Cancer rates not explained by smoking: a county-level analysis
Abstract Background Debates over the importance of “lifestyle” versus “environment” contributions to cancer have been going on for over 40 years. While it is clear that cigarette smoking is the most significant cancer risk factor, the contributions of occupational and environmental carcinogens in ai...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2020-06-01
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| Series: | Environmental Health |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12940-020-00613-x |
| _version_ | 1818290562576416768 |
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| author | Douglas J. Myers Polly Hoppin Molly Jacobs Richard Clapp David Kriebel |
| author_facet | Douglas J. Myers Polly Hoppin Molly Jacobs Richard Clapp David Kriebel |
| author_sort | Douglas J. Myers |
| collection | DOAJ |
| description | Abstract Background Debates over the importance of “lifestyle” versus “environment” contributions to cancer have been going on for over 40 years. While it is clear that cigarette smoking is the most significant cancer risk factor, the contributions of occupational and environmental carcinogens in air, water and food remain controversial. In practice, most cancer prevention messaging focuses on reducing cigarette smoking and changing other personal behaviors with little mention of environmental chemicals, despite widespread exposure to many known carcinogens. To inform decision-making on cancer prevention priorities, we evaluated the potential impact of smoking cessation on cancer rates. Methods Using cancer incidence data from 612 counties in the SEER database, and county-level smoking prevalences, we investigated the impact of smoking cessation on incidence for 12 smoking-related cancer types, 2006—2016. A multilevel mixed-effects regression model quantified the association between county-level smoking prevalence and cancer incidence, adjusting for age, gender and variability over time and among counties. We simulated complete smoking cessation and estimated the effects on county-level cancer rates. Results Regression models showed the expected strong association between smoking prevalence and cancer incidence. Simulating complete smoking cessation, the incidence of the 12 smoking-related cancer types fell by 39.8% (54.9% for airways cancers; 28.9% for non-airways cancers). And, while the actual rates of smoking-related cancers from 2006 to 2016 declined (annual percent change (APC) = − 0.8, 95% CI = − 1.0 to − 0.5%), under the scenario of smoking elimination, the trend in cancer incidence at these sites was not declining (APC = − 0.1, 95% CI = − 0.4 to + 0.1%). Not all counties were predicted to benefit equally from smoking elimination, and cancer rates would fall less than 10% in some counties. Conclusions Smoking prevention has produced dramatic reductions in cancer in the US for 12 major types. However, we estimate that eliminating smoking completely would not affect about 60% of cancer cases of the 12 smoking-related types, leaving no improvement in the incidence trend from 2006 to 2016. We conclude that cancer prevention strategies should focus not only on lifestyle changes but also the likely contributions of the full range of risk factors, including environmental/occupational carcinogens. |
| first_indexed | 2024-12-13T02:30:09Z |
| format | Article |
| id | doaj.art-5900a5be8c814075b77eff8d2d84c26b |
| institution | Directory Open Access Journal |
| issn | 1476-069X |
| language | English |
| last_indexed | 2024-12-13T02:30:09Z |
| publishDate | 2020-06-01 |
| publisher | BMC |
| record_format | Article |
| series | Environmental Health |
| spelling | doaj.art-5900a5be8c814075b77eff8d2d84c26b2022-12-22T00:02:31ZengBMCEnvironmental Health1476-069X2020-06-0119111010.1186/s12940-020-00613-xCancer rates not explained by smoking: a county-level analysisDouglas J. Myers0Polly Hoppin1Molly Jacobs2Richard Clapp3David Kriebel4Department of Community and Environmental Health, College of Health Sciences, Boise State UniversityLowell Center for Sustainable Production, University of Massachusetts, LowellLowell Center for Sustainable Production, University of Massachusetts, LowellLowell Center for Sustainable Production, University of Massachusetts, LowellLowell Center for Sustainable Production, University of Massachusetts, LowellAbstract Background Debates over the importance of “lifestyle” versus “environment” contributions to cancer have been going on for over 40 years. While it is clear that cigarette smoking is the most significant cancer risk factor, the contributions of occupational and environmental carcinogens in air, water and food remain controversial. In practice, most cancer prevention messaging focuses on reducing cigarette smoking and changing other personal behaviors with little mention of environmental chemicals, despite widespread exposure to many known carcinogens. To inform decision-making on cancer prevention priorities, we evaluated the potential impact of smoking cessation on cancer rates. Methods Using cancer incidence data from 612 counties in the SEER database, and county-level smoking prevalences, we investigated the impact of smoking cessation on incidence for 12 smoking-related cancer types, 2006—2016. A multilevel mixed-effects regression model quantified the association between county-level smoking prevalence and cancer incidence, adjusting for age, gender and variability over time and among counties. We simulated complete smoking cessation and estimated the effects on county-level cancer rates. Results Regression models showed the expected strong association between smoking prevalence and cancer incidence. Simulating complete smoking cessation, the incidence of the 12 smoking-related cancer types fell by 39.8% (54.9% for airways cancers; 28.9% for non-airways cancers). And, while the actual rates of smoking-related cancers from 2006 to 2016 declined (annual percent change (APC) = − 0.8, 95% CI = − 1.0 to − 0.5%), under the scenario of smoking elimination, the trend in cancer incidence at these sites was not declining (APC = − 0.1, 95% CI = − 0.4 to + 0.1%). Not all counties were predicted to benefit equally from smoking elimination, and cancer rates would fall less than 10% in some counties. Conclusions Smoking prevention has produced dramatic reductions in cancer in the US for 12 major types. However, we estimate that eliminating smoking completely would not affect about 60% of cancer cases of the 12 smoking-related types, leaving no improvement in the incidence trend from 2006 to 2016. We conclude that cancer prevention strategies should focus not only on lifestyle changes but also the likely contributions of the full range of risk factors, including environmental/occupational carcinogens.http://link.springer.com/article/10.1186/s12940-020-00613-xCancer preventionSmoking cessationEpidemiologySmoking-related cancers |
| spellingShingle | Douglas J. Myers Polly Hoppin Molly Jacobs Richard Clapp David Kriebel Cancer rates not explained by smoking: a county-level analysis Environmental Health Cancer prevention Smoking cessation Epidemiology Smoking-related cancers |
| title | Cancer rates not explained by smoking: a county-level analysis |
| title_full | Cancer rates not explained by smoking: a county-level analysis |
| title_fullStr | Cancer rates not explained by smoking: a county-level analysis |
| title_full_unstemmed | Cancer rates not explained by smoking: a county-level analysis |
| title_short | Cancer rates not explained by smoking: a county-level analysis |
| title_sort | cancer rates not explained by smoking a county level analysis |
| topic | Cancer prevention Smoking cessation Epidemiology Smoking-related cancers |
| url | http://link.springer.com/article/10.1186/s12940-020-00613-x |
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