Proportion and number of cancer cases and deaths attributable to potentially modifiable risk factors in the United States, 2019.
Level 4 - case-series / case-control
Epidemiological population-attributable risk modeling based on survey prevalence data and meta-analytic relative risks
PubMed 38990124 · doi:10.3322/caac.21858
What was done
Using 2019 US national cancer registry and mortality data for adults aged 30 and older across 30 cancer types (excluding nonmelanoma skin cancer), the authors estimated the proportion and number of cancer cases and deaths attributable to potentially modifiable risk factors. Evaluated exposures included cigarette smoking, secondhand smoke, excess body weight, alcohol consumption, consumption of red and processed meats, low intake of fruits, vegetables, dietary fiber, and calcium, physical inactivity, ultraviolet radiation, and seven carcinogenic infections. Exposure prevalence was drawn from nationally representative surveys and relative risks were obtained from published pooled analyses and meta-analyses.
What was found
In 2019, 40.0% (713,340 of 1,781,649) of all incident cancer cases and 44.0% (262,120 of 595,737) of cancer deaths were attributable to the evaluated modifiable risk factors. Cigarette smoking contributed the largest share (19.3% of cases, 28.5% of deaths), followed by excess body weight (7.6% of cases, 7.3% of deaths), and alcohol intake (5.4% of cases, 4.1% of deaths). For 19 of the 30 cancer types evaluated, over 50% of cases and deaths were attributable to these modifiable risks. Lung cancer accounted for the highest number of attributable cases (201,660) and deaths (122,740). The next highest attributable case counts were female breast (83,840), skin melanoma (82,710), and colorectal cancer (78,440); for deaths, colorectal (25,800), liver (14,720), and esophageal cancer (13,600) followed lung cancer.
Why it matters
This study provides updated national benchmarks demonstrating that over 40% of cancer incidence and mortality in the United States remains tied to preventable lifestyle, dietary, infectious, and environmental exposures. The estimates pinpoint cigarette smoking, obesity, and alcohol as the highest-yield targets for cancer prevention and public health policy.
Limits
The findings depend on population-attributable fraction models that assume causal relationships and may not fully account for risk factor interactions or latency periods. Exposure prevalence estimates derived from national surveys are subject to self-report and recall bias. Several potentially modifiable environmental, occupational, and socio-environmental carcinogens were not evaluated.
Cited by
- supports The American Cancer Society estimates that about 40% of cancer cases in the United States could be prevented through optimal lifestyle practices.