Abstract
Environmental exposures and avoidable risk factors account for a large proportion of cancer burden. Exposures and lifestyle vary over time and between populations, which calls for updated and population-specific quantification of how various avoidable risk factors influence cancer risk to plan and design rational and targeted prevention initiatives. The study considered 12 risk-factor groups categorized as class I carcinogens by IARC/WCRF. Exposure data was derived from national studies and surveys and were linked to cancer incidence in 2018 based on the nationwide Danish Cancer Registry. In 2018, 23,078 men and 21,196 women were diagnosed with cancer excluding non-melanoma skin cancer, in Denmark. Of these, 14,235 (32.2%) were estimated to be attributable to avoidable class I carcinogens. Tobacco smoking accounted for 14.6% of total cancers, followed by UV-radiation that accounted for 5.8%. Based on exposure data from 2008, one-third of the cancers in Denmark in 2018 are estimated to be caused by class I carcinogens with tobacco use being the main contributor followed by UV-radiation. Our results should be integrated with public health policies to effectively increase awareness and promote strategies to decrease risk factor exposures at population level.
Highlights
Environmental exposures and avoidable risk factors account for a large proportion of cancer burden
Incidence patterns vary between cancer types with increasing incidence in Denmark for e.g. brain tumors, kidney cancer, malignant melanoma of the skin and female thyroid cancer, whereas decreasing incidences are documented for ovarian cancer, lung cancer in men and pancreatic cancer in w omen[3,4]
We used a standard formula where p is the proportion of the population in each exposure level (1, 2, ... n) and excess relative risk (ERR) (the relative risk (RR) − 1) at each exposure level (1, 2, ... n)
Summary
Environmental exposures and avoidable risk factors account for a large proportion of cancer burden. Based on exposure data from 2008, one-third of the cancers in Denmark in 2018 are estimated to be caused by class I carcinogens with tobacco use being the main contributor followed by UV-radiation. The global number of patients with cancer is expected to double over the 50 years To counteract this trend evidence-based and comprehensive cancer prevention strategies are needed to reduce the prevalence of risk factors and thereby the number of future cancer cases. Estimates on 17 cancer types in 69 countries suggests that 42% of cancer cases would have been avoidable if known environmental risk factors had been e liminated[9]. While Denmark and UK are comparable neighbor countries, differences in risk factor prevalences exist, e.g., Denmark has higher smoking prevalence, while the UK has a higher prevalence of obesity, and PAF estimates have revealed substantial differences between various countries for specific risk factors, cancer types and combinations h ereof[13,14,15]
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