Environment, lifestyle, and cancer in women

Abstract

Environmental and lifestyle factors significantly contribute to gynecological cancers. The risk of ovarian cancer, one the most lethal gynecological cancer, is associated with obesity, poor dietary habits, and environmental pollutants, exacerbating hormonal imbalances, inflammation, and oxidative stress. Protective factors, such as the Mediterranean diet and oral contraceptives, modulate risk by reducing ovulatory cycles, particularly in genetically predisposed women. Uterine cancer is associated with metabolic factors, with obesity driving hormonal disruptions and systemic inflammation. Physical inactivity and diets rich in animal fats increase the risk of endometrial cancer, along with air pollution and microbiome imbalances contribute to endometrial carcinogenesis. Cervical cancer is primarily driven by persistent high-risk HPV infection, with smoking enhancing viral persistence and oncogenesis. Nutritional deficiencies in antioxidants and folate weaken immune defenses, while vaginal and gut microbiome dysbiosis fosters neoplastic progression. Vulvar and vaginal cancers, though less common, share risk factors such as obesity, smoking, and occupational exposures, disrupting immune responses and epithelial integrity. Microbial imbalances exacerbate these malignancies, creating a pro-inflammatory microenvironment. The interplay between modifiable factors and genetic predisposition, including high-penetrance mutations and polygenic risk scores, highlights the complexity complexity of prevention of gynecological cancers. Epigenetic mechanisms, such as DNA methylation and histone modifications, further modulate susceptibility and tumor progression, influenced by environmental and lifestyle exposures. In addition, promoting and supporting healthy lifestyle changes, including smoking cessation, increased physical activity, and a balanced diet, are crucial for improving long-term outcomes and quality of life in gynecological cancer survivors. Addressing these factors through personalized prevention, leveraging predictive models incorporating genetics and modifiable risks, enables tailored lifestyle interventions and avoidance of environmental exposures. Combined with equitable public health initiatives, these strategies have the potential to reduce the burden of gynecological cancers and improve women's health globally.

Keywords: Lifestyle and cancer; cancer risk factors; diet and cancer; environmental exposures; epidemiology of cancer; hormonal influences; reproductive factors.

FIGURE 1

Leading risk factors at the most detailed level for attributable cancer age‐standardized DALY rates, 2010–2019 for the global level, for men, women, and both sexes combined. The data in parentheses are 95% uncertainty intervals (UIs). Rows are color‐coded as follows: Red = environmental and occupational risk factors; blue = behavioral risk factors; green = metabolic risk factors. Dashed lines indicate a decrease in rank; solid lines indicate an increase or no change in rank. Risk factors at the most detailed level reflect the GBD hierarchy in which these categories of risks fall, ranging from levels 2 to 4. ASR, age‐standardized rate; DALY, disability‐adjusted life‐year; SDI, sociodemographic index.