Wikipedia

Cancer prevention

Cancer preventionis the practice of taking active measures to decrease the incidence ofcancerandmortality.[1][2]The practice of prevention depends on both individual efforts to improve lifestyle and seekpreventive screening,andsocioeconomicorpublic policyrelated to cancer prevention.[3]Globalizedcancer prevention is regarded as a critical objective due to its applicability to large populations, reducing long term effects of cancer by promotingproactive health practicesand behaviors, and its perceived cost-effectiveness and viability for allsocioeconomic classes.[2]

The majority of cancer cases are due to the accumulation ofenvironmental pollutionbeing inherited asepigenetic damageand most of these environmental factors are controllable lifestyle choices.[4]Greater than a reported 75% of cancer deaths could be prevented by avoiding risk factors including:tobacco,overweight/obesity,an insufficientdiet,physical inactivity,alcohol,sexually transmitted infections,andair pollution.[5]Not all environmental causes are controllable, such as naturally occurringbackground radiation,and other cases of cancer are caused throughhereditarygenetic disorders.Currentgenetic engineeringtechniques under development may serve as preventive measures in the future.[6]Future preventive screening measures can be additionally improved by minimizing invasiveness and increasingspecificityby taking individual biological makeup into account, also known as "population-basedpersonalizedcancer screening. "[2]

Death rateadjusted for agefor malignant cancer per 100,000 inhabitants in 2004.[7]

While anyone can get cancer,[8]age is one of the biggest factors that increases theriskof cancer: 3 out of 4 cancers are found in people aged 55 or older.

Risk reduction

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Dietary

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Main article:Diet and cancer
Advertisement for a healthy diet to possibly reduce cancer risk

An average 35% of human cancer mortality is attributed to the diet of the individual.[9]Studies have linked excessive consumption of red orprocessed meatto an increased risk ofbreast cancer,colon cancer,andpancreatic cancer,a phenomenon which could be due to the presence ofcarcinogensin meats cooked at high temperatures.[10][11]

Dietary recommendations for reducing cancer risk typically include an emphasis onvegetables,fruit,whole grains,and fish, and an avoidance of processed and red meat (beef, pork, lamb), animal fats, andrefined carbohydrates.[12][13]The World Cancer Research Fund recommends a diet rich in fruits and vegetables to reduce the risk of cancer. A diet rich in foods of plant origin, including non-starchy fruits and vegetables, non-starchy roots and tubers, and whole grains, may have protective effects against cancer.[14]Consumption ofcoffeeis associated with a reduced risk ofliver cancer.[15]Substituting processed foods, such as biscuits, cakes or white bread – which are high in fat, sugars and refined starches – with a plant-based diet may reduce the risk of cancer.[14]

While many dietary recommendations have been proposed to reduce the risk of cancer, the evidence to support them is not definitive.[12][13]The primary dietary factors that increase risk areobesityandalcoholconsumption; with a diet low infruitsandvegetablesand high inred meatbeing implicated but not confirmed.[16][17]A 2014 meta-analysis did not find a relationship between consuming fruits and vegetables and reduced cancer risk.[18]

Physical activity

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Research shows that regularphysical activitymay help to reduce cancer up to 30%,[19][20][21]with up to 300 minutes per week of moderate to vigorous intensity of physical activity recommended.[22][23]Even though, the beneficial effect of exercise relative to cancer development is known, there is a lack of clear understanding of the mechanisms underlying this relationship.[24]Some potential mechanisms by which physical activity minimises cancer risk are alterations in free radical generation, alterations in steroid hormones, changes in body composition, and direct effects on the tumour. Differentbiological pathwaysinvolved in cancer have been studied suggesting that physical activity reduces cancer risk by helping weight control,[23]reducing hormones such asestrogenandinsulin,reducinginflammation,and strengthening theimmune system.[21][25]Steroid hormones have significant effects on the development of reproductive cancer, and exercise minimises cancer risks by regulating steroid hormones.[24]Similarly, exercise affects cancers that can be controlled by the immune system's ability through immune enhancement.[24]

Medication and supplements

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In the general population,NSAIDsreduce the risk ofcolorectal cancer;however, due to the cardiovascular and gastrointestinal side effects, they cause overall harm when used to lower cancer risk.[26]Aspirinhas been found to reduce the risk of death from cancer by about 7%.[27]COX-2 inhibitorsmay decrease the rate ofpolypformation in people withfamilial adenomatous polyposishowever are associated with the same adverse effects as NSAIDs.[28]Daily use oftamoxifenorraloxifenehas been demonstrated to reduce the risk of developingbreast cancerin high-risk women.[29]The benefit verses harm for5-alpha-reductase inhibitorsuch asfinasterideis not clear.[30]

Vitaminshave not been found to be effective at reducing cancer risk,[31]although low blood levels ofvitamin Dare correlated with increased cancer risk.[32][33]Whether this relationship is causal and vitamin D supplementation is protective is not determined.[34]Beta-carotenesupplementation has been found to increaselung cancerrates in those who are at high risk.[35]Folic acidsupplementation has not been found effective in preventing colon cancer and may increase colon polyps.[36]A 2018 systematic review concluded thatseleniumhas no beneficial effect in reducing the risk of cancer based on high quality evidence.[37]

Avoidance of carcinogens

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The United StatesNational Toxicology Program(NTP) has identified thechemical substanceslisted below as known human carcinogens in the NTP's 15th Report on Carcinogens. Simply because a substance has been designated as a carcinogen, however, 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.[38]

Ingestion

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Inhalation

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Skin exposure

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Vaccination

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Anti-cancervaccinescan be preventive or be used astherapeutic treatment.[2]All such vaccines inciteadaptive immunityby enhancingcytotoxic T lymphocyte(CTL) recognition and activity againsttumor-associated or tumor-specific antigens(TAA and TSAs).

Vaccines have been developed that preventinfectionby somecarcinogenicviruses.[39]Human papillomavirus vaccine(GardasilandCervarix) decreases the risk of developingcervical cancer.[39]Thehepatitis B vaccineprevents infection with hepatitis B virus and thus decreases the risk of liver cancer.[39]The administration of human papillomavirus and hepatitis B vaccinations is recommended when resources allow.[40]

Some cancer vaccines are usuallyimmunoglobulin-based and targetantigensspecific to cancer or abnormal human cells.[2][41]These vaccines may be given to treat cancer during the progression of disease to boost the immune system's ability to recognize and attack cancer antigens as foreign entities. Antibodies for cancer cell vaccines may be taken from the patient's own body (autologousvaccine) or from another patient (allogeneicvaccine).[39]Several autologous vaccines, such asOncophagefor kidney cancer and Vitespen for a variety of cancers, have either been released or are undergoingclinical trial.FDA-approved vaccines, such asSipuleucel-Tformetastasizingprostate cancerorNivolumabformelanomaand lung cancer can act either by targeting over-expressed ormutatedproteinsor by temporarily inhibitingimmune checkpointsto boost immune activity.[2][42]

Screening

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Main article:Cancer screening

Screening procedures, commonly sought for more prevalent cancers, such as colon, breast, and cervical, have greatly improved in the past few decades from advances inbiomarkeridentification and detection.[2]Early detection of pancreatic cancer biomarkers was accomplished using aSERS-basedimmunoassayapproach.[43]A SERS-based multiplex protein biomarker detection platform in amicrofluidic chipcan be used to detect several protein biomarkers to predict the type of disease and critical biomarkers and increase the chance of diagnosis between diseases with similar biomarkers (e.g.pancreatic cancer,ovarian cancer,andpancreatitis).[44]

To improve the chances of detecting cancer early, all eligible people should take advantage of cancer screening services. However, overall uptake of cancer screening among the general population is not widespread, especially among disadvantaged groups (e.g. those withlow income,mental illnesses,or are from differentethnic groups) who face different barriers that lead to lower attendance rates.[45]

Cervical cancer

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Cervical cancer is usually screened throughin vitroexamination of the cells of the cervix (e.g.Pap smear),colposcopy,or direct inspection of thecervix(after application of diluteacetic acid), or testing forHPV,theoncogenicvirus that is the necessary cause of cervical cancer.[39]Screening is recommended for women over 21 years, initially women between 21 and 29 years old are encouraged to receive Pap smear screens every three years, and those over 29 every five years.[2]For women older than the age of 65 and with no history of cervical cancer or abnormality, and with an appropriate precedence of negative Pap test results may cease regular screening.[46]

Still, adherence to recommended screening plans depends on age and may be linked to "educational level,culture,psychosocial issues,andmarital status,"further emphasizing the importance of addressing these challenges in regards to cancer screening.[2]

Colorectal cancer

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Colorectal canceris most often screened with thefecal occult bloodtest (FOBT). Variants of this test includeguaiac-based FOBT(gFOBT), thefecal immunochemical test(FIT), andstool DNA testing(sDNA).[47]Further testing includesflexible sigmoidoscopy(FS),total colonoscopy(TC), orcomputed tomography(CT) scans if a total colonoscopy is non-ideal. A recommended age at which to begin screening is 50 years. However, this is highly dependent on medical history and exposure to risk factors for colorectal cancer. Effective screening has been shown to reduce the incidence of colorectal cancer by 33% and colorectal cancer mortality by 43%.[2]

Breast cancer

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The estimated number of new breast cancer cases in the US in 2018 is predicted to be more than 1.7 million, with more than six hundred thousand deaths.[48]Factors such asbreast size,reduced physical activity,obesityandoverweight status,infertilityand never having had children,hormone replacement therapy(HRT), and genetics are risk factors for breast cancer.[2]Mammogramsare widely used to screen for breast cancer, and are recommended for women 50–74 years of age by theUS Preventive Services Task Force(USPSTF). However, the USPSTF does not recommend mammograms for women 40–49 years old due to the possibility ofoverdiagnosis.[2][49]

Preventable causes of cancer

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As of 2017,tobacco use,diet and nutrition,physical activity,obesity/overweight status,infectious agents,and chemical and physicalcarcinogenshave been reported to be the leading areas where cancer prevention can be practiced through enacting positive lifestyle changes, getting appropriate regular screening, and getting vaccinated.[50]

The development of many common cancers are incited by such risk factors. For example, consumption of tobacco and alcohol, a medical history ofgenital wartsandSTDs,immunosuppression,unprotected sex,and early age of firstsexual intercourseandpregnancyall may serve as risk factors for cervical cancer. Obesity, red meat orprocessed meatconsumption, tobacco andalcohol,and a medical history ofinflammatory bowel diseasesare all risk factors for colorectal cancer (CRC). On the other hand, exercise and consumption of vegetables may help decrease the risk of CRC.[2]

Several preventable causes of cancer were highlighted in Doll and Peto's landmark 1981 study,[5]estimating that 75 – 80% of cancers in the United States could be prevented by avoidance of 11 different factors. A 2013 review of more recent cancer prevention literature by Schottenfeld et al.,[51]summarizing studies reported between 2000 and 2010, points to most of the same avoidable factors identified by Doll and Peto. However, Schottenfeld et al. considered fewer factors (e.g. non inclusion of diet) in their review than Doll and Peto, and indicated that avoidance of these fewer factors would result in prevention of 60% of cancer deaths. The table below indicates the proportions of cancer deaths attributed to different factors, summarizing the observations of Doll and Peto, Shottenfeld et al. and several other authors, and shows the influence of major lifestyle factors on the prevention of cancer, such as tobacco, an unhealthy diet, obesity and infections.

Proportions of cancer deaths in the United States attributed to different factors
Factor Doll &
Peto[5][needs update]		 Schottenfeld
et al.[51]		 Other reports
Tobacco 30% 30% 38% men, 23% women,[52]30%,[53]25-30%
Unhealthy diet 35% - 32%,[54]10%,[55]30-35%
Obesity * 10% 14% women, 20% men, among non-smokers,[56]10-20%, 19-20%United States,16-18%Great Britain,13%Brazil,11-12%China[57]
Infection† 10% 5-8% 7-10%,[58]8% developed nations, 26% developing nations,[53]10% high income, 25% African
Alcohol 3% 3-4% 3.6%,[53]8% USA, 20% France[59]
Occupational exposures 4% 3-5% 2-10%, may be 15-20% in men[60]
Radiation (solar and ionizing) 3% 3-4% up to 10%
Physical inactivity * <5% 7%[61]
Reproductive and sexual behavior 1-13% - -
Pollution 2%[needs update] - -
Medicines and medical procedures 1% - -
Industrial products <1%[needs update] - -
Food additives <1%[needs update] - -

*Included in diet

†Carcinogenic infections include: for theuterine cervix(human papillomavirus[HPV]),liver(hepatitis B virus[HBV] andhepatitis C virus[HCV]), stomach (Helicobacter pylori[H pylori]),lymphoid tissues(Epstein-Barr virus[EBV]),nasopharynx(EBV),urinary bladder(Schistosoma hematobium), andbiliary tract(Opisthorchis viverrini,Clonorchis sinensis)

History of cancer prevention

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Cancer has been thought to be a preventable disease since the time ofRoman physician Galen,who observed that an unhealthy diet was correlated with cancer incidence. In 1713,Italian physician Ramazzinihypothesized thatabstinencecaused lower rates of cervical cancer in nuns. Further observation in the 18th century led to the discovery that certain chemicals, such as tobacco, soot and tar (leading toscrotalcancer inchimney sweeps,as reported byPercivall Pottin 1775), could serve as carcinogens for humans. Although Pott suggested preventive measures for chimney sweeps (wearing clothes to prevent contact bodily contact with soot), his suggestions were only put into practice inHolland,resulting in decreasing rates of scrotal cancer in chimney sweeps. Later, the 19th century brought on the onset of the classification of chemical carcinogens.[62]

In the early 20th century, physical and biological carcinogens, such asX-ray radiationor theRous Sarcoma Virusdiscovered 1911, were identified. Despite observed correlation of environmental or chemical factors with cancer development, there was a deficit of formal prevention research and lifestyle changes for cancer prevention were not feasible during this time.[62]

In Europe, in 1987 theEuropean Commissionlaunched theEuropean Code Against Cancerto help educate the public about actions they can take to reduce their risk of getting cancer.[63]The first version of the code covered 10 recommendations covering tobacco, alcohol, diet, weight, sun exposure, exposure to known carcinogens, early detection and participation in organized breast and cervical cancer screening programs.[64]In the early 1990s, theEuropean School of Oncologyled a review of the code and added details about the scientific evidence behind each of the recommendations.[64]Later updates were coordinated by theInternational Agency for Research on Cancer.The fourth edition of the code,[1],developed in 2012‒2013, also includes recommendations on participation invaccination programsfor hepatitis B (infants) and human papillomavirus (girls),breast feedingandhormone replacement therapy,and participation in organized colorectal cancer screening programs.

See also

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References

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