11.5: Risk Factors for Cancer
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It is usually impossible to know why one person develops cancer and another does not. But research has shown that certain risk factors may increase a person’s chances of developing cancer. There are also factors—called protective risk factors, or just protective factors—that are linked to a lower risk of cancer.
Cancer risk factors include exposure to chemicals or other substances, as well as certain behaviors. They also include circumstances that people cannot control, like age and family history. A family history of certain cancers can be a sign of a possible inherited cancer syndrome.
Most cancer risks, as well as protective factors, are initially identified in epidemiology studies. In these studies, scientists look at large groups of people and compare those who develop cancer with those who do not. These studies may show that those who develop cancer are more or less likely to behave in certain ways, or to be exposed to certain substances, than those who do not develop cancer.
On their own, such studies cannot prove that a behavior or substance causes cancer. For example, the finding could be a result of chance, or the true risk factor could be something other than the suspected risk factor. But findings of this type sometimes get attention in the media, and this can lead to false beliefs about how cancer starts and spreads.
When many studies all point to a similar association between a potential risk factor and an increased risk of cancer, and when a possible mechanism exists that could explain how the risk factor could actually cause cancer, scientists can be more confident about the relationship between the two.
Although some risk factors can be avoided, others—such as growing older—cannot. Limiting exposure to avoidable risk factors may lower a person’s risk of developing certain cancers.
Some of the most studied risk factors for cancer are listed below.
Advancing age is the most important risk factor for cancer overall, and for many specific types of cancer. According to the most recent statistical data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results program, the median age of a cancer diagnosis is 66 years. This means that half of cancer cases occur in people below this age and half in people above this age. One-quarter of new cancer cases are diagnosed in people aged from 65 to 74.
But the disease can occur at any age. For example, bone cancer is most frequently diagnosed among people under age 20, with more than one-fourth of cases occurring in this age group. And 10 percent of leukemias are diagnosed in children and adolescents under 20 years of age, whereas only 1 percent of cancer overall is diagnosed in that age group.
Drinking alcohol can increase a person’s risk of cancer of the mouth, throat, esophagus, larynx (voice box), liver, and breast. The more a person consumes alcohol, the higher his or her risk. The risk of cancer is much higher for those who drink alcohol and also use tobacco.
Doctors advise people who drink to do so in moderate amounts. The federal government’s Dietary Guidelines for Americans defines moderate alcohol drinking as up to one drink per day for women and up to two drinks per day for men.
It has been suggested that certain substances in red wine, such as resveratrol, have anticancer properties. However, no evidence exists that drinking red wine reduces the risk of cancer.
Cancer-Causing Substances in the Environment
Cancer is caused by changes to certain genes that alter the way our cells function. Some of these genetic changes occur naturally when DNA is replicated during the process of cell division. But others are the result of environmental exposures that damage DNA. These exposures may include substances known as carcinogens, any substance that causes cancer, such as the chemicals in tobacco smoke; and radiation, such as ultraviolet rays from the sun. People can avoid some cancer-causing exposures, such as tobacco smoke and the sun’s rays. But others are harder to avoid, especially if they are found in the air, water, and food, or the materials people use to do their jobs. Scientists are studying which exposures may cause or contribute to the development of cancer. Understanding which exposures are harmful, and where they are found, may help people avoid them.
Simply because a substance has been designated as a carcinogen, however, that does not mean that the substance will necessarily cause cancer. Many factors influence whether a person exposed to a carcinogen will develop cancer, including the amount and duration of the exposure and the individual’s genetic background.
Many studies have looked at the possibility that specific dietary components ornutrients are associated with increases or decreases in cancer risk. Studies of cancer cells in the laboratory and of animal models have sometimes provided evidence that isolated compounds may be carcinogenic, or have anticancer activity.
But with few exceptions, studies of human populations have not yet shown definitively that any dietary component causes or protects against cancer. Sometimes the results of epidemiologic studies, which compare the diets of people with and without cancer have indicated that people with and without cancer differ in their intake of a particular dietary component.
However, these results show only that the dietary component is associated with a change in cancer risk, not that the dietary component is responsible for, or causes, the change in risk. For example, participants with and without cancer could differ in other ways besides their diet, and it is possible that some other difference accounts for the variance in cancer risk.
Estrogens, a group of female sex hormones, are known human carcinogens. Although these hormones have essential physiological roles in both females and males, they have also been associated with an increased risk of certain cancers. For instance, taking combined menopausal hormone therapy (estrogen plus progestin, which is a synthetic version of the female hormone progesterone) can increase a woman’s risk of breast cancer. Menopausal hormone therapy with estrogen alone increases the risk of endometrial cancer and is used only in women who have had a hysterectomy.
A woman who is considering menopausal hormone therapy should discuss the possible risks and benefits with her doctor.
Studies have also shown that a woman’s risk of breast cancer is related to the estrogen and progesterone made by her ovaries, known as endogenous estrogen and progesterone. Being exposed for a long time and/or to high levels of these hormones has been linked to an increased risk of breast cancer. Increases in exposure can be caused by starting menstruation early, going through menopause late, being older at first pregnancy, and never having given birth. Conversely, having given birth is a protective factor for breast cancer.
People who are obese may have an increased risk of several types of cancer, including cancers of the breast (in women who have been through menopause), colon, rectum, esophagus, kidney, pancreas, gallbladder, and the lining of the uterus, called the endometrium.
Conversely, eating a healthy diet, being physically active, and maintaining a healthy weight may reduce the risk of some cancers. These healthy behaviors also lessen the risk of other illnesses, such as heart disease, type II diabetes, and high blood pressure.
The sun, sunlamps, and tanning booths all give off ultraviolet (UV) radiation. Exposure to UV radiation causes early aging of the skin and skin damage that can lead to skin cancer.
People of all ages should limit the amount of time they spend in the sun, especially between mid-morning and late afternoon, and avoid other sources of UV radiation, such as tanning beds. It is important to keep in mind that UV radiation is reflected by sand, water, snow, and ice and can go through windshields and windows.
The best way to lessen UV damage when spending time in the sun is to wear long sleeves, long pants, a hat with a wide brim, and sunglasses with lenses that absorb UV radiation. Sunscreen with a sun protection factor (SPF) of at least 15 may help prevent skin cancer but does not work as well as staying out of the sun and wearing protective clothing.
Tobacco use is a leading cause of cancer and of death from cancer. People who use tobacco products, or are regularly exposed to environmental tobacco smoke (called secondhand smoke), have an increased risk of cancer because tobacco products and secondhand smoke have many chemicals that damage DNA.
Tobacco use causes many types of cancer, including cancer of the lung, larynx, mouth, esophagus, throat, bladder, kidney, liver, stomach, pancreas, colon and rectum, and cervix, as well as acute myeloid leukemia. People who use smokeless tobacco, such as snuff or chewing tobacco, have increased risks of cancers of the mouth, esophagus, and pancreas.
No level of tobacco use is safe. People who use any type of tobacco product are strongly urged to quit. People who quit smoking, regardless of their age, have substantial gains in life expectancy compared with those who continue to smoke. Also, quitting smoking at the time of a cancer diagnosis reduces the risk of death.
Cancer Prevention Overview
Cancer prevention is action taken to lower the chance of getting cancer. In addition to the physical problems and emotional distress caused by cancer, the high costs of care are also a burden to patients, their families, and to the public. Preventative measures can lower the number of new cases and cancer deaths, and reduce the burden of cancer on society.
Scientists are studying ways to prevent cancer, including the following:
- Avoiding or controlling factors known to cause cancer
- Improving diet and adopting a healthier lifestyle
- Finding precancerous conditions early
- Incorporating chemoprevention: the use of medicines that treat precancerous conditions or prevent cancer from starting
Patients and their doctors must choose from a plethora of cancer treatments. The types of treatment a patient receives depend on the type of cancer a person has and how advanced it is. Some people with cancer will have only one treatment. But most people have a combination of treatments, such as surgery with chemotherapy and/or radiation therapy. They may also undergo immunotherapy, targeted therapy, or hormone therapy.
Clinical trials are also an option for some patients. Clinical trials are research studies that involve people. Understanding what they are and how they work can help patients decide if taking part in a trial is a good option.
When seeking treatment for cancer, patients have a lot to learn and consider. It is normal for them to feel overwhelmed and confused. Talking with their doctor and learning all they can about their treatment options, including clinical trials, can help them make a decision they feel good about.