Cancer prevention

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Cancer prevention is the practice of taking active measures to decrease the incidence of cancer and mortality. [1] [2] The practice of prevention is dependent upon both individual efforts to improve lifestyle and seek preventive screening, and socioeconomic or public policy related to cancer prevention. [3] Globalized cancer prevention is regarded as a critical objective due to its applicability to large populations, reducing long term effects of cancer by promoting proactive health practices and behaviors, and its perceived cost-effectiveness and viability for all socioeconomic classes. [2]

Contents

The majority of cancer cases are due to the accumulation of environmental pollution being inherited as epigenetic damage and many, but not all, of these environmental factors are controllable lifestyle choices. [4] Greater than a reported 75% of cancer deaths could be prevented by avoiding risk factors including: tobacco, overweight / obesity, an insufficient diet, physical inactivity, alcohol, sexually transmitted infections, and air pollution. [5] [6] Not all environmental causes are controllable, such as naturally occurring background radiation, and other cases of cancer are caused through hereditary genetic disorders. Current gene editing techniques under development may serve as preventive measures in the future. [7] Future preventive screening measures can be additionally improved by minimizing invasiveness and increasing specificity by taking individual biologic make up into account, also known as "population-based personalized cancer screening." [2]

Focuses

Death rate adjusted for age for malignant cancer per 100,000 inhabitants in 2004. .mw-parser-output .legend{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .legend-color{display:inline-block;min-width:1.25em;height:1.25em;line-height:1.25;margin:1px 0;text-align:center;border:1px solid black;background-color:transparent;color:black}.mw-parser-output .legend-text{} no data <= 55 55-80 80-105 105-130 130-155 155-180 180-205 205-230 230-255 255-280 280-305 >= 305 Malignant neoplasms world map - Death - WHO2004.svg
Death rate adjusted for age for malignant cancer per 100,000 inhabitants in 2004.

While anyone can get cancer, [9] age is one of the biggest factors that can make a person more likely to get cancer: 3 out of 4 cancers are found in people aged 55 or older.

Dietary

This advertisement advises a healthy diet to prevent cancer. Make healthy choices poster.jpg
This advertisement advises a healthy diet to prevent cancer.

While many dietary recommendations have been proposed to reduce the risk of cancer, the evidence to support them is not definitive. [10] [11] The primary dietary factors that increase risk are obesity and alcohol consumption; with a diet low in fruits and vegetables and high in red meat being implicated but not confirmed. [12] [13] A 2014 meta-analysis did not find a relationship between fruits and vegetables and cancer. [14] Consumption of coffee is associated with a reduced risk of liver cancer. [15] Studies have linked excessive consumption of red or processed meat to an increased risk of breast cancer, colon cancer, and pancreatic cancer, a phenomenon which could be due to the presence of carcinogens in meats cooked at high temperatures. [16] [17] Dietary recommendations for cancer prevention typically include an emphasis on vegetables, fruit, whole grains, and fish, and an avoidance of processed and red meat (beef, pork, lamb), animal fats, and refined carbohydrates. [10] [11]

Physical activity

Research shows that regular physical activity helps to reduce up to 30% [18] [19] the risk of a variety of cancer types, such as colon cancer, breast cancer, lung cancer and endometrium cancer. [20] [21] The biological mechanisms underlying this association are still not well understood [21] but different biological pathways involved in cancer have been studied suggesting that physical activity reduces cancer risk by helping weight control, reducing hormones such as estrogen and insulin, reducing inflammation and strengthening the immune system. [21] [22] As little as four minutes a day of exercise has been shown to reduce cancer risk by 17%. [23]

Medication and supplements

The concept that medications can be used to prevent cancer is attractive, and evidence supports their use in a few defined circumstances. [24] [ not specific enough to verify ] In the general population, NSAIDs reduce the risk of colorectal cancer however due to the cardiovascular and gastrointestinal side effects they cause overall harm when used for prevention. [25] Aspirin has been found to reduce the risk of death from cancer by about 7%. [26] COX-2 inhibitor may decrease the rate of polyp formation in people with familial adenomatous polyposis however are associated with the same adverse effects as NSAIDs. [27] Daily use of tamoxifen or raloxifene has been demonstrated to reduce the risk of developing breast cancer in high-risk women. [28] The benefit verses harm for 5-alpha-reductase inhibitor such as finasteride is not clear. [29] A study showing a proof-of-principle has also been done with the human proteins IFNalpha2a and macrophage-CSF, produced by genetically modified hens. [30]

Vitamins have not been found to be effective at preventing cancer, [31] although low blood levels of vitamin D are correlated with increased cancer risk. [32] [33] Whether this relationship is causal and vitamin D supplementation is protective is not determined. [34] Beta-Carotene supplementation has been found to increase lung cancer rates in those who are high risk. [35] Folic acid supplementation has not been found effective in preventing colon cancer and may increase colon polyps. [36] A 2018 systematic review concluded that selenium has no beneficial effect in reducing the risk of cancer based on high quality evidence. [37]

Vaccination

Anti-cancer vaccines can be preventive / prophylactic or be used as therapeutic treatment. [2] All such vaccines incite adaptive immunity by enhancing cytotoxic T lymphocyte (CTL) recognition and activity against tumor-associated or tumor-specific antigens (TAA and TSAs).

Vaccines have been developed that prevent infection by some carcinogenic viruses. [38] Human papillomavirus vaccine (Gardasil and Cervarix) decreases the risk of developing cervical cancer. [38] The hepatitis B vaccine prevents infection with hepatitis B virus and thus decreases the risk of liver cancer. [38] The administration of human papillomavirus and hepatitis B vaccinations is recommended when resources allow. [39]

Some cancer vaccines are usually immunoglobulin-based and target antigens specific to cancer or abnormal human cells. [2] [40] These vaccines may be given to treat cancer during the progression of disease to boost the immune system's ability to recognize and attack cancer antigens as foreign entities. Antibodies for cancer cell vaccines may be taken from the patient's own body (autologous vaccine) or from another patient (allogeneic vaccine). [38] Several autologous vaccines, such as Oncophage for kidney cancer and Vitespen for a variety of cancers, have either been released or are undergoing clinical trial. FDA-approved vaccines, such as Sipuleucel-T for metastasizing prostate cancer or Nivolumab for melanoma and lung cancer can act either by targeting over-expressed or mutated proteins or by temporarily inhibiting immune checkpoints to boost immune activity. [2] [41]

Screening

Screening procedures, commonly sought for more prevalent cancers, such as colon, breast, and cervical, have greatly improved in the past few decades from advances in biomarker identification and detection. [2] Early detection of pancreatic cancer biomarkers was accomplished using SERS-based immunoassay approach. [42] A SERS-base multiplex proteinbiomarker detection platform in a microfluidic chip to detect is used to detect several protein biomarkers to predict the type of disease and critical biomarkers and increase the chance of diagnosis between diseases with similar biomarkers (PC, OVC, and pancreatitis). [43]

For detecting cancer early all eligible people need to go to screenings but disadvantaged groups face different barriers that lead to lower attendance rates. [44]

Cervical cancer

Cervical cancer is usually screened through in vitro examination of the cells of the cervix (e.g. Pap smear), colposcopy, or direct inspection of the cervix (after application of dilute acetic acid), or testing for HPV, the oncogenic virus that is the necessary cause of cervical cancer. [38] Screening is recommended for women over 21 years, initially women between 21–29 years old are encouraged to receive Pap smear screens every three years, and those over 29 every five years. [2] For women older than the age of 65 and with no history of cervical cancer or abnormality, and with an appropriate precedence of negative Pap test results may cease regular screening. [45]

Still, adherence to recommended screening plans depends on age and may be linked to "educational level, culture, psychosocial issues, and marital status," further emphasizing the importance of addressing these challenges in regards to cancer screening. [2]

Colorectal cancer

Colorectal cancer is most often screened with the fecal occult blood test (FOBT). Variants of this test include guaiac-based FOBT (gFOBT), the fecal immunochemical test (FIT), and stool DNA (sDNA) testing. [46] Further testing includes flexible sigmoidoscopy (FS), total colonoscopy (TC), or computed tomography (CT) scans if a TC is non-ideal. A recommended age at which to begin screening is 50 years. However, this is highly dependent on medical history and exposure to CRC risk factors. Effective screening has been shown to reduce CRC incidence by 33% and CRC morality by 43%. [2]

Breast cancer

The estimated number of new breast cancer cases in the US in 2018 is predicted to be more than 1.7 million, with more than six-hundred thousand deaths. [47] Factors such as breast size, reduced physical activity, obesity and overweight status, infertility and never having had children, hormone replacement therapy (HRT), and genetics are risk factors for breast cancer. [2] Mammograms are widely used to screen for breast cancer, and are recommended for women 50–74 years of age by the US Preventive Services Task Force (USPSTF). However, the USPSTF recommended against mammographies for women 40–49 years old due to possibility of overdiagnosis. [2] [48]

Preventable causes of cancer

As of 2017, tobacco use, diet and nutrition, physical activity, obesity/overweight status, infectious agents, and chemical and physical carcinogens have been reported to be the leading areas where cancer prevention can be practiced through enacting positive lifestyle changes, getting appropriate regular screening, and getting vaccinated. [49]

The development of many common cancers are incited by such risk factors. For example, consumption of tobacco and alcohol, a medical history of genital warts and STDs, immunosuppression, unprotected sex, and early age of first sexual intercourse and pregnancy all may serve as risk factors for cervical cancer. Obesity, red meat or processed meat consumption, tobacco and alcohol, and a medical history of inflammatory bowel diseases are all risk factors for colorectal cancer (CRC). On the other hand, exercise and consumption of vegetables may help decrease the risk of CRC. [2]

Several preventable causes of cancer were highlighted in Doll and Peto's landmark 1981 study, [5] estimating that 75 – 80% of cancers in the United States could be prevented by avoidance of 11 different factors. A 2013 review of more recent cancer prevention literature by Schottenfeld et al., [50] summarizing studies reported between 2000 and 2010, points to most of the same avoidable factors identified by Doll and Peto. However, Schottenfeld et al. considered fewer factors (e.g. non inclusion of diet) in their review than Doll and Peto, and indicated that avoidance of these fewer factors would result in prevention of 60% of cancer deaths. The table below indicates the proportions of cancer deaths attributed to different factors, summarizing the observations of Doll and Peto, Shottenfeld et al. and several other authors, and shows the influence of major lifestyle factors on the prevention of cancer, such as tobacco, an unhealthy diet, obesity and infections.

Proportions of cancer deaths in the United States attributed to different factors
FactorDoll &
Peto [5] 		Schottenfeld
et al. [50] 		Other reports
Tobacco 30%30%38% men, 23% women, [51] 30%, [52] 25-30% [6]
Deleterious diet35%-32%, [53] 10%, [54] 30-35% [6]
Obesity *10%14% women, 20% men, among non-smokers, [55] 10-20%, [6] 19-20% United States, 16-18% Great Britain, 13% Brazil, 11-12% China [56]
Infection†10%5-8%7-10%, [57] 8% developed nations, 26% developing nations, [52] 10% high income, 25% African [6]
Alcohol 3%3-4%3.6%, [52] 8% USA, 20% France [58]
Occupational exposures4%3-5%2-10%, may be 15-20% in men [59]
Radiation (solar and ionizing) 3%3-4%up to 10% [6]
Physical inactivity *<5%7% [60]
Reproductive and sexual behavior1-13%--
Pollution2%--
Medicines and medical procedures1%--
Industrial products<1%--
Food additives<1%--

*Included in diet

†Carcinogenic infections include: for the uterine cervix (human papillomavirus [HPV]), liver (hepatitis B virus [HBV] and hepatitis C virus [HCV]), stomach (Helicobacter pylori [H pylori]), lymphoid tissues (Epstein-Barr virus [EBV]), nasopharynx (EBV), urinary bladder (Schistosoma hematobium), and biliary tract (Opisthorchis viverrini, Clonorchis sinensis)

History of cancer prevention

Cancer has been thought to be a preventable disease since the time of Roman physician Galen, who observed that unhealthy diet was correlated with cancer incidence. In 1713, Italian physician Ramazzini hypothesized that abstinence caused lower rates of cervical cancer in nuns. Further observation in the 18th century led to the discovery that certain chemicals, such as tobacco, soot and tar (leading to scrotal cancer in chimney sweepers, as reported by Percivall Pot in 1775), could serve as carcinogens for humans. Although Potts suggested preventive measures for chimney sweeps (wearing clothes to prevent contact bodily contact with soot), his suggestions were only put into practice in Holland, resulting in decreasing rates of scrotal cancer in chimney sweeps. Later, the 19th century brought on the onset of the classification of chemical carcinogens. [61]

In the early 20th century, physical and biological carcinogens, such as X ray radiation or the Rous Sarcoma Virus discovered 1911, were identified. Despite observed correlation of environmental or chemical factors with cancer development, there was a deficit of formal prevention research and lifestyle changes for cancer prevention were not feasible during this time. [61]

In Europe, in 1987 the European Commission launched the European Code Against Cancer to help educate the public about actions they can take to reduce their risk of getting cancer. [62] The first version of the Code covered 10 recommendations covering tobacco, alcohol, diet, weight, sun exposure, exposure to known carcinogens, early detection and participation in organised breast and cervical cancer screening programmes. [63] In the early 1990s, the European School of Oncology led a review of the Code and added details about the scientific evidence behind each of the recommendations. [63] Later updates were coordinated by the International Agency for Research on Cancer. The fourth edition of the Code, , developed in 2012‒2013, also includes recommendations on participation in vaccination programmes for hepatitis B (infants) and human papillomavirus (girls), breast feeding and hormone replacement therapy, and participation in organised colorectal cancer screening programmes.

See also

Related Research Articles

<span class="mw-page-title-main">Cervical cancer</span> Cancer arising from the cervix

Cervical cancer is a cancer arising from the cervix. It is due to the abnormal growth of cells that have the ability to invade or spread to other parts of the body. Early on, typically no symptoms are seen. Later symptoms may include abnormal vaginal bleeding, pelvic pain or pain during sexual intercourse. While bleeding after sex may not be serious, it may also indicate the presence of cervical cancer.

<span class="mw-page-title-main">Breast cancer</span> Cancer that originates in mammary glands

Breast cancer is a cancer that develops from breast tissue. Signs of breast cancer may include a lump in the breast, a change in breast shape, dimpling of the skin, milk rejection, fluid coming from the nipple, a newly inverted nipple, or a red or scaly patch of skin. In those with distant spread of the disease, there may be bone pain, swollen lymph nodes, shortness of breath, or yellow skin.

<span class="mw-page-title-main">Cancer</span> Group of diseases involving abnormal cell growth and spread

Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors, which do not spread. Possible signs and symptoms include a lump, abnormal bleeding, prolonged cough, unexplained weight loss, and a change in bowel movements. While these symptoms may indicate cancer, they can also have other causes. Over 100 types of cancers affect humans.

<span class="mw-page-title-main">Human papillomavirus infection</span> Human disease

Human papillomavirus infection is caused by a DNA virus from the Papillomaviridae family. Many HPV infections cause no symptoms and 90% resolve spontaneously within two years. In some cases, an HPV infection persists and results in either warts or precancerous lesions. These lesions, depending on the site affected, increase the risk of cancer of the cervix, vulva, vagina, penis, anus, mouth, tonsils, or throat. Nearly all cervical cancer is due to HPV, and two strains – HPV16 and HPV18 – account for 70% of all cases. HPV16 is responsible for almost 90% of HPV-positive oropharyngeal cancers. Between 60% and 90% of the other cancers listed above are also linked to HPV. HPV6 and HPV11 are common causes of genital warts and laryngeal papillomatosis.

<span class="mw-page-title-main">Colorectal cancer</span> Cancer of the colon or rectum

Colorectal cancer (CRC), also known as bowel cancer, colon cancer, or rectal cancer, is the development of cancer from the colon or rectum. Signs and symptoms may include blood in the stool, a change in bowel movements, weight loss, and fatigue. Most colorectal cancers are due to old age and lifestyle factors, with only a small number of cases due to underlying genetic disorders. Risk factors include diet, obesity, smoking, and lack of physical activity. Dietary factors that increase the risk include red meat, processed meat, and alcohol. Another risk factor is inflammatory bowel disease, which includes Crohn's disease and ulcerative colitis. Some of the inherited genetic disorders that can cause colorectal cancer include familial adenomatous polyposis and hereditary non-polyposis colon cancer; however, these represent less than 5% of cases. It typically starts as a benign tumor, often in the form of a polyp, which over time becomes cancerous.

Lifestyle diseases can be defined as diseases linked with one's lifestyle. These diseases are non-communicable diseases. They are caused by lack of physical activity, unhealthy eating, alcohol, substance use disorders and smoking tobacco, which can lead to heart disease, stroke, obesity, type II diabetes and lung cancer. The diseases that appear to increase in frequency as countries become more industrialized and people live longer include Alzheimer's disease, arthritis, atherosclerosis, asthma, cancer, chronic liver disease or cirrhosis, chronic obstructive pulmonary disease, colitis, irritable bowel syndrome, type 2 diabetes, heart disease, hypertension, metabolic syndrome, chronic kidney failure, osteoporosis, PCOD, stroke, depression, obesity and vascular dementia.

<span class="mw-page-title-main">Cardiovascular disease</span> Class of diseases that involve the heart or blood vessels

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<span class="mw-page-title-main">Deoxycholic acid</span> Bile acid

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<span class="mw-page-title-main">Preventive healthcare</span> Prevention of the occurrence of diseases

Preventive healthcare, or prophylaxis, is the application of healthcare measures to prevent diseases. Disease and disability are affected by environmental factors, genetic predisposition, disease agents, and lifestyle choices, and are dynamic processes that begin before individuals realize they are affected. Disease prevention relies on anticipatory actions that can be categorized as primal, primary, secondary, and tertiary prevention.

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<span class="mw-page-title-main">Red meat</span> Meat which is red when raw, with high myoglobin content

In gastronomy, red meat is commonly red when raw, in contrast to white meat, which is pale in color before cooking. In culinary terms, only flesh from mammals or fowl is classified as red or white. In nutritional science, red meat is defined as any meat that has more of the protein myoglobin than white meat. White meat is defined as non-dark meat from fish or chicken.

<span class="mw-page-title-main">Alcohol and cancer</span> Relationship between cancer and the consumption of alcohol

Alcohol causes cancers of the oesophagus, liver, breast, colon, oral cavity, rectum, pharynx, and larynx, and probably causes cancers of the pancreas. Consumption of alcohol in any quantity can cause cancer. The more alcohol is consumed, the higher the cancer risk, and no amount can be considered safe. Alcoholic beverages were classified as a Group 1 carcinogen by the International Agency for Research on Cancer (IARC) in 1988.. An estimated 3.6% of all cancer cases and 3.5% of cancer deaths worldwide are attributable to consumption of alcohol. 740,000 cases of cancer in 2020 or 4.1% of new cancer cases were attributed to alcohol.

<span class="mw-page-title-main">Diet and cancer</span> Connections between dietary habits and cancer

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Risk factors for breast cancer may be divided into preventable and non-preventable. Their study belongs in the field of epidemiology. Breast cancer, like other forms of cancer, can result from multiple environmental and hereditary risk factors. The term environmental, as used by cancer researchers, means any risk factor that is not genetically inherited.

<span class="mw-page-title-main">Cancer screening</span> Method to detect cancer

Cancer screening aims to detect cancer before symptoms appear. This may involve blood tests, urine tests, DNA tests, other tests, or medical imaging. The benefits of screening in terms of cancer prevention, early detection and subsequent treatment must be weighed against any harms.

Cancer is caused by genetic changes leading to uncontrolled cell growth and tumor formation. The basic cause of sporadic (non-familial) cancers is DNA damage and genomic instability. A minority of cancers are due to inherited genetic mutations. Most cancers are related to environmental, lifestyle, or behavioral exposures. Cancer is generally not contagious in humans, though it can be caused by oncoviruses and cancer bacteria. The term "environmental", as used by cancer researchers, refers to everything outside the body that interacts with humans. The environment is not limited to the biophysical environment, but also includes lifestyle and behavioral factors.

<span class="mw-page-title-main">Gynecologic cancer disparities in the United States</span>

Gynecologic cancer disparities in the United States refer to differences in incidence, prevalence, and mortality from gynecologic cancers between population groups. The five main types of gynecologic cancer include cervical cancer, ovarian cancer, endometrial cancer, vaginal cancer, and vulvar cancer. For patients with these and other gynecologic malignancies within the United States, disparities across the care continuum by socioeconomic status and racial/ethnic background have been previously identified and studied. The causes behind these disparities are multifaceted and a complex interplay of systemic differences in health as well as individual patient factors such as cultural, educational, and economic barriers.

Marian L. Neuhouser is an American epidemiologist who is the Head of Cancer Prevention at the Fred Hutchinson Cancer Center. Her research focuses on the role of nutrition in the prevention of cancer.

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