cancers was $9.6 billion (95% ci: $7.8 billion to $11.3 billion): consisting of $1.7 billion in direct and $8.0 billion in indirect costs. Applying the lowest rf rates to each province would result in an annual reduction of 6204 cancers (13.2% of the potentially avoidable cancers) and a reduction in economic burden of $1.2 billion. Despite substantial reductions in the prevalence and intensity of ts, ts remains the dominant risk factor from the perspective of cancer prevention in Canada, although ew and au are becoming increasingly important rfs.
Highlights
Assessing the economics of cancers and their management has a long history in Canada
The effects of smoking and alcohol use are higher in men than in women, and the effects of excess weight and physical inactivity are higher in women (Table i)
The prevalence of tobacco smoking in Canada has declined to 17.5% in 2013 from 21.6% in 2000; at the same time, the prevalence of physical inactivity declined to 43.6% from 49.0%
Summary
Assessing the economics of cancers and their management has a long history in Canada. In the early 1990s, Statistics Canada developed the Population Health Model to “assist in the evaluation of cancer control interventions and policy decision-making”[1], with a focus on lung[2,3], breast[4,5,6], and colorectal cancers[7]. The Canadian Partnership Against Cancer developed the Cancer Risk Management Model to “gain insight into the cost/benefit of cancer control strategies to help guide and strengthen decision-making”[8], with a focus on lung[9] and colorectal cancers[10]. Parkin and colleagues found that 14 rfs are responsible for 42.7% of cancers in the United Kingdom[17] Of those 14 rfs, 4 (smoking, excess weight, alcohol use, and physical inactivity) cause 70% of preventable cancers
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