This document discusses cancer prevention through lifestyle modifications. It notes that 50-65% of cancer cases are potentially preventable by lifestyle changes like not smoking, maintaining a healthy diet and weight, limiting alcohol intake, and exercising regularly. Specific lifestyle risk factors that can increase cancer risk, such as smoking, poor diet, obesity, excessive alcohol, infections, and radiation exposure, are reviewed. The document emphasizes the role of diet, recommending a Mediterranean-style diet with fruits/vegetables and fish to reduce overall cancer risk.

1. CANCER PREVENTION
Robert A. Wascher, MD, FACS, FSSO
Chief, Department of Surgery
Director, Comprehensive Breast Cancer Program
Cancer Treatment Centers of America
Goodyear, AZ
Clinical Professor of Surgery
University of Arizona College of Medicine - Phoenix

2. Cancer Treatment Centers of America®
A national network of dedicated comprehensive
cancer care centers specializing in advanced and
complex cancers
We provide patient-centered, multidisciplinary, team-
based care to patients with cancer
CANCER PREVENTION

3. 60 to 65% of cancer
patients will be alive
and cancer-free in 5
years (“cured”)….
50 to 60% of all cancer
cases are potentially
preventable with
lifestyle modification….
CANCER PREVENTION

4. Few Diagnoses Cause as Much Fear or Concern as
Cancer…
CANCER PREVENTION

5. Cancer as a Public Health Issue in the United States
CANCER PREVENTION

6. • 1,660,000 new cancer cases in 2013
• 580,000 cancer deaths in 2013
• ~14 million living cancer patients
• ~1:2 men will develop cancer
• ~1:3 women will develop cancer
Cancer Facts & Figures; American Cancer Society, 2013
Cancer as a Public Health Issue in the United States
CANCER PREVENTION

7. CANCER PREVENTION
• Current 5-year overall cancer survival: ~65%
• Overall annual cancer-associated deaths have modestly decreased
over the past 15 years
• Cancer-associated death rates have increased for cancers of the
esophagus, pancreas, bladder, and liver
• Regional differences in cancer death rate trends: rate of
improvement in death rates more modest in South and Midwest
• Gender differences persist: lung cancer rates in men improving,
but just barely leveling-off for women

8. CANCER PREVENTION
• Cancer incidence predicted to rise by 45% between 2010 and 2030
• U.S. population is getting older, more obese, and more ethnically
diverse (all are known risk factors for cancer)
• Among the elderly, cancer incidence to rise by 67% (2010 to 2030)
• Among ethnic minority populations (which are also aging and
becoming more obese), predicted 99% increase in cancer incidence
(2010 to 2030)
Smith BD, et al. J Clin Oncol 2009; 27:2745-2746
SEER Cancer Statistics review, 1975 - 2005

9. CANCER PREVENTION
Lifestyle-Associated
Cancer Risk Factors
(Risk Factors That
You Can Change!)

10. At least 50% of all cancer cases linked to modifiable lifestyle factors
• Tobacco (20% all cancer cases; 30% of all cancer deaths)
• Diet (↑ meat, ↑ salt, ↓ fruit, ↓ vegetables, ↓ whole grains)
• Overweight & Obesity
• Alcohol
• Occupation
• UV Radiation (sun & tanning beds)
• Infections
• Ionizing Radiation (medical X-rays)
• Sedentary Lifestyle (lack of exercise)
• Reproductive (late or absent childbearing, no breastfeeding, exposure to HPV
and other oncogenic viruses, hormone replacement therapy)
Br J Cancer. 2011; 105: S77–S81
CANCER PREVENTION

11. Br J Cancer. 2011; 105: S77–S81
CANCER PREVENTION

12. CANCER PREVENTION
Tobacco
• 19% of U.S. population still smokes…
• #1 cause of preventable cancers => 1 out of 5 of all cancer cases;
30% of all cancer deaths (~175,000 deaths/ year)
• #1 cause of preventable death => 1 in 5 deaths (~450,000/ year)

13. CANCER PREVENTION
Exposure to Inhaled Carcinogens
• Tobacco => 90 to 95% of all lung cancer cases; and cancers of
the nasal cavity, larynx, esophagus, stomach, colon, rectum, liver,
pancreas, breast, ovary, cervix, prostate, bladder, and leukemia
• Diesel exhaust => lung cancer
Diet
• Red meat and processed meats
• Other animal-based foods
• Salt
• High glycemic-index foods (sugar & carbs)
• Alcohol

14. CANCER PREVENTION
Chronic Diseases
• Obesity
• Diabetes
• Infection with viruses and bacteria (HBV, HCV, HIV, HPV,
H. pylori)
Medications
• Hormone replacement therapy (especially combination HRT)
Ionizing Radiation
• Medical x-rays (IOM => at least 2% of all cancers)
• Radon gas (5 to 8% of lung cancer cases)
Sedentary Lifestyle (exercise more!)

15. CANCER PREVENTION
Obesity
BMI > 25 is estimated to cause at least 100,500 new cases of cancer
every year in the United States (5 to 7% of all cases), including:
49% of endometrial (uterus) cancers (20,700 cases/year)
35% of esophageal cancers ( 5,800 cases/year)
28% of pancreatic cancers (11,900 cases/year)
24% of kidney cancers (13,900 cases/year)
21% of gallbladder cancers ( 2,000 cases/year)
17 % of breast cancers (33,000 cases/year)
9% of colorectal cancers (13,200 cases/year)
American Institute for Cancer research/WCRF's Policy and Action for Cancer Prevention, 2009;
Cancer Facts and Figures 2009, American Cancer Society

16. CANCER PREVENTION
Diabetes
• Nurses’ Health Study (~120,000 women, 30 to 55 years of age):
• 43% increase (RR) in colon cancer & 11% increase (RR) in
rectal cancer.
• Other studies: 50% increase in pancreatic cancer risk; and
increased risk of cancers of the breast, liver, kidney, and uterus
Hu F, et al. JNCI 1999; 17:542-547.
Gioavannucci E, Michaud D. Gastroenterology 2007; 132:2208-2225.

17. Alcohol & Cancer
• ~4% of all cancer cases in the U.S. (5% in men, 2% in women)
• #8 overall cause of cancer (#4 cause among top 11 lifestyle-
associated causes)
• 4 to 6% of cancer deaths => 23,000 to 34,000 deaths/year
(33,000 MVA fatalities/year; 16,000 homicides/year)
Sci Transl Med. 2012;4:127rv4
Br J Cancer. 2011; 105: S77–S81
Am J Public Health. 2013; 103:641-648
Int J. Cancer. 2006; 119: 884-7
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18. Cancer Types Most Closely Linked With Alcohol
• Breast
• Esophagus
• Stomach
• Colon
• Rectum
• Pancreas
• Liver
• Alcohol + Tobacco: Lung, Oral Cavity, Pharynx, Larynx
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19. CANCER PREVENTION
Cancer Prevention Lifestyle: Diet & Nutrition

20. CANCER PREVENTION
Lifestyle & Dietary Factors: Diet
• European Prospective Investigation into Cancer and Nutrition-
Potsdam Study (EPIC-P) (n >23,000 healthy volunteers; 35 to 65
years of age average follow-up >8 years)
• Just 4 factors were associated with a 40% reduction in cancer
risk, 93% reduction in diabetes risk, 81% reduction in risk of
heart attack, 50% reduction in risk of stroke, 78% overall
decrease in risk of all chronic serious diseases:
• BMI <30
• Moderate exercise (≥ 3.5 hours/week)
• Diet rich in whole grains, fresh fruits & vegetables, and
low in meat & other animal-source foods
• Abstention from tobacco
Ford ES, et al. Archives of Internal Medicine 2009; 169:1355-1362.

21. CANCER PREVENTION
Lifestyle & Dietary Factors: Diet
• “Mediterranean Diet:” Fresh fruits and vegetables, nuts, fish
& healthy cooking oils (canola oil and olive oil); substitutes herbs
and spices for salt; minimal amounts of red meat & processed
meats
• 12% overall reduction in cancer risk, and a 50% reduction
in GI cancer risk
• Reduced risk of cancers of the lung, esophagus, breast,
stomach, colon, and rectum
Kant AK, et al. J Nutrition 2009; 139:1374-1380.
La Vecchia C, Boestti C. Public Health Nutrition 2006; 9:1077-1082.

22. CANCER PREVENTION
Eating more fish (and less meat) reduces cancer risk!

23. ???
CANCER PREVENTION