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Causes and Prevention


Cancer prevention is action taken to lower the risk of getting cancer. This can include maintaining a healthy lifestyle, avoiding exposure to known cancer-causing substances, and taking medicines or vaccines that can prevent cancer from developing.

Risk Factors

It is usually not possible to know exactly why one person develops cancer and another doesn’t. But research has shown that certain risk factors may increase a person’s chances of developing cancer. (There are also factors that are linked to a lower risk of cancer. These are sometimes called protective risk factors, or just protective factors.)

Cancer risk factors include exposure to chemicals or other substances, as well as certain behaviors. They also include things people cannot control, like age and family history. A family history of certain cancers can be a sign of a possible inherited cancer syndrome.

Most cancer risk (and protective) factors are initially identified in epidemiology studies. In these studies, scientists look at large groups of people and compare those who develop cancer with those who don’t. These studies may show that the people who develop cancer are more or less likely to behave in certain ways or to be exposed to certain substances than those who do not develop cancer.

Such studies, on their own, cannot prove that a behavior or substance causes cancer. For example, the finding could be a result of chance, or the true risk factor could be something other than the suspected risk factor. But findings of this type sometimes get attention in the media, and this can lead to wrong ideas about how cancer starts and spreads.

When many studies all point to a similar association between a potential risk factor and an increased risk of cancer, and when a possible mechanism exists that could explain how the risk factor could actually cause cancer, scientists can be more confident about the relationship between the two.

The list below includes the most-studied known or suspected risk factors for cancer. Although some of these risk factors can be avoided, others—such as growing older—cannot. Limiting your exposure to avoidable risk factors may lower your risk of developing certain cancers.

 

Age

Advancing age is the most important risk factor for cancer overall, and for many individual cancer types. According to the most recent statistical data from NCI’s Surveillance, Epidemiology, and End Results program, the median age of a cancer diagnosis is 66 years. This means that half of cancer cases occur in people below this age and half in people above this age. One-quarter of new cancer cases are diagnosed in people aged 65 to 74.

A similar pattern is seen for many common cancer types. For example, the median age at diagnosis is 61 years for breast cancer, 68 years for colorectal cancer, 70 years for lung cancer, and 66 years for prostate cancer.

But the disease can occur at any age. For example, bone cancer is most frequently diagnosed among people under age 20, with more than one-fourth of cases occurring in this age group. And 10 percent of leukemias are diagnosed in children and adolescents under 20 years of age, whereas only 1 percent of cancer overall is diagnosed in that age group. Some types of cancer, such as neuroblastoma, are more common in children or adolescents than in adults.


Alcohol

Drinking alcohol can increase your risk of cancer of the mouth, throat, esophagus, larynx (voice box), liver, and breast. The more you drink, the higher your risk. The risk of cancer is much higher for those who drink alcohol and also use tobacco.

Doctors advise people who drink to do so in moderate amounts. The federal government’s Dietary Guidelines for Americans defines moderate alcohol drinking as up to one drink per day for women and up to two drinks per day for men.

It has been suggested that certain substances in red wine, such as resveratrol, have anticancer properties. However, there is no evidence that drinking red wine reduces the risk of cancer.


Cancer-Causing Substances in the Environment

Cancer is caused by changes to certain genes that alter the way our cells function. Some of these genetic changes occur naturally when DNA is replicated during the process of cell division. But others are the result of environmental exposures that damage DNA. These exposures may include substances, such as the chemicals in tobacco smoke, or radiation, such as ultraviolet rays from the sun.

People can avoid some cancer-causing exposures, such as tobacco smoke and the sun’s rays. But others are harder to avoid, especially if they are in the air we breathe, the water we drink, the food we eat, or the materials we use to do our jobs. Scientists are studying which exposures may cause or contribute to the development of cancer. Understanding which exposures are harmful, and where they are found, may help people to avoid them.

The substances listed below are among the most likely carcinogens to affect human health. Simply because a substance has been designated as a carcinogen, however, does not mean that the substance will necessarily cause cancer. Many factors influence whether a person exposed to a carcinogen will develop cancer, including the amount and duration of the exposure and the individual’s genetic background.


Chronic Inflammation

Inflammation is a normal physiological response that causes injured tissue to heal. An inflammatory process starts when chemicals are released by the damaged tissue. In response, white blood cells make substances that cause cells to divide and grow to rebuild tissue to help repair the injury. Once the wound is healed, the inflammatory process ends.

In chronic inflammation, the inflammatory process may begin even if there is no injury, and it does not end when it should. Why the inflammation continues is not always known. Chronic inflammation may be caused by infections that don’t go away, abnormal immune reactions to normal tissues, or conditions such as obesity. Over time, chronic inflammation can cause DNA damage and lead to cancer. For example, people with chronic inflammatory bowel diseases, such as ulcerative colitis and Crohn disease, have an increased risk of colon cancer.

Many studies have investigated whether anti-inflammatory medications, such as aspirin or non-steroidal anti-inflammatory drugs, reduce the risk of cancer. However, a clear answer is not yet available.


Diet

Many studies have looked at the possibility that specific dietary components or nutrients are associated with increases or decreases in cancer risk. Studies of cancer cells in the laboratory and of animal models have sometimes provided evidence that isolated compounds may be carcinogenic (or have anticancer activity).

But with few exceptions, studies of human populations have not yet shown definitively that any dietary component causes or protects against cancer. Sometimes the results of epidemiologic studies that compare the diets of people with and without cancer have indicated that people with and without cancer differ in their intake of a particular dietary component.

However, these results show only that the dietary component is associated with a change in cancer risk, not that the dietary component is responsible for, or causes, the change in risk. For example, study participants with and without cancer could differ in other ways besides their diet, and it is possible that some other difference accounts for the difference in cancer.

When evidence emerges from an epidemiologic study that a dietary component is associated with a reduced risk of cancer, a randomized trial may be done to test this possibility. Random assignment to dietary groups ensures that any differences between people who have high and low intakes of a nutrient are due to the nutrient itself rather than to other undetected differences. (For ethical reasons, randomized studies are not generally done when evidence emerges that a dietary component may be associated with an increased risk of cancer.)

Scientists have studied many additives, nutrients, and other dietary components for possible associations with cancer risk. These include:

  • Alcohol
    Although red wine has been suspected of reducing cancer risk, there is no scientific evidence for such an association. Also, alcohol is a known cause of cancer. Heavy or regular alcohol consumption increases the risk of developing cancers of the oral cavity (excluding the lips), pharynx (throat), larynx (voice box), esophagus, liver, breast, colon, and rectum. The risk of developing cancer increases with the amount of alcohol a person drinks.
  • Antioxidants
    Antioxidants are chemicals that block the activity of other chemicals, known as free radicals, that may damage cells. Laboratory and animal research has shown that exogenous antioxidants can help prevent the free radical damage associated with the development of cancer, but research in humans has not demonstrated convincingly that taking antioxidant supplements can help reduce the risk of developing or dying from cancer. Some studies have even shown an increased risk of some cancers.
  • Artificial sweeteners
    Studies have been conducted on the safety of several artificial sweeteners, including saccharin, aspartame, acesulfame potassium, sucralose, neotame, and cyclamate. There is no clear evidence that the artificial sweeteners available commercially are associated with cancer risk in humans.
  • Calcium
    Calcium is an essential dietary mineral that can be obtained from food and supplements. Research results overall support a relationship between higher intakes of calcium and reduced risks of colorectal cancer, but the results of studies have not always been consistent. Whether a relationship exists between higher calcium intakes and reduced risks of other cancers, such as breast and ovarian cancer, is unclear. Some research suggests that a high calcium intake may increase the risk of prostate cancer.
  • Charred meat
    Certain chemicals, called HCAs and PAHs, are formed when muscle meat, including beef, pork, fish, and poultry, is cooked using high-temperature methods. Exposure to high levels of HCAs and PAHs can cause cancer in animals; however, whether such exposure causes cancer in humans is unclear.
  • Cruciferous vegetables
    Cruciferous vegetables contain chemicals known as glucosinolates, which break down into several compounds that are being studied for possible anticancer effects. Some of these compounds have shown anticancer effects in cells and animals, but the results of studies with humans have been less clear.
  • Fluoride
    Fluoride in water helps to prevent and can even reverse tooth decay. Many studies, in both humans and animals, have shown no association between fluoridated water and cancer risk.
  • Garlic
    Some studies have suggested that garlic consumption may reduce the risk of developing several types of cancer, especially cancers of the gastrointestinal tract. However, the evidence is not definitive.
  • Tea
    Tea contains polyphenol compounds, particularly catechins, which are antioxidants. Results of epidemiologic studies examining the association between tea consumption and cancer risk have been inconclusive. Few clinical trials of tea consumption and cancer prevention have been conducted and their results have also been inconclusive.
  • Vitamin D
    Vitamin D helps the body use calcium and phosphorus to make strong bones and teeth. It is obtained primarily through exposure of the skin to sunlight, but it can also be obtained from some foods and dietary supplements. Epidemiologic studies in humans have suggested that higher intakes of vitamin D or higher levels of vitamin D in the blood may be associated with a reduced risk of colorectal cancer, but the results of randomized studies have been inconclusive.

Hormones

Estrogens, a group of female sex hormones, are known human carcinogens. Although these hormones have essential physiological roles in both females and males, they have also been associated with an increased risk of certain cancers. For instance, taking combined menopausal hormone therapy (estrogen plus progestin, which is a synthetic version of the female hormone progesterone) can increase a woman’s risk of breast cancer. Menopausal hormone therapy with estrogen alone increases the risk of endometrial cancer and is used only in women who have had a hysterectomy.

A woman who is thinking about menopausal hormone therapy should discuss the possible risks and benefits with her doctor.

Studies have also shown that a woman’s risk of breast cancer is related to the estrogen and progesterone made by her ovaries (known as endogenous estrogen and progesterone). Being exposed for a long time and/or to high levels of these hormones has been linked to an increased risk of breast cancer. Increases in exposure can be caused by starting menstruation early, going through menopause late, being older at first pregnancy, and never having given birth. Conversely, having given birth is a protective factor for breast cancer.


Immunosuppression

Many people who receive organ transplants take medications to suppress the immune system so the body won’t reject the organ. These "immunosuppressive" drugs make the immune system less able to detect and destroy cancer cells or fight off infections that cause cancer. Infection with HIV also weakens the immune system and increases the risk of certain cancers. 

Research has shown that transplant recipients are at increased risk of a large number of different cancers. Some of these cancers can be caused by infectious agents, whereas others are not. The four most common cancers among transplant recipients and that occur more commonly in these individuals than in the general population are non-Hodgkin lymphoma (NHL) and cancers of the lung, kidney, and liver. NHL can be caused by Epstein-Barr virus (EBV) infection, and liver cancer by chronic infection with the hepatitis B (HBV) and hepatitis C (HCV) viruses. Lung and kidney cancers are not generally thought to be associated with infection.

People with HIV/AIDS also have increased risks of cancers that are caused by infectious agents, including EBV; human herpesvirus 8, or Kaposi sarcoma-associated virus; HBV and HCV, which cause liver cancer; and human papillomavirus, which causes cervical, anal, oropharyngeal, and other cancers. HIV infection is also associated with increased risks of cancers that are not thought to be caused by infectious agents, such as lung cancer.


Infectious Agents

Certain infectious agents, including viruses, bacteria, and parasites, can cause cancer or increase the risk that cancer will form. Some viruses can disrupt signaling that normally keeps cell growth and proliferation in check. Also, some infections weaken the immune system, making the body less able to fight off other cancer-causing infections. And some viruses, bacteria, and parasites also cause chronic inflammation, which may lead to cancer.

Most of the viruses that are linked to an increased risk of cancer can be passed from one person to another through blood and/or other body fluids. As described below, you can lower your risk of infection by getting vaccinated, not having unprotected sex, and not sharing needles.


Obesity

People who are obese may have an increased risk of several types of cancer, including cancers of the breast (in women who have been through menopause), colon, rectum, endometrium (lining of the uterus), esophagus, kidney, pancreas, and gallbladder.

Conversely, eating a healthy diet, being physically active, and keeping a healthy weight may help reduce risk of some cancers. These healthy behaviors are also important to lessen the risk of other illnesses, such as heart disease, type II diabetes, and high blood pressure.


Radiation

Radiation of certain wavelengths, called ionizing radiation, has enough energy to damage DNA and cause cancer. Ionizing radiation includes radon, x-rays, gamma rays, and other forms of high-energy radiation. Lower-energy, non-ionizing forms of radiation, such as visible light and the energy from cell phones and electromagnetic fields, do not damage DNA and have not been found to cause cancer.     

Radon

Radon is a radioactive gas given off by rocks and soil. Radon is formed when the radioactive element radium breaks down. Radium in turn is formed when the radioactive elements uranium and thorium break down. People who are exposed to high levels of radon have an increased risk of lung cancer.

If you live in an area of the country that has high levels of radon in its rocks and soil, you may wish to test your home for this gas. Home radon tests are easy to use and do not cost much. Most hardware stores sell test kits. There are many ways to lessen the amount of radon in a home to a safe level. For more information on radon, see the Radon page and the Radon and Cancer fact sheet.

X-Rays and Other Sources of Radiation

High-energy radiation, such as x-rays, gamma rays, alpha particles, beta particles, and neutrons, can damage DNA and cause cancer. These forms of radiation can be released in accidents at nuclear power plants and when atomic weapons are made, tested, or used.

Certain medical procedures, such as chest x-rays, computed tomography (CT) scans, positron emission tomography (PET) scans, and radiation therapy can also cause cell damage that leads to cancer. However, the risks of cancer from these medical procedures are very small, and the benefit from having them is almost always greater than the risks.

Talk with your doctor if you think you may be at risk for cancer because you were exposed to radiation. People considering CT scans should talk with their doctors about whether the procedure is necessary for them and about its risks and benefits. Cancer patients may want to talk with their doctors about how radiation treatment could increase their risk for a second cancer later on.

Sunlight

The sun, sunlamps, and tanning booths all give off ultraviolet (UV) radiation. Exposure to UV radiation causes early aging of the skin and skin damage that can lead to skin cancer.

People of all ages and skin tones should limit the amount of time they spend in the sun, especially between mid-morning and late afternoon. It is important to keep in mind that UV radiation is reflected by sand, water, snow, and ice and can go through windshields and windows. Even though skin cancer is more common among people with a light skin tone, people of all skin tones can develop skin cancer, including those with dark skin.

Keep in mind that the sun's rays...

  • are strongest between 10:00 a.m. and 4:00 p.m.
  • can go through light clothing, windshields, windows, and clouds
  • are reflected by sand, water, snow, ice, and pavement

Tobacco

The Global Economic Burden of Tobacco Global cost of tobacco tops $1 trillion, but control strategies can be "highly cost effective," says NCI’s Dr. Mark Parascandola.

Tobacco use is a leading cause of cancer and of death from cancer. People who use tobacco products or who are regularly around environmental tobacco smoke (also called secondhand smoke) have an increased risk of cancer because tobacco products and secondhand smoke have many chemicals that damage DNA.

Tobacco use causes many types of cancer, including cancer of the lung, larynx (voice box), mouth, esophagus, throat, bladder, kidney, liver, stomach, pancreas, colon and rectum, and cervix, as well as acute myeloid leukemia. People who use smokeless tobacco (snuff or chewing tobacco) have increased risks of cancers of the mouth, esophagus, and pancreas.

There is no safe level of tobacco use. People who use any type of tobacco product are strongly urged to quit.  People who quit smoking, regardless of their age, have substantial gains in life expectancy compared with those who continue to smoke. Also, quitting smoking at the time of a cancer diagnosis reduces the risk of death.

 


The Genetics

Cancer is caused by certain changes to genes, the basic physical units of inheritance. Genes are arranged in long strands of tightly packed DNA called chromosomes.

ON THIS PAGE

 

Genetic Changes and Cancer

Cancer is a genetic disease—that is, cancer is caused by certain changes to genes that control the way our cells function, especially how they grow and divide.

Genes carry the instructions to make proteins, which do much of the work in our cells. Certain gene changes can cause cells to evade normal growth controls and become cancer. For example, some cancer-causing gene changes increase production of a protein that makes cells grow. Others result in the production of a misshapen, and therefore nonfunctional, form of a protein that normally repairs cellular damage.

Genetic changes that promote cancer can be inherited from our parents if the changes are present in germ cells, which are the reproductive cells of the body (eggs and sperm). Such changes, called germline changes, are found in every cell of the offspring.

Cancer-causing genetic changes can also be acquired during one’s lifetime, as the result of errors that occur as cells divide or from exposure to carcinogenic substances that damage DNA, such as certain chemicals in tobacco smoke, and radiation, such as ultraviolet rays from the sun. Genetic changes that occur after conception are called somatic (or acquired) changes.

There are many different kinds of DNA changes. Some changes affect just one unit of DNA, called a nucleotide. One nucleotide may be replaced by another, or it may be missing entirely. Other changes involve larger stretches of DNA and may include rearrangements, deletions, or duplications of long stretches of DNA.

Sometimes the changes are not in the actual sequence of DNA. For example, the addition or removal of chemical marks, called epigenetic modifications, on DNA can influence  whether the gene is “expressed”—that is, whether and how much messenger RNA is produced. (Messenger RNA in turn is translated to produce the proteins encoded by the DNA.)

In general, cancer cells have more genetic changes than normal cells. But each person’s cancer has a unique combination of genetic alterations. Some of these changes may be the result of cancer, rather than the cause. As the cancer continues to grow, additional changes will occur. Even within the same tumor, cancer cells may have different genetic changes.


Hereditary Cancer Syndromes

Inherited genetic mutations play a major role in about 5 to 10 percent of all cancers. Researchers have associated mutations in specific genes with more than 50 hereditary cancer syndromes, which are disorders that may predispose individuals to developing certain cancers.

Genetic tests for hereditary cancer syndromes can tell whether a person from a family that shows signs of such a syndrome has one of these mutations. These tests can also show whether family members without obvious disease have inherited the same mutation as a family member who carries a cancer-associated mutation.

Many experts recommend that genetic testing for cancer risk be considered when someone has a personal or family history that suggests an inherited cancer risk condition, as long as the test results can be adequately interpreted (that is, they can clearly tell whether a specific genetic change is present or absent) and when the results provide information that will help guide a person’s future medical care.

Cancers that are not caused by inherited genetic mutations can sometimes appear to “run in families.” For example, a shared environment or lifestyle, such as tobacco use, can cause similar cancers to develop among family members. However, certain patterns in a family—such as the types of cancer that develop, other non-cancer conditions that are seen, and the ages at which cancer develops—may suggest the presence of a hereditary cancer syndrome.

Even if a cancer-predisposing mutation is present in a family, not everyone who inherits the mutation will necessarily develop cancer. Several factors influence the outcome in a given person with the mutation, including the pattern of inheritance of the cancer syndrome


Genetic Tests for Hereditary Cancer Syndromes

Genetic tests for mutatations that cause hereditary cancer syndromes are usually requested by a person’s doctor or other health care provider. Genetic counseling can help people consider the risks, benefits, and limitations of genetic testing in their particular situations.

A genetic counselor, doctor, or other health care professional trained in genetics can help an individual or family understand their test results and explain the possible implications of test results for other family members.

People considering genetic testing should understand that their results may become known to other people or organizations that have legitimate, legal access to their medical records, such as their insurance company or employer, if their employer provides the patient’s health insurance as a benefit.


Identifying Genetic Changes in Cancer

Lab tests called DNA sequencing tests can “read” DNA. By comparing the sequence of DNA in cancer cells with that in normal cells, such as blood or saliva, scientists can identify genetic changes in cancer cells that may be driving the growth of an individual’s cancer. This information may help doctors sort out which therapies might work best against a particular tumor.

Tumor DNA sequencing can also reveal the presence of inherited mutations. Indeed, in some cases, the genetic testing of tumors has shown that a patient’s cancer could be associated with a hereditary cancer syndrome that the family was not aware of.

As with testing for specific mutations in hereditary cancer syndromes, clinical DNA sequencing has implications that patients need to consider. For example, they may learn incidentally about the presence of inherited mutations that may cause other diseases, in them or in their family members.


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