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

Katrina F Brown, Harriet Rumgay, Casey Dunlop, Margaret Ryan, Frances Quartly, Alison Cox, Andrew Deas, Lucy Elliss-Brookes, Anna Gavin, Luke Hounsome, Dyfed Huws, Nick Ormiston-Smith, Jon Shelton, Ceri White, D Max Parkin, Katrina F Brown, Harriet Rumgay, Casey Dunlop, Margaret Ryan, Frances Quartly, Alison Cox, Andrew Deas, Lucy Elliss-Brookes, Anna Gavin, Luke Hounsome, Dyfed Huws, Nick Ormiston-Smith, Jon Shelton, Ceri White, D Max Parkin

Abstract

Background: Changing 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.

Methods: Population 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.

Results: Nearly 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.

Conclusion: Tobacco 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. Regular collection of risk factor exposure prevalence data which corresponds with epidemiological evidence is vital for analyses like this and should remain a priority for the UK Government and devolved Administrations.

Conflict of interest statement

The authors declare that they have no competing interests.

References

    1. World Health Organization. International Classification of Diseases and Related Health Problems. 10th revision (WHO, Geneva, 2015).
    1. Cancer Research UK. Cancer Awareness Measure (CAM) Key Findings Report; 2014 & Trends Analysis (2008-2014) (Cancer Research UK, London 2016).
    1. Cancer Research UK. Incidence trends over time for all cancers combined. (Accessed October 2017).
    1. Smittenaar CR, Petersen KA, Stewart K, Moitt N. Cancer incidence and mortality projections in the UK until 2035. Br. J. Cancer. 2016;115:1147–1155. doi: 10.1038/bjc.2016.304.
    1. Parkin DM, et al. The fraction of cancer attributable to lifestyle and environmental factors in the UK in 2010. Br. J. Cancer. 2011;105:Si–S81.
    1. Whiteman DC, et al. Cancers in Australia in 2010 attributable to modifiable factors: introduction and overview. Aust. NZ J. Public Health. 2015;39:403–407. doi: 10.1111/1753-6405.12468.
    1. Parkin DM. 1. The fraction of cancer attributable to lifestyle and environmental factors in the UK in 2010. Br. J. Cancer. 2011;105(S2):S2–S5. doi: 10.1038/bjc.2011.474.
    1. Bromley, C. & Shelton, N. The Scottish Health Survey Topic Report: UK Comparisons (The Scottish Government, Edinburgh, 2010)
    1. International Agency for Research on Cancer. List of classifications by cancer sites with sufficient or limited evidence in humans, Volumes 1 to 118. (Accessed October 2017).
    1. World Cancer Research Fund. Continuous Update Project (CUP) Matrix. (Accessed October 2017).
    1. Lauby-Secretan B, et al. Body fatness and cancer—viewpoint of the IARC Working Group. N. Engl. J. Med. 2016;375:794–798. doi: 10.1056/NEJMsr1606602.
    1. Khan G, Hashim MJ. Global burden of deaths from Epstein-Barr virus attributable malignancies 1990-2010. Infect. Agent Cancer. 2014;9:38. doi: 10.1186/1750-9378-9-38.
    1. Saraiya M, et al. US assessment of HPV types in cancers: implications for current and 9-valent HPV vaccines. J. Natl. Cancer Inst. 2015;107:djv086. doi: 10.1093/jnci/djv086.
    1. Walboomers JM, et al. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J. Pathol. 1999;189:12–19. doi: 10.1002/(SICI)1096-9896(199909)189:1<12::AID-PATH431>;2-F.
    1. Parkin DM. 11. Cancers attributable to infection in the UK in 2010. Br. J. Cancer. 2011;105:S49–S56. doi: 10.1038/bjc.2011.484.
    1. Berrington de González A, Darby S. Risk of cancer from diagnostic X-rays: estimates for the UK and 14 other countries. Lancet. 2004;363:345–351. doi: 10.1016/S0140-6736(04)15433-0.
    1. Scientific Advisory Committee on Nutrition. Carbohydrates and Health (TSO, London, 2015).
    1. Kyu H. H. et al. Physical activity and risk of breast cancer, colon cancer, diabetes, ischemic heart disease, and ischemic stroke events: systematic review and dose-response meta-analysis for the Global Burden of Disease Study 2013. BMJ 354 (2016) doi: .
    1. Department of Health. Infant Feeding Recommendation (TSO, London, 2003).
    1. Department of Health. UK Chief Medical Officers’ Low Risk Drinking Guidelines. (TSO., London, 2016).
    1. Public Health England. The Eatwell Guide (TSO, London, 2016).
    1. Information Services Division Scotland. Cancer incidence and mortality in Scotland; by site/type of cancer, sex and age; year of diagnosis/registration of death: 2015. (Accessed October 2017).
    1. Northern Ireland Cancer Registry. Cancer Information: Official Statistics: By Site. (Accessed October 2017).
    1. Office for National Statistics. Cancer Registration Statistics, England: 2015. Cancer diagnoses and age-standardised incidence rates for all cancer sites by age, sex and region. (Accessed October 2017).
    1. Welsh Cancer Intelligence and Surveillance Unit. Incidence by age band and gender (Wales and health boards). (Accessed October 2017).
    1. Parkin DM, Boyd L, Walker LC. 16. The fraction of cancer attributable to lifestyle and environmental factors in the UK in 2010. Br. J. Cancer. 2011;105(S2):S77–S81. doi: 10.1038/bjc.2011.489.
    1. NHS Digital. Health Survey for England, 2015: Trend tables–Adult tables. (Accessed October 2017).
    1. Scottish Government. Scottish Health Survey 2015 trend tables. (Accessed October 2017).
    1. Welsh Government. Welsh Health Survey. Tables–Health-related lifestyle trends, 2003/04-2015. (Accessed October 2017).
    1. Northern Ireland Statistics and Research Agency. Continuous Household Survey Results: 9. Smoking. (Accessed October 2017).
    1. Office for National Statistics. Adult smoking habits in the UK: 2015. (Accessed October 2017).
    1. Office for National Statistics. Adult drinking habits in Great Britain: 2005 to 2016. .
    1. McGill R, et al. Are interventions to promote healthy eating equally effective for all? Systematic review of socioeconomic inequalities in impact. BMC Public Health. 2015;15:457. doi: 10.1186/s12889-015-1781-7.
    1. Khalifa MM, Sharaf RR, Aziz RK. Helicobacter pylori: a poor man’s gut pathogen? Gut Pathog. 2010;2:2. doi: 10.1186/1757-4749-2-2.
    1. Islami F. et al. Proportion and number of cancer cases and deaths attributable to potentially modifiable risk factors in the United States. CA Cancer J. Clin. doi: (2017).
    1. Grundy A, et al. Cancer incidence attributable to lifestyle and environmental factors in Alberta in 2012: summary of results. CMAJ Open. 2017;5:E540–E545. doi: 10.9778/cmajo.20160045.
    1. Whiteman DC, et al. Cancers in Australia in 2010 attributable to modifiable factors: summary and conclusions. Aust. NZ J. Public Health. 2015;39:477–484. doi: 10.1111/1753-6405.12471.
    1. Arnold M, et al. Obesity and cancer: an update of the global impact. Cancer Epidemiol. 2016;41:8–15. doi: 10.1016/j.canep.2016.01.003.
    1. Peto R, Lopez A, Boreman J, Thun M, Heath C. Mortality from tobacco in developed countries: indirect estimation from national vital statistics. Lancet. 1992;339:1268–1278. doi: 10.1016/0140-6736(92)91600-D.
    1. Tachfouti N, Raherison C, Obtel M, Nejjari C. Mortality attributable to tobacco: review of different methods. Arch. Publ. Health. 2014;72:22. doi: 10.1186/2049-3258-72-22.
    1. Weyers W. The ‘epidemic’ of melanoma between under- and overdiagnosis. J. Cutan. Pathol. 2012;39:9–16. doi: 10.1111/j.1600-0560.2011.01831.x.
    1. World Health Organization. What is moderate-intensity and vigorous-intensity physical activity? (Accessed October 2017)
    1. Hutchings S, Rushton L. Estimating the burden of occupational cancer: assessing bias and uncertainty. Occup. Environ. Med. 2017;74:604–611. doi: 10.1136/oemed-2016-103810.
    1. Perez-Cornago A, et al. Tall height and obesity are associated with an increased risk of aggressive prostate cancer: results from the EPIC cohort study. BMC Med. 2017;15:115–125. doi: 10.1186/s12916-017-0876-7.
    1. World Cancer Research Fund. International systematic literature review: the associations between food, nutrition and physical activity and the risk of prostate cancer. (Accessed January 2018).
    1. Bagnardi V, et al. Alcohol consumption and site-specific cancer risk: a comprehensive dose-response meta-analysis. Br J Cancer. 2015;112:580–593. doi: 10.1038/bjc.2014.579.
    1. Prabhu A, Obi KO, Rubenstein JH. The synergistic effects of alcohol and tobacco consumption on the risk of esophageal squamous cell carcinoma: a meta-analysis. Am. J. Gastroenterol. 2014;109:822–827. doi: 10.1038/ajg.2014.71.
    1. Darby S, et al. Radon in homes and risk of lung cancer: collaborative analysis of individual data from 13 European case–control studies. BMJ. 2005;330:223–228. doi: 10.1136/bmj.38308.477650.63.
    1. Boniface S, Shelton N. How is alcohol consumption affected if we account for under-reporting? A hypothetical scenario. Eur. J. Publ Health. 2013;23:1076–1081. doi: 10.1093/eurpub/ckt016.
    1. Air Quality Expert Group. Fine Particulate Matter (PM2.5) in the United Kingdom (TSO, London, 2012).
    1. Public Health England. Ionising Radiation Exposure of the UK Population: 2010 Review (TSO, London, 2016).
    1. Frazer K. et al. Legislative smoking bans for reducing harms from secondhand smoke exposure, smoking prevalence and tobacco consumption. Cochrane Database Syst. Rev.2. doi: (2016).
    1. McManus, S., Bebbington, P., Jenkins, R. & Brugha, T. (eds) Mental Health and Wellbeing in England: Adult Psychiatric Morbidity Survey 2014 (NHS Digital, Leeds, 2016)
    1. Hiscock R, Judge K, Bauld L. Social inequalities in quitting smoking: what factors mediate the relationship between socioeconomic position and smoking cessation? J. Publ. Health. 2011;33:39–47. doi: 10.1093/pubmed/fdq097.
    1. Briggs ADM, et al. Health impact assessment of the UK soft drinks industry levy: a comparative risk assessment modelling study. Lancet Publ. Health. 2017;2:e15–e22. doi: 10.1016/S2468-2667(16)30037-8.
    1. Public Health England. Sugar Reduction. The Evidence for Action (PHE, London, 2015).
    1. Ilic D., Neuberger M. M., Djulbegovic M. & Dahm P. Screening for prostate cancer. Cochrane Database Syst. Rev.1. 10.1002/14651858.CD004720.pub3. (2013)
    1. Manser R. et al. Screening for lung cancer. Cochrane Database Syst. Rev.6. doi: (2013).
    1. Mosch C. G., Jaschinski T. & Eikermann M. Impact of epithelial ovarian cancer screening on patient-relevant outcomes in average-risk postmenopausal women (Protocol). Cochrane Database Syst. Rev.7. (2014).

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe