Reducing the Risk of Cancer Development Research in basic, translational, and population sciences has broadened our understanding of the factors that increase an individual’s risk of developing cancer (see Figure 7, p. 39). Modifiable risk factors, including tobacco use, unhealthy diet, physical inactivity, UV exposure, alcohol consumption, pathogenic infections, and obesity contribute to the development of 40 percent of all cancers. Given that several of these risks can be avoided, many cases of cancer can potentially be prevented. The increased recognition of these risk factors, which also contribute to many other chronic diseases such as those of the cardiovascular system, will help local and national public health organizations increase prevention efforts, lessening the negative health and economic impact of these diseases, including cancer. Between 1991 and 2020, the United States experienced a 33 percent decline in overall cancer mortality largely due to the implementation of public health campaigns and policy initiatives designed to reduce smoking and increase early detection of cancers (2). However, while smoking rates have declined, the increasing prevalence of other risk factors, including obesity among U.S. children and adults, is cause for concern. Additionally, there is a lack of widespread uptake in the United States of preventive interventions such as vaccination against cancer-causing viruses including human papillomavirus (HPV), which is the primary cause of cervical cancer. Addressing and reducing all modifiable risk factors, especially those on the rise such as obesity, are required to continue the downward trend in cancer-related deaths. Prevalence of modifiable risk factors is higher in segments of the U.S. population that experience cancer disparities, such as racial or ethnic, and sexual and gender minorities, as well as other medically underserved populations. These inequities stem from decades of structural, social, and institutional injustices that have placed disadvantaged populations in unfavorable living environments and contributed to behaviors that increase cancer risk (see Figure 2, p. 19). For example, racial or ethnic minorities are more likely to live in areas that may have high levels of air pollution, no green spaces for physical activity, and/or little to no availability of healthy food options such as fresh fruits and vegetables. It is important that all stakeholders in public health work together to increase education and access to cancer prevention resources and eliminate the disproportionate burden of cancer risk factors in these populations. Eliminate Tobacco Use The use of tobacco products is the leading preventable cause of cancer and is associated with the development of 17 different types of cancer in addition to lung cancer. Nearly 20 percent IN THIS SECTION, YOU WILL LEARN: ⚫ In the United States, 40 percent of all cancers are associated with modifiable risk factors. ⚫ The significant decline in cancer mortality over the past three decades is largely attributable to reductions in smoking and increased cancer screening following the implementation of public health campaigns and policy initiatives. ⚫ Nearly 20 percent of U.S. cancer diagnoses are related to excess body weight, unhealthy dietary patterns, alcohol intake, and physical inactivity. ⚫ Many cases of skin cancer can be prevented by protecting the skin from ultraviolet radiation from the sun and indoor tanning devices. ⚫ Nearly all cases of cervical cancer, as well as many cases of head and neck and anal cancers, can be prevented by HPV vaccination; many cases of liver cancer can be prevented by HBV vaccination. Globally, nearly half of all cancer deaths in 2019 were attributable to risk factors that include smoking, alcohol, and high body-mass index (121). AACR Cancer Progress Report 2023 Reducing the Risk of Cancer Development 38
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