Modifiable Risk Factors

Modifiable risk factors for cancer include tobacco use, sun exposure, diet, exercise, obesity, alcohol use, hormone replacement therapy (HRT), environmental occupational exposures, infectious exposures, and sexual activity.

Tobacco use:

Tobacco use accounts for approximately one third of cancer deaths in the India. Of these, lung cancer is the most common, but cancers of the blood, head and neck, esophagus, liver, pancreas, liver, stomach, cervix, kidney, colon, and bladder have also been linked to smoking. Many chemicals are present in tobacco smoke, including at least 69 known carcinogens. Smokeless tobacco—chewing tobacco and dipping snuff—contains at least 28 carcinogens.​

Smoking may also promote more aggressive forms of cancer: for example, tobacco use is associated with higher-grade and higher-stage prostate cancer. Secondhand smoke, also known as environmental tobacco smoke, has been associated with both lung and sinus cancers in nonsmokers. ln addition, considerable evidence indicates that smokeless tobacco and cigars also have deadly consequences, including lung, laryngeal, esophageal, and oral cancers.​

Carcinogenesis from tobacco use occurs through several mechanisms, including direct delivery of carcinogens to tissues, inflammation, and breakdown of physiologic barriers. Cessation of tobacco use has been shown to reduce both cancer-related and all-cause mortality. Health benefits start soon after quitting and can be seen even in long-time users. For former smokers who have been abstinent for 10 years, the risk of lung cancer is one half that of current smokers. This risk falls to as low as 10% for ex-smokers who have quit for 30 years or more. Moreover, the risk for cancers of the mouth, throat, and esophagus lessens significantly 5 years after quitting, and the risk of developing bladder or cervical cancers also decreases after just a few years of being nicotine free.​

Most individuals require several quit attempts before they are able to stop smoking. The addiction to tobacco use is both psychologic and biochemical. Medications are available to address the biochemical aspects, whereas counseling and other social support are recommended for treating the psychologic aspects.​

Sun Exposure: ​

Non melanoma skin cancers comprise 40% of malignancies in the US. The incidence rates of melanoma, although much less common than non melanoma skin cancers is increasing and this condition has a much higher propensity for metastasis and death.​

Ultraviolet radiation is a well-established carcinogen for both melanoma and non melanoma skin cancers. However, the patterns of sunlight exposure associated with these cancers differ significantly. Squamous cell carcinoma tends to occur in those who have chronic sun exposure, often due to occupational exposure from working outdoors.​

Diet: ​

Multiple components of the diet have been studied, both singly and in combination, for their effects on cancer risk. However, study of diet has proven difficult. Epidemiologic studies may have limited reliability because of inaccurate recall and multiple confounding factors, whereas clinical trials are subject to noncompliance, inappropriate form of the nutrient, or an insufficient follow-up period.​

Consumption of calcium has been associated with a decreased incidence of any cancer in women and a decreased incidence of colon cancers in both men and women​

The link between fruit and vegetable intake and decreased overall cancer risk is weak, however, pooled analyses suggest a 25% reduction in the incidence of distal (but not proximal) colon cancer in those who consumed more than 800 g of fruits and vegetables per day.​

Exercise: ​

Estimates indicate that a sedentary lifestyle is responsible for approximately 5% of cancer deaths.

Higher levels of physical activity have been associated with decreases in the risks of colon and breast cancers, and possible decreased risks of endometrial, prostate, liver, pancreatic, stomach, and lung cancers have been described as well.​

Obesity: ​

Epidemiologic studies have indicated that excess weight or obesity result in 14% of cancer deaths in men and 20% of cancer deaths in women



Alcohol use

Long-term alcohol use has been associated with approximately 4% of incident cancer cases.​

Hormone Replacement Therapy: ​

Considerable epidemiologic evidence suggests that the duration of a woman's exposure to endogenous estrogen affects breast cancer risk. Support for this hypothesis includes the increased risk of breast cancer for women with an earlier age of menarche, later age of menopause, nulliparity, and later age at first live birth, as well as higher serum estrogen concentrations. For women who take estrogen-¬only hormone replacement therapy, meta-analyses of epidemiologic studies indicate a mildly increased risk of breast cancer.​

Environmental and occupational exposures: ​

Geographic patterns of cancer incidence may provide insight into cancer etiology. Possible risk factors include environmental exposures and occupational exposures from the air or water.​

Workplace exposure to chemicals such as coal-tar–based products, benzene, cadmium, uranium, asbestos, or nickel can significantly increase cancer risk. For example, a significant proportion of bladder cancers may be due to chemical exposures in the aluminum, dye, paint, petroleum, rubber, and textile industries. Occupational exposures to radon and asbestos have been linked to lung cancer, and a small percentage of lung cancers are attributable to air pollution. Arsenic exposure has also been linked to increased incidence of non melanoma skin cancers

Global Vision Is a Cancer Care NGO Working for needy Cancer patients in India for more Information Visithttp://globalvisionnngo.org

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[Dhruv Bindhani]

The provided text outlines various modifiable risk factors for cancer, emphasizing that lifestyle choices and environmental exposures significantly impact cancer development. It concludes by mentioning a non-governmental organization (NGO), Global Vision, dedicated to cancer care in India.

Modifiable Risk Factors for Cancer​

The text identifies several key areas where individuals can potentially reduce their cancer risk:

• Tobacco Use: This is highlighted as a major contributor, accounting for approximately one-third of cancer deaths in India. Both smoking and smokeless tobacco are linked to a wide array of cancers, including lung, head and neck, esophagus, liver, pancreas, stomach, cervix, kidney, colon, and bladder. Tobacco smoke contains at least 69 known carcinogens, while smokeless tobacco contains at least 28. Smoking can also lead to more aggressive cancer forms. Secondhand smoke is associated with lung and sinus cancers in non-smokers. Quitting tobacco significantly reduces cancer risk, with benefits seen even in long-time users, improving dramatically over decades of abstinence. Successful cessation often requires addressing both psychological and biochemical aspects of addiction through medication, counseling, and social support.
• Sun Exposure: Ultraviolet (UV) radiation is a known carcinogen for both melanoma and non-melanoma skin cancers. While non-melanoma skin cancers are more common (40% of malignancies in the US), melanoma is more prone to metastasis and death, and its incidence is rising. The pattern of sun exposure differs: chronic sun exposure (e.g., occupational) is linked to squamous cell carcinoma, whereas intermittent intense exposure is often associated with melanoma.
• Diet: Studying the link between diet and cancer is complex due to recall inaccuracies in epidemiologic studies and compliance issues in clinical trials. However, some associations have been observed:
  
  • Calcium: Consumption of calcium has been linked to a decreased incidence of any cancer in women and colon cancers in both men and women.
  • Fruits and Vegetables: While the overall link to reduced cancer risk is weak, pooled analyses suggest a 25% reduction in distal (but not proximal) colon cancer incidence with very high daily intake (over 800g).
• Exercise: A sedentary lifestyle is estimated to be responsible for approximately 5% of cancer deaths. Higher levels of physical activity are associated with decreased risks of colon and breast cancers, with possible benefits for endometrial, prostate, liver, pancreatic, stomach, and lung cancers.
• Obesity: Epidemiological studies indicate that excess weight or obesity contribute to 14% of cancer deaths in men and 20% in women.
• Alcohol Use: Long-term alcohol consumption is associated with approximately 4% of incident cancer cases.
• Hormone Replacement Therapy (HRT): For women taking estrogen-only HRT, meta-analyses suggest a mildly increased risk of breast cancer. The duration of endogenous (naturally produced) estrogen exposure also influences breast cancer risk, with factors like earlier menarche, later menopause, nulliparity, and later age at first live birth increasing risk due to prolonged exposure to higher serum estrogen concentrations.
• Environmental and Occupational Exposures: Geographic patterns of cancer incidence often point to environmental and occupational exposures from air or water. Workplace exposure to carcinogens like coal-tar–based products, benzene, cadmium, uranium, asbestos, and nickel can significantly increase cancer risk. For instance, a notable proportion of bladder cancers may be linked to chemical exposures in industries such as aluminum, dye, paint, petroleum, rubber, and textile. Radon and asbestos exposure are tied to lung cancer, and air pollution also contributes to a small percentage of lung cancers. Arsenic exposure has been linked to non-melanoma skin cancers.

Global Vision: A Cancer Care NGO​

The text concludes by mentioning Global Vision, a Cancer Care NGO operating in India. This organization works to support needy cancer patients, indicating efforts to address the impact of cancer, likely through awareness, screening, and assistance programs, given the context of modifiable risk factors and the challenges of cancer care.