Preventable Incidence and Mortality of Carcinoma Associated With Lifestyle Factors Among White Adults in the United States | Cancer Screening, Prevention, Control | JAMA Oncology | JAMA Network
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    1 Comment for this article
    &bsol;&quot;Lifestyle&bsol;&quot; May Be a Misnomer
    Stephen B. Strum, MD, FACP | Medical Oncologist Specializing in Prostate Cancer
    This is such an important contribution by Song & Giovannucci. It is especially true in the context of the epidemic of obesity. sedentary behavior, media obsession with alcohol consumption and cigarette smoking, and the interaction that the legalization of marijuana will have on many of these \"lifestyle factors\". But doesn't the term lifestyle miss the boat? Are not these four factors more appropriately identified as biological milieu− what we immerse or expose our unique biological organism to? All four factors have many thousands of peer-reviewed publications relating to their impact on our biology, as it relates to cancer and other crucial systems.

    Individuals who attend to all four factors− who listen to their biology− probably do the same with other milieu factors e.g. lipid status, omega 3 versus 6 fatty acid intake, vitamin D intake, carbohydrate restriction, vitamin and supplement intake, etc. All of these issues and more impact cancer growth and relate to the energy metabolism of cancer i.e. cancer fuels.

    The focus of all physicians should indeed be on prevention; the patient medical record should index these factors and others. I refer to this approach as SAIN medicine: Systems Analysis and Integrity Networking. The landmark article by Song & Giovannucci should evolve our focus and perspective about how we can reduce the incidence and mortality from most types of cancer. Their findings are staggering given that the data presented show that only 18.4% of women and 25.31% of men follow a healthy \"lifestyle\". We, so-called sentient beings, do not listen to our biology!
    Original Investigation
    September 2016

    Preventable Incidence and Mortality of Carcinoma Associated With Lifestyle Factors Among White Adults in the United States

    Author Affiliations
    • 1Clinical and Translational Epidemiology Unit and Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
    • 2Departments of Nutrition and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
    • 3Channing Division of Network Medicine, Department of Medicine, Harvard Medical School, Boston, Massachusetts
    JAMA Oncol. 2016;2(9):1154-1161. doi:10.1001/jamaoncol.2016.0843

    Importance  Lifestyle factors are important for cancer development. However, a recent study has been interpreted to suggest that random mutations during stem cell divisions are the major contributor to human cancer.

    Objective  To estimate the proportion of cases and deaths of carcinoma (all cancers except skin, brain, lymphatic, hematologic, and nonfatal prostate malignancies) among whites in the United States that can be potentially prevented by lifestyle modification.

    Design, Setting, and Participants  This prospective cohort study analyzes cancer and lifestyle data from the Nurses’ Health Study, the Health Professionals Follow-up Study, and US national cancer statistics to evaluate associations between lifestyle and cancer incidence and mortality.

    Exposures  A healthy lifestyle pattern was defined as never or past smoking (pack-years <5), no or moderate alcohol drinking (≤1 drink/d for women, ≤2 drinks/d for men), BMI of at least 18.5 but lower than 27.5, and weekly aerobic physical activity of at least 75 vigorous-intensity or 150 moderate-intensity minutes. Participants meeting all 4 of these criteria made up the low-risk group; all others, the high-risk group.

    Main Outcomes and Measures  We calculated the population-attributable risk (PAR) by comparing incidence and mortality of total and major individual carcinomas between the low- and high-risk groups. We further assessed the PAR at the national scale by comparing the low-risk group with the US population.

    Results  A total of 89 571 women and 46 339 men from 2 cohorts were included in the study: 16 531 women and 11 731 men had a healthy lifestyle pattern (low-risk group), and the remaining 73 040 women and 34 608 men made up the high-risk group. Within the 2 cohorts, the PARs for incidence and mortality of total carcinoma were 25% and 48% in women, and 33% and 44% in men, respectively. For individual cancers, the respective PARs in women and men were 82% and 78% for lung, 29% and 20% for colon and rectum, 30% and 29% for pancreas, and 36% and 44% for bladder. Similar estimates were obtained for mortality. The PARs were 4% and 12% for breast cancer incidence and mortality, and 21% for fatal prostate cancer. Substantially higher PARs were obtained when the low-risk group was compared with the US population. For example, the PARs in women and men were 41% and 63% for incidence of total carcinoma, and 60% and 59% for colorectal cancer, respectively.

    Conclusions and Relevance  A substantial cancer burden may be prevented through lifestyle modification. Primary prevention should remain a priority for cancer control.