Some of the causes of cancer have first and last names. Not all, but most, yes. Name, Surname and Medicine. Because they are avoidable, as the oncologist Josep Tabernero recalled in an interview with EL PAÍS back in 2017: “By changing habits, 40% of the tumors could already be reduced.” And he wasn’t on the wrong track. An international study published this Thursday in The Lancet magazine reveals the true impact of these carcinogens: almost half of the cancer deaths worldwide in 2019 (4.45 million) are due to preventable risk factors such as tobacco, alcohol, obesity and pollution , unhealthy diet or occupational exposure to harmful elements such as asbestos, among others. A few months ago, another oncologist, Frenchman Thierry Philip, pointed out the target of the great enemy: “If Europeans under 20 quit smoking tomorrow, cancer mortality would be halved in 50 years.”
The researchers reviewed data from the Global Burden of Disease, Injury, and Risk Factor (GBD) study, which examined 369 causes of death and disability and 87 risk factors for 204 countries and territories. In particular, they focused on examining the impact of 34 risk factors on death and ill health in 23 types of cancer and found that these risk factors actually explain 44.4% of cancer deaths worldwide. More men than women: Half of all cancer deaths in men and more than a third of deaths from oncological processes in women have these potentially preventable elements as a starting point.
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There are environmental risk factors such as pollution; Behaviors such as smoking, drinking alcohol or having unprotected sex; and metabolic, such as B. high body mass index or high blood sugar levels. However, the main focus is on tobacco, which promotes the occurrence of up to 16 types of cancer. It is the number one risk factor, light years ahead of the second, alcohol, and the third, high body mass index, associated with overweight and obesity. To see the impact of each of them, the researchers used the indicator of disability-adjusted life years (DALY), which measures the global burden of disease and expresses years lost through illness, disability or early death. The age-standardized DALY rate for tobacco was 677.3 years lost per 100,000 population/year, while the rates for alcohol were 155 and for high body mass index 134.
A waitress serves alcoholic drinks on a terrace in Berlin August 9. Krisztian Bocsi (Bloomberg)
The researchers also found differences between men and women: they are more exposed to these risk factors and the burden of disease means more years lost due to illness, disability or premature death from cancer. There was a discrepancy in DALYs attributed to smoking and alcohol use, much higher in males, “which may reflect males being more exposed than females to these behavioral risk factors,” the authors explain. Likewise, disability-adjusted life years attributable to carcinogens at work were higher among them, which the researchers add may indicate ‘that men are more likely than women to be employed in jobs with a higher risk of exposure to carcinogens.
Metabolic risk boom
Despite the fact that these risk factors are well known to oncologists and citizens, research warns that deaths related to these preventable factors have increased by 20% over the past decade. And while tobacco remains the leading cause of cancer, metabolic risks were responsible for the largest percentage increase in cancer deaths and morbidity, with deaths increasing by 34.7%.
The weight of metabolic factors is growing along with rates of obesity and overweight, which have skyrocketed over the past 20 years: excess fat has gone from two million deaths in 1990 to five million in 2019, according to data archive Our World in Data The scientific community has also warned that unhealthy diets and physical inactivity, which lead to obesity, continue to rise, as does obesity in adults and children. A 2019 study by the Hospital del Mar Medical Research Institute (IMIM) in Barcelona concluded that eight out of ten men and 55% of women will be overweight or obese by 2030.
Customers at a McDonald’s restaurant in London last July. HANNAH MCKAY (Portal)
The situation varies greatly from country to country. But the highest burden of disease lies in the most developed countries. Despite better access to diagnosis, better treatments and higher survival rates, it makes sense that the burden of this disease should fall on rich countries, explains Esteve Fernández, director of cancer epidemiology, prevention and control at the Catalan Institute of Oncology: “Cancer is a chronic disease typical of developed countries and heading towards developing countries. As a country grows, it shifts from a contagious disease pattern to a chronic disease pattern.”
Research indicates that middle- and low-income countries are in the midst of an “epidemiological transition”: although in 2019 the proportion of years of life lost attributable to cancer risk factors increased in rich countries, the development is seen In over the past decade, these DALY rates have fallen in the most developed areas and risen in lower-middle-income countries. “The increased cancer burden attributed to metabolic risk may be the result of an epidemiological transition in these countries, in which improvements in development at the country level are associated with increases in obesity,” the researchers speculate in the article.
On the map showing the weight of risk factors in disease burden and years lost to cancer, Spain is halfway between the worst and the best on all indicators. In the middle, César Rodríguez, Vice President of the Spanish Society of Medical Oncology, explains: “We are not first in anything, but second in everything. For example, with metabolic factors such as obesity or overweight. The myth of the Mediterranean diet is very good, but there are countries that are better than us. It seems that we are adopting customs and habits similar to those of countries worse off than us.”
The age-adjusted DALY ratio for environmental and occupational factors, such as exposure to pollution or carcinogens such as asbestos, cadmium or chromium, is skyrocketing in China and almost all of Europe (except Spain, Portugal, Ireland and some countries in the middle of the continent). ). DALY ratios for behavioral factors such as tobacco, alcohol or unhealthy diet are low in Scandinavian countries, while they have the highest thresholds in, for example, Eastern Europe and Argentina; Spain, France, Italy, Great Britain and North America are just behind the highest values. Conversely, the weight of metabolic risk is more evident in the United States, parts of Latin America, the United Kingdom and Eastern Europe.
preventable deaths
Rodríguez assures that the study is “of high quality”: “And it indirectly tells us what the preventable deaths are. 45% of cancer deaths depend on risk factors that we could change and thus avoid.” The other half of the deaths, adds Rodríguez, point to other causes: from hereditary to other unavoidable risk factors such as aging or yet to be known Variables. In fact, in the article itself, the researchers point out that in addition to the data collection itself, which is more or less complex depending on the country, limitations include that the risk factors included in the study “are based on evidence of cancer risk factors, but with increasing knowledge Additional important risk factors may be included in other updates to the GBD, they note.”In addition, there are known risk factors for cancer, such as exposure to sunlight (i.e., ultraviolet radiation) and infectious agents such as Helicobacter pylori, that are not included in the GBD study are,” they add.
The researchers point to the need for “greater political commitment” to promote health policies to prevent cancer. “Significant progress has been made globally in reducing tobacco exposure that can be linked to coordinated national and international prevention efforts. Interventions through tobacco control and regulation policies, including smoking ban policies, increased tobacco taxes, and advertising bans (…) have played an important role in these efforts. Similar measures, including taxes and advertising bans, have been recommended to reduce harmful alcohol consumption.
Fernández assures that there is still a long way to go to continue winning spaces and lives for tobacco. “Its influence is four to five times higher than the rest of the factors. The sad thing is that we don’t do anything and the worst thing is that you know what strategies work but governments don’t implement them. There is a gap between what we know works and what is being put into practice: Smoking ban legislation works well because it protects non-smokers and makes smokers think. We also know that increasing the price reduces the purchase of tobacco and controls advertising or makes simple packaging. These are cheap measures,” defends the expert, who also proposes increasing taxes on sugary drinks or banning machines with unhealthy products from schools.
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