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The Policy Report

The Next Step: Policy and Preventability

Making it Easier to Make Healthy Choices

AICR asked the expert panel behind the 2007 Expert Report – and its 10 Recommendations for Cancer Prevention – to lend their in-depth understanding of the science of cancer prevention to the development of a report on cancer prevention policy. They were joined in that task by leading policy experts specializing in the fields of physical activity, economics, and the psychology of health behaviors.

Evidence for the policy report came partly from two systematic literature reviews that investigated two specific questions:

What factors shape the patterns of behavior that affect cancer risk (namely diet, physical activity and body fatness)? And Around the world, what effects have specific interventions had on those patterns of behavior?

The policy report also sought to determine how much cancer could be prevented through diet, physical activity and weight management.

Preventability estimates were calculated using information on:

  • Cancer risk associated with lifestyle factor
  • Prevalence of low, moderate and high levels/consumption of lifestyle factor in each country
  • Incidence of different cancers in each country

The full methodology used to calculate the estimates, as well as more information estimates, can be found in Appendix A of the Policy Report.

Briefly: Estimates were made for lifestyle factors judged to be convincing or probable modifiers of cancer risk in the Second Expert Report, with a few exceptions; thus 12 cancers were included.

Highest versus lowest risk estimates were used for cancer risk. One research study (ideally large and recent) was chosen from those collected as part of the Second Expert Report, where the size of effect was representative of all studies.

Information on prevalence of lifestyle factors was obtained from national surveys. These two pieces of information were used to estimate preventability for each lifestyle factor.

The information on incidence of cancer was used to provide an overall estimate of preventability for each country.

Percentage Of Cancers That Could Be Prevented Via Healthy Diet, Regular Physical Activity And Healthy Weight

US

UK

Brazil

China

Endometrium
(lining of the uterus)

70

56

52

34

Esophagus

69

75

60

44

Mouth, pharynx & larynx

63

67

63

44

Stomach

47

45

41

33

Colon

45

43

37

17

Pancreas

39

41

34

14

Breast

38

42

28

20

Lung

36

33

36

38

Kidney

24

19

13

8

Gallbladder

21

16

10

6

Liver

15

17

6

6

Prostate

11

20

n/a

n/a

These 12 cancers combined

35

37

30

27

The table shows estimates for each cancer for the four countries. Totals are given for the 12 cancers (common cancers) studied as well as for all cancers.
The estimate for all cancers assumes that all cancers not listed in the tables are not related to cancer risk.

How Many Cancers Are Preventable?

For the 12 common cancers, about 35 per cent of cases in the USA are preventable through a healthy diet, being physically active and maintaining a healthy weight. The estimate for the other countries is 37 per cent for the UK, 30 per cent for Brazil and 27 per cent for China.

This translates to about 340,000 preventable cases of cancer in the USA, about 79,000 for the UK, about 61,000 for Brazil and about 620,000 for China.

The updated figures confirm that about a third of the most common cancers in higher-income countries and about a quarter in lower-income countries could be prevented through eating healthily, being physically active and maintaining a healthy weight.

Limitations

These figures are estimates and not precise values. They are likely to be underestimates as only those cancers judged to be convincingly or probably linked to lifestyle factors by the Second Expert Report Panel are included.

For the 2009 Policy Report, these estimates were based on GLOBOCAN 2002 data. In February of 2011, those original estimates were been updated with the most recent global incidence data from GLOBOCAN 2008* on cancer rates.

In order to estimate how preventable cancer is in different parts of the world figures were calculated for two high-income countries (USA and UK), a middle-income country (Brazil) and a low-income country (China).

* Ferlay J, Shin HR, Bray F, Forman D, Mathers C and Parkin DM. GLOBOCAN 2008, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 10 [Internet]. Lyon, France: International Agency for Research on Cancer; 2010. Available from: http://globocan.iarc.fr]

Sir Michael Marmot on the Policy Report

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