Priority For Cancer Prevention Research Articles

Cancer rates not explained by smoking: a county-level analysis

BackgroundDebates over the importance of “lifestyle” versus “environment” contributions to cancer have been going on for over 40 years. While it is clear that cigarette smoking is the most significant cancer risk factor, the contributions of occupational and environmental carcinogens in air, water and food remain controversial. In practice, most cancer prevention messaging focuses on reducing cigarette smoking and changing other personal behaviors with little mention of environmental chemicals, despite widespread exposure to many known carcinogens. To inform decision-making on cancer prevention priorities, we evaluated the potential impact of smoking cessation on cancer rates.MethodsUsing cancer incidence data from 612 counties in the SEER database, and county-level smoking prevalences, we investigated the impact of smoking cessation on incidence for 12 smoking-related cancer types, 2006—2016. A multilevel mixed-effects regression model quantified the association between county-level smoking prevalence and cancer incidence, adjusting for age, gender and variability over time and among counties. We simulated complete smoking cessation and estimated the effects on county-level cancer rates.ResultsRegression models showed the expected strong association between smoking prevalence and cancer incidence. Simulating complete smoking cessation, the incidence of the 12 smoking-related cancer types fell by 39.8% (54.9% for airways cancers; 28.9% for non-airways cancers). And, while the actual rates of smoking-related cancers from 2006 to 2016 declined (annual percent change (APC) = − 0.8, 95% CI = − 1.0 to − 0.5%), under the scenario of smoking elimination, the trend in cancer incidence at these sites was not declining (APC = − 0.1, 95% CI = − 0.4 to + 0.1%). Not all counties were predicted to benefit equally from smoking elimination, and cancer rates would fall less than 10% in some counties.ConclusionsSmoking prevention has produced dramatic reductions in cancer in the US for 12 major types. However, we estimate that eliminating smoking completely would not affect about 60% of cancer cases of the 12 smoking-related types, leaving no improvement in the incidence trend from 2006 to 2016. We conclude that cancer prevention strategies should focus not only on lifestyle changes but also the likely contributions of the full range of risk factors, including environmental/occupational carcinogens.

Abstract C132: A multilevel approach to accelerating the human papillomavirus (HPV) vaccine at a rural clinic for Native and non-Native youth

Abstract Accelerating the uptake of Human Papillomavirus (HPV) vaccinations is a priority for cancer prevention and an issue for mitigating cancer health disparities particularly among rural youth, both Native American and non-Native. The rate of HPV vaccinations for rural and Native adolescents is markedly lower than urban adolescents. Based on a Memorandum of Collaboration between the UC Davis Comprehensive Cancer Center and Northern Valley Indian Health (NVIH), a tribal health organization serving rural youth; funding from the National Cancer Institute; and the principles of community-based participatory research, we developed a multi-level approach to accelerate the HPV vaccination rates at the NVIH rural clinic in Willows, CA. Ultimately, the goal is to raise the HPV vaccination rates among patients ages 11-17 from the current 27% at this clinic to the Healthy People 2020 goal of 80%. Our presentation documents a year’s relationship-building that includes the intentional input and promising data from multiple levels for launching an accelerated HPV vaccination program, exemplifying the collaboration between NVIH and a NCI Comprehensive Cancer Center. Starting with community outreach and engagement, our multiple levels included provider and staff trainings; and parent workshops. We began by surveying 12 community members on their HPV vaccination knowledge, attitudes, and behaviors and learned that they had low knowledge of the HPV vaccine and stressed the importance of educating both the community as well as parents. We followed with training of 26 clinic providers and 44 staff (participants were from all four of NVIH’s medical clinics). Pre-tests were administered prior to the training and post-tests administered four months later. The training content had 3 objectives: (1) explaining the importance of HPV vaccinations and the rationale for vaccinating at ages 11-12; (2) providing an effective recommendation by clinicians; and (3) providing support to families to decide in favor of HPV vaccination. While there was attrition from pre to post tests, we achieved significant quantitative realignment of the rank order of HPV vaccination (from 3rd to most important) over other vaccinations and increased confidence in their ability to make a strong HPV vaccination recommendation (14% and 6% respectively). Interviews from parents provided insights on their perspectives of HPV vaccination that should be incorporated. Our next steps will be to apply these findings into a multi-pronged HPV vaccination intervention program for rural Native and non-Native adolescents. Citation Format: Julie HT Dang, Duke LeTran, Alexandra Gori, Arzoo Mojadedi, Teresa Martens, Sharon McClure, Inder Wadhwa, Chester Austin, Moon S Chen, Jr. A multilevel approach to accelerating the human papillomavirus (HPV) vaccine at a rural clinic for Native and non-Native youth [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C132.

Combined lifestyle factors, incident cancer, and cancer mortality: a systematic review and meta-analysis of prospective cohort studies

BackgroundCancer poses a huge disease burden, which could be reduced by adopting healthy lifestyles mainly composed of healthy diet, body weight, physical activity, limited alcohol consumption, and avoidance of smoking. However, no systematic review has summarised the relations of combined lifestyle factors with cancer morbidity and mortality.MethodsEMBASE and PubMed were searched up to April 2019. Cohort studies investigating the association of combined lifestyle factors with risks of incident cancer and cancer mortality were selected. Summary hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using random-effects models. Heterogeneity and publication bias tests were conducted.ResultsThe HRs (95% CIs) comparing individuals with the healthiest versus the least healthy lifestyles were 0.71 (0.66–0.76; 16 studies with 1.9 million participants) for incident cancer and 0.48 (0.42–0.54; 30 studies with 1.8 million participants) for cancer mortality. Adopting the healthiest lifestyles was also associated with 17 to 58% lower risks of bladder, breast, colon, endometrial, oesophageal, kidney, liver, lung, rectal, and gastric cancer. The relations were largely consistent and significant among participants with different characteristics in the subgroup analyses.ConclusionsAdopting healthy lifestyles is associated with substantial risk reduction in cancer morbidity and mortality, and thus should be given priority for cancer prevention.

Cancer and Body Composition: An Association of Global Relevance

Context: Worldwide, cancer is the second leading cause of death, with a rapidly increasing global incidence: it is present in high and in lower-middle income countries (LMICs). Overweight and obesity are also a major global health concern, and while they were once considered conditions specific to the ‘Western’ world, this geographic patterning has begun to shift. Evidence Acquisition: Given the large body of evidence regarding associations between lower socioeconomic status and greater cancer incidence and mortality, we undertook a narrative review focusing on global cancer burden and risk, and the association between cancer and body composition, particularly in LMICs. Using the MeSH terms ‘cancer’ and ‘body composition’, and keywords ‘overweight’ or ‘obesity’, and the phrase ‘lower-and middle-income countries’, we identified relevant articles for inclusion in this narrative review. Results: The key diagnostic mechanism underpinning these associations may be the varied prevalence and distribution of the risk factors most commonly associated to cancer incidence, including smoking, alcohol and diet. Approximately one-third of cancerrelated deaths in high income countries (HICs) are due to dietary and behavioural risk factors, which includes overweight and obesity and physical inactivity, and these same risk factors are prevalent in LMICs, which is where the current, yet minimal, priorities for cancer prevention are aimed at reducing. Conclusions: These data have specific relevance to LMICs in context of increasing levels of obesity, fewer healthcare resources in many LMICs, and lower financial investment into the prevention and management of cancer. Recognising and understanding the process by which cancer risk is linked to body composition parameters and obesity-related lifestyle factors will inform future intervention and prevention efforts. The focus needs to be directed towards implementing and practising such programs across all sectors of the globe, especially within low socioeconomic subpopulations.

La prévention des cancers : rôle et implication des professionnels de santé (in partie III : Les nouveaux enjeux de la prévention et du dépistage)

Priorities for cancer prevention in France are well identified: first of all reducing the exposure of the population to tobacco and alcohol consumption, improving the population food and physical activities practices, improving the protection and follow up of workers exposed to carcinogens, and a better understanding of the impact of long term exposure to environmental and food pollutants.Effective cancer prevention requires health professionals to take better account of the respective weight of the various causes of cancer. Their investment is necessary at several levels. In primary prevention for vaccinations, detection and help to addictions cessation, together with better taking into account all behavioral risk factors for their patients, giving scientifically supported information to help them make informed choices encouraging behavioral changes.This kind of investment is especially useful as well in tertiary prevention for the care and follow up of patients diagnosed with cancer.Health professionals also have an important part to play with patients to prevent misinformation and to overcome stereotypes on health issues at stake. They must have at their disposal a state of knowledge and uncertainty in every health field, including environmental health.

The Expanding Potential for Cohort Studies to Inform Priorities for Cancer Prevention

While the contributions of cohorts to informing cancer prevention have grown, areas that have been omitted from recent discussions are identified and implications for training discussed. In particular, greater familiarity with and collaboration in modeling of disease can inform prevention building from cohort data to synthesis of behavior, cohort, and population evidence.

Priorities for cancer prevention

1in favour of lifestyle choices to prevent cancer seems to be based on the questionable premise that pollutants should be investigated individually for their ability to cause disease. This approach might work for tobacco smoke and other easily isolated causes with obvious eff ects that lend themselves well to epidemiological study. However, it is not suitable for variable inadvertent exposures to complex mixtures of substances for long periods. Our best understanding is that several carcinogenic exposures accumulate and the overall eff ect is what causes cancer in individuals and populations. Stewart repeats some of the arguments of Colditz 2 and Thun 3

Priorities for cancer prevention: lifestyle choices versus unavoidable exposures

Although cancer prevention in the USA and other developed countries focuses on disease attributable to lifestyle factors such as smoking, alcohol intake, sun exposure, and obesity, cancer caused by involuntary exposures is a concern. The term environmental is ambiguously used to distinguish between lifestyle and unavoidable exposures. The general community is said to be vulnerable to carcinogens encountered in pollution, contaminated food, and consumer products. In view of these concerns, assessments of the carcinogenicity of particular chemicals are of little assistance in prevention of cancer. Appraisal of cancer attributable to widespread and localised pollution, pesticides, endocrine disrupting chemicals, and consumer products yields diverse outcomes, from established causation to absence of harm. The precautionary principle is not a practicable approach for unknown carcinogenic risks. Procedures for individuals to reduce exposure to recognised or suspect carcinogens in consumer products are not effective measures for cancer prevention. Anxiety concerning insidious cancer causation could divert attention from proven means of cancer prevention.

Phthalates Not in Plastic Food Packaging

I am writing with regard to a misleading photograph and caption in the article “Children’s Centers Study Kids and Chemicals” (Phillips 2005) published in the October 2005 issue of EHP. The article includes the following caption (p. A 665): Mothers, babies, and chemicals. Researchers are studying whether variations in the enzymes that metabolize the phthalates found in some plastic bottles correlate with later birth and growth outcomes. Above the caption is a photograph of a mother-to-be holding a plastic water bottle. Contrary to both the photograph and caption, phthalates are not used in plastic beverage bottles, nor are they used in plastic food wrap, food containers, or any other type of plastic food packaging sold in the United States. The term “phthalates,” short for “orthophthalates,” refers to a class of additives that are used in some plastic products, specifically products made with a particular type of plastic—polyvinyl chloride (PVC or vinyl)—to make the material soft and flexible. Vinyl shower curtains, cable, wire, and flooring are examples of flexible PVC products that can contain phthalates. Plastic beverage bottles sold in the United States are made from a type of plastic known as polyethylene terephthalate (PET). Although polyethylene terephthalate (the plastic) and phthalate (the additive) may have similar names, the substances are chemically dissimilar. PET is not considered an orthophthalate, nor does PET require the use of phthalates or other softening additives. Another article in the same issue, “Are EDCs Blurring Issues of Gender?” (Hood 2005), echoes this misperception concerning phthalates and plastic food packaging. The article, which discusses phthalates, contains a photograph of plastic beverage bottles (p. A675) and, in the last two paragraphs (p. A677), makes reference to both plastic wrap and Saran Wrap. As a point of clarification, phthalates are not used in plastic food wraps sold in the United States categorically, and SC Johnson’s website specifically states that “… phthalates are not used in any Saran or Ziploc product” (SC Johnson 2006). The article (Hood (2005) also discusses bisphenol A, a substance used to make the plastic in some reusable water bottles, but not the convenience-size beverage packaging shown in the photograph. The American Plastics Council respectfully requests that EHP address the misinformation that appeared in these articles and which is available on the EHP website.

Estimates of Cancer Incidence in China for 2000 and Projections for 2005

Abstract Knowledge of the incidence of cancer is a fundamental requirement of rational planning and monitoring of cancer control programs. The lack of national-level information systems on health indicators in China means that estimation methods are required. Estimates and projections of national level cancer mortality have been previously made using sample surveys of deaths. Using these mortality data, incidence rates in 2000 and 2005 were estimated by means of the ratio of cancer cases/deaths (by site, age, and sex) in good quality cancer registries in China. A total of 2.1 million cancer cases were estimated for the year 2000 (1.3 million in men, 0.8 million in women), with the most common sites being lung, liver, and stomach in men, and breast, lung, and stomach in women. The total number of new cases is expected to increase by 14.6% by 2005, primarily as a result of population growth and aging. In addition, the rising rates of lung cancer incidence (in both sexes) and breast cancer mean that there will be much greater increases in the number of cases at these two sites (27% for lung cancer in men, 38% for lung and breast cancer in women). These two cancers are now the priorities for cancer prevention, early detection, and therapy in China.

The Research and Development Agenda for Cancer Prevention and Education in Australia

In Australia the most important preventable causes of cancer, in order of importance, are tobacco smoking, diet, obesity, sunlight exposure, alcohol consumption and occupational exposure to carcinogens. We review and discuss these causes and their potential preventability and discuss three broad strategies in cancer prevention: public health policy and legislation, screening, and education and behavior change. In each of these broad areas, current research evidence and relevant approaches to research and development are considered. Six areas of research and development priority for cancer prevention and education are suggested: cigarette smoking (particularly among children and adolescents); protection of the skin from exposure to strong sunlight; screening; dietary choices; occupational exposures; and the social and environmental context of cancer prevention. All of these strategies and concerns will not apply to every country in the Asia-Pacific region but may be useful as guidelines and as a stimulus for determining particular local priorities.

Cost-effective priorities for cancer prevention.

Faced with limited resources, the United States must set priorities for research to identify preventable causes of cancer. A quantitative approach to priority setting, based on principles of decision analysis and cost-effectiveness analysis, can offer guidance in this process. An illustrative application of such a model suggests that the National Institutes of Health-supported clinical trial of dietary beta-carotene offers a greater expected reduction in cancer mortality per research dollar than carcinogen bioassays of high-volume industrial chemicals such as p-dichlorobenzene. National research priorities should reflect the relative cost-effectiveness of such investments.