Causes- The
great majority of cancers, some 90–95% of cases, are due to environmental factors. The remaining 5–10% are
due to inherited genetics. Environmental, as used by cancer
researchers, means any cause that is not inherited genetically, such as lifestyle, economic and behavioral
factors, and not merely pollution. Common environmental factors that contribute
to cancer death include tobacco (25–30%), diet and obesity (30–35%), infections (15–20%), radiation (both ionizing and non-ionizing, up to 10%),
stress, lack of physical activity, and environmental
pollutants.
It
is nearly impossible to prove what caused a cancer in any individual, because
most cancers have multiple possible causes. For example, if a person who uses
tobacco heavily develops lung cancer, then it was probably caused by the
tobacco use, but since everyone has a small chance of developing lung cancer as
a result of air pollution or radiation, then there is a small chance that the
cancer developed because of air pollution or radiation. Excepting the rare
transmissions that occur with pregnancies and only a marginal few organ donors,
cancer is generally not a transmissible disease.
PREVENTION -Cancer prevention is defined as active
measures to decrease the risk of cancer. The vast majority of cancer cases are
due to environmental risk factors, and many, but not all, of these
environmental factors are controllable lifestyle choices. Thus, cancer is
considered a largely preventable disease. Between 70% and 90% of common cancers
are due to environmental factors and therefore possibly preventable.
Greater
than 30% 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. Not all environmental causes are
controllable, such as naturally occurring background radiation, and other cases of cancer
are caused through hereditary genetic disorders, and thus it is not possible to
prevent all cases of cancer.
Dietary:
While
many dietary recommendations have been proposed to reduce the risk of cancer,
the evidence to support them is not definitive. 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. A 2014
meta-analysis did not find a relationship between fruits and vegetables and
cancer. Consumption of coffee is associated with a
reduced risk of liver cancer. Studies have linked
excessive consumption of red or processed meat to an increased risk of breast
cancer, colon cancer, and pancreatic cancer, a phenomenon that could be due to the
presence of carcinogens in meats cooked at high temperatures. This was
confirmed in 2015 by the IARC of the World Health
Organization,
which determined that eating processed meat (e.g., bacon, ham, hot
dogs, sausages) and, to a lesser degree, red meat was linked to some cancers.
Medication:
The
concept that medications can be used to prevent cancer is attractive, and
evidence supports their use in a few defined circumstances. 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.
Aspirin has been found to reduce the risk of death
from cancer by about 7%. COX-2 inhibitor may decrease the rate of polyp formation in people with familial
adenomatous polyposis,
however it is associated with the same adverse effects as NSAIDs. Daily use of tamoxifen or raloxifene has been demonstrated to reduce the risk of
developing breast cancer in high-risk women. The
benefit versus harm for 5-alpha-reductase
inhibitor
such as finasteride is not clear.
Vitamins have not been found to be
effective at preventing cancer, although low blood levels of vitamin D are correlated with increased cancer risk. Whether
this relationship is causal and vitamin D supplementation is protective is not
determined. Beta-Carotene supplementation has been
found to increase lung cancer rates in those who are
high risk. Folic acid supplementation has not
been found effective in preventing colon cancer and may increase colon polyps.
It is unclear if selenium supplementation has an effect.
Vaccination: Vaccines have been developed that prevent infection
by some carcinogenic viruses. Human papillomavirus vaccine (Gardasil and Cervarix) decreases the risk of developing cervical cancer. The hepatitis B vaccine prevents infection with
hepatitis B virus and thus decreases the risk of liver cancer. The
administration of human papillomavirus and hepatitis B vaccinations is
recommended when resources allow.
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