Preventability of cancer: the relative contributions of biologic and social and physical environmental determinants of cancer mortality

Abstract

Whereas models of cancer disparities and variation in cancer burden within population groups now specify multiple levels of action from biologic processes to individual risk factors and social and physical contextual factors, approaches to estimating the preventable proportion of cancer use more traditional direct models often from single exposures to cancer at specific organ sites. These approaches are reviewed, and the strengths and limitations are presented. The need for additional multilevel data and approaches to estimation of preventability are identified. International or regional variation in cancer may offer the most integrated exposure assessment over the life course. For the four leading cancers, which account for 50% of incidence and mortality, biologic, social, and physical environments play differing roles in etiology and potential prevention. Better understanding of the interactions and contributions across these levels will help refine prevention strategies.

Figure 1

Biological, social, and physical environmental causes of cancer.

Figure 2

Age-specific incidence per 100,000 of colon cancer comparing high-, moderate, and low-risk women within the Nurses’ Health Study cohort.

Figure 3

Decline in colorectal cancer incidence partitioned between changing risk factors and screening. From Edwards et al. 2010 (43).

Figure 4

Average time line for normal tissue to invasive cancer.