The fraction of cancer attributable to modifiable risk factors in England, Wales, Scotland, Northern Ireland, and the United Kingdom in 2015

Abstract

BackgroundChanging population-level exposure to modifiable risk factors is a key driver of changing cancer incidence. Understanding these changes is therefore vital when prioritising risk-reduction policies, in order to have the biggest impact on reducing cancer incidence. UK figures on the number of risk factor-attributable cancers are updated here to reflect changing behaviour as assessed in representative national surveys, and new epidemiological evidence. Figures are also presented by UK constituent country because prevalence of risk factor exposure varies between them.MethodsPopulation attributable fractions (PAFs) were calculated for combinations of risk factor and cancer type with sufficient/convincing evidence of a causal association. Relative risks (RRs) were drawn from meta-analyses of cohort studies where possible. Prevalence of exposure to risk factors was obtained from nationally representative population surveys. Cancer incidence data for 2015 were sourced from national data releases and, where needed, personal communications. PAF calculations were stratified by age, sex and risk factor exposure level and then combined to create summary PAFs by cancer type, sex and country.ResultsNearly four in ten (37.7%) cancer cases in 2015 in the UK were attributable to known risk factors. The proportion was around two percentage points higher in UK males (38.6%) than in UK females (36.8%). Comparing UK countries, the attributable proportion was highest in Scotland (41.5% for persons) and lowest in England (37.3% for persons). Tobacco smoking contributed by far the largest proportion of attributable cancer cases, followed by overweight/obesity, accounting for 15.1% and 6.3%, respectively, of all cases in the UK in 2015. For 10 cancer types, including two of the five most common cancer types in the UK (lung cancer and melanoma skin cancer), more than 70% of UK cancer cases were attributable to known risk factors.ConclusionTobacco and overweight/obesity remain the top contributors of attributable cancer cases. Tobacco smoking has the highest PAF because it greatly increases cancer risk and has a large number of cancer types associated with it. Overweight/obesity has the second-highest PAF because it affects a high proportion of the UK population and is also linked with many cancer types. Public health policy may seek to mitigate the level of harm associated with exposure or reduce exposure levels—both approaches may effectively impact cancer incidence. Differences in PAFs between countries and sexes are primarily due to varying prevalence of exposure to risk factors and varying proportions of specific cancer types. This variation in turn is affected by socio-demographic differences which drive differences in exposure to theoretically avoidable ‘lifestyle’ factors. PAFs at UK country level have not been available previously and they should be used by policymakers in devolved nations. PAFs are estimates based on the best available data, limitations in those data would generally bias toward underestimation of PAFs. R...

Non-Hodgkin lymphoma

“…Non-Hodgkin lymphoma is more common in patients who are immunosuppressed, such as patients with HIV/AIDS or recipients of an organ transplant. Although smoking may be associated with some lymphoma subtypes,9 it is not a well established risk factor for non-Hodgkin lymphoma as a whole 10. There is a slightly elevated risk in family members, but non-Hodgkin lymphoma is not generally considered hereditary.…”

Primary prevention: a need for concerted action

“…Other factors were unhealthy diet (5.4%), overweight and obesity (5.4%), infections (4%), occupational exposures (3.6%), UV (3%), ionising radiation (1.9%; radon and medical), lack of physical activity (0.9%), exogenous hormones (0.7%), no or shorter term breastfeeding [0.5%; breastfeeding reduces the mothers’ breast cancer risk (Scoccianti et al ., )], atmospheric pollution (0.4%) or environmental exposures to chemicals (0.1%). In parallel, another comprehensive calculation was performed for the UK (Brown et al ., ), estimating similar impact by tobacco (15.1%), overweight/obesity (6.3%), unhealthy diet (4.8%), UV (3.8%), occupational exposures (3.8%), infections (3.6%), alcohol (3.3%), ionising radiation (1.9%), not breastfeeding (0.7%), exogenous hormones/oral contraceptives (0.6%) and lack of physical activity (0.5%). Noteworthy differences in comparison with France are the lower relative contribution from alcohol consumption (3.3% versus 8%) and the higher relative contribution by air pollution (1% versus 0.4%).…”

Cancer Prevention Europe

“…Recent detailed estimates in France, the UK and Germany suggest that around 40% of cancers in Europe could be prevented if current understanding of established risk and protective factors was translated into effective primary prevention (Behrens et al ., ; Brown et al ., ; Gredner et al ., ; Mons et al ., ; Soerjomataram et al ., ). Cancer screening and other approaches to early detection of premalignant lesions or surveillance among very high‐risk groups can also contribute to reduce cancer incidence and mortality.…”