CANCER RISK FACTORS

Cancer is a group of more than 100 different diseases, each with

their own set of risk factors.

The risk of developing cancer increases as we age, so age along

with gender, race and personal and family medical history, are
risk factors for cancer.

Other risk factors are largely related to lifestyle choices, while

certain infections, occupational exposures and some
environmental factors can also be related to developing cancer.

On the basis of strength of evidence in the scientific literature,

we distinguish below between known and possible risk factors
by site.
 Risk Factors

Doctors often cannot explain why one person develops cancer

and another does not.
But research shows that certain risk factors increase the
chance that a person will develop cancer.
These are the most common risk factors for cancer:
Growing older
Tobacco
Sunlight
Ionizing radiation
Certain chemicals and other substances
Some viruses and bacteria
Certain hormones
Family history of cancer
Alcohol
Poor diet, lack of physical activity, or being overweight
Over time, several factors may act together to cause normal cells
to become cancerous.

When thinking about risk of getting cancer, these are some things
to keep in mind:
- Not everything causes cancer.
- Cancer is not caused by an injury, such as a bump or bruise.
- Cancer is not contagious. Although being infected with certain
viruses or bacteria may increase the risk of some types of cancer,
no one can "catch" cancer from another person.
- Having one or more risk factors does not mean that you will get
cancer. Most people who have risk factors never develop cancer.
- Some people are more sensitive than others to the known risk
factors.
Growing Older
The most important risk factor for cancer is growing older. Most
cancers occur in people over the age of 65. But people of all ages,
including children, can get cancer, too.

Tobacco
Tobacco use is the most preventable cause of death.
Each year, more than 180,000 Americans die from cancer that is related to
tobacco use.
Using tobacco products or regularly being around tobacco smoke (environmental
or secondhand smoke) increases the risk of cancer.

Smokers are more likely than nonsmokers to develop cancer of the lung, larynx
(voice box), mouth, esophagus, bladder, kidney, throat, stomach, pancreas, or
cervix. They also are more likely to develop acute myeloid leukemia (cancer that
starts in blood cells).

People who use smokeless tobacco (snuff or chewing tobacco) are at increased
risk of cancer of the mouth.
 Tobacco
Quitting is important for anyone who uses tobacco -
even people who have used it for many years. The
risk of cancer for people who quit is lower than the
risk for people who continue to use tobacco. (But the
risk of cancer is generally lowest among those who
never used tobacco.)

Also, for people who have already had cancer,

quitting may reduce the chance of getting another
cancer.
 Sunlight

Ultraviolet (UV) radiation comes from the sun, sunlamps, and tanning booths.
It causes early aging of the skin and skin damage that can lead to skin cancer.

Doctors encourage people of all ages to limit their time in the sun and to avoid
other sources of UV radiation:
It is best to avoid the midday sun (from mid-morning to late afternoon) whenever
possible. You also should protect yourself from UV radiation reflected by sand,
water, snow, and ice. UV radiation can penetrate light clothing, windshields, and
windows.
Wear long sleeves, long pants, a hat with a wide brim, and sunglasses with lenses
that absorb UV.
Use sunscreen. Sunscreen may help prevent skin cancer, especially sunscreen with
a sun protection factor (SPF) of at least 15. But sunscreens cannot replace avoiding
the sun and wearing clothing to protect the skin.
Stay away from sunlamps and tanning booths. They are no safer than sunlight.
 Ionizing Radiation

Ionizing radiation can cause cell damage that leads to cancer.

This kind of radiation comes from rays that enter the Earth's atmosphere from outer space,
radioactive fallout, radon gas, x-rays, and other sources.

Radioactive fallout can come from accidents at nuclear power plants or from the production, testing, or use of atomic
weapons. People exposed to fallout may have an increased risk of cancer, especially leukemia and cancers of the
thyroid, breast, lung, and stomach.

Radon is a radioactive gas that you cannot see, smell, or taste. It forms in soil and rocks.
People who work in mines may be exposed to radon. In some parts of the country, radon is
found in houses. People exposed to radon are at increased risk of lung cancer.

Medical procedures are a common source of radiation:

- Doctors use radiation (low-dose x-rays) to take pictures of the inside of the body. These pictures help
to diagnose broken bones and other problems.
- Doctors use radiation therapy (high-dose radiation from large machines or from radioactive
substances) to treat cancer.
- The risk of cancer from low-dose x-rays is extremely small. The risk from radiation therapy is slightly
higher. For both, the benefit nearly always outweighs the small risk.
 Certain Chemicals and Other Substances

People who have certain jobs (such as painters, construction

workers, and those in the chemical industry) have an
increased risk of cancer.

Many studies have shown that exposure to asbestos,

benzene, benzidine, cadmium, nickel, or vinyl chloride in the
workplace can cause cancer.

Follow instructions and safety tips to avoid or reduce contact

with harmful substances both at work and at home. Although
the risk is highest for workers with years of exposure, it makes
sense to be careful at home when handling pesticides, used
engine oil, paint, solvents, and other chemicals.
 Some Viruses and Bacteria
Being infected with certain viruses or bacteria may increase the risk of developing
cancer:
Human papillomaviruses (HPVs): HPV infection is the main cause of cervical cancer.
It also may be a risk factor for other types of cancer.
Hepatitis B and hepatitis C viruses: Liver cancer can develop after many years of
infection with hepatitis B or hepatitis C.
Human T-cell leukemia/lymphoma virus (HTLV-1): Infection with HTLV-1 increases a
person's risk of lymphoma and leukemia.
Human immunodeficiency virus (HIV): HIV is the virus that causes AIDS. People who
have HIV infection are at greater risk of cancer, such as lymphoma and a rare cancer
called Kaposi sarcoma.
Epstein-Barr virus (EBV): Infection with EBV has been linked to an increased risk of
lymphoma.
Human herpesvirus 8 (HHV8): This virus is a risk factor for Kaposi's sarcoma.
Helicobacter pylori : This bacterium can cause stomach ulcers. It also can cause
stomach cancer and lymphoma in the stomach lining.
 What to do
Do not have unprotected sex or share needles. You can get an HPV infection by having
sex with someone who is infected. You can get hepatitis B, hepatitis C, or HIV infection
from having unprotected sex or sharing needles with someone who is infected.

You may want to consider getting the vaccine that prevents hepatitis B infection.
Health care workers and others who come into contact with other people's blood
should ask their doctor about this vaccine.

If you think you may be at risk for HIV or hepatitis infection, ask your doctor about
being tested. These infections may not cause symptoms, but blood tests can show
whether the virus is present. If so, the doctor may suggest treatment. Also, the doctor
can tell you how to avoid infecting other people.

If you have stomach problems, see a doctor. Infection with H. pylori can be detected
and treated.
 Certain Hormones
Doctors may recommend hormones (estrogen alone or estrogen along with
progestin) to help control problems (such as hot flashes, vaginal dryness, and
thinning bones) that may occur during menopause. However, studies show that
menopausal hormone therapy can cause serious side effects. Hormones may
increase the risk of breast cancer, heart attack, stroke, or blood clots.

A woman considering menopausal hormone therapy should discuss the possible

risks and benefits with her doctor.

Diethylstilbestrol (DES), a form of estrogen, was given to some pregnant women

in the United States between about 1940 and 1971. Women who took DES
during pregnancy may have a slightly higher risk of developing breast cancer.
Their daughters have an increased risk of developing a rare type of cancer of the
cervix. The possible effects on their sons are under study.

Women who believe they took DES and daughters who may have been exposed
to DES before birth should talk with their doctor about having checkups.
 Family History of Cancer
Most cancers develop because of changes (mutations) in genes. A
normal cell may become a cancer cell after a series of gene changes
occur. Tobacco use, certain viruses, or other factors in a person's lifestyle
or environment can cause such changes in certain types of cells.

Some gene changes that increase the risk of cancer are passed from
parent to child. These changes are present at birth in all cells of the body.

It is uncommon for cancer to run in a family. However, certain types of

cancer do occur more often in some families than in the rest of the
population. For example, melanoma and cancers of the breast, ovary,
prostate, and colon sometimes run in families. Several cases of the same
cancer type in a family may be linked to inherited gene changes, which
may increase the chance of developing cancers. However, environmental
factors may also be involved. Most of the time, multiple cases of cancer
in a family are just a matter of chance.
 Genetic testing
People in risk, need genetic testing.
These tests can check for certain inherited
gene changes that increase the chance of
developing cancer. But inheriting a gene
change does not mean someone will definitely
develop cancer. It means that they have an
increased chance of developing the disease.
 Alcohol
Having more than two drinks each day for many years may
increase the chance of developing cancers of the mouth,
throat, esophagus, larynx, liver, and breast.

The risk increases with the amount of alcohol that a

person drinks. For most of these cancers, the risk is higher
for a drinker who uses tobacco.

Doctors advise people who drink to do so in

moderation. Drinking in moderation means no more
than one drink per day for women and no more than
two drinks per day for men.
 Poor Diet, Lack of Physical Activity, or Being Overweight

People who have a poor diet, do not have enough physical

activity, or are overweight may be at increased risk of
several types of cancer. For example, studies suggest that
people whose diet is high in fat have an increased risk of
cancers of the colon, uterus, and prostate.

Lack of physical activity and being overweight are risk

factors for cancers of the breast, colon, esophagus, kidney,
and uterus
Having a healthy diet, being physically active, and maintaining a
healthy weight may help reduce cancer risk.

Suggest the following:

Eat well: A healthy diet includes plenty of foods that are high
in fiber, vitamins, and minerals. This includes whole-grain
breads and cereals and 5 to 9 servings of fruits and vegetables
every day. Also, a healthy diet means limiting foods high in fat
(such as butter, whole milk, fried foods, and red meat).
Be active and maintain a healthy weight: Physical activity can
help control your weight and reduce body fat. Most scientists
agree that it is a good idea for an adult to have moderate
physical activity (such as brisk walking) for at least 30 minutes
on 5 or more days each week.
 Oral Cavity & Pharynx
Mouth
Tobacco and alcohol usage accounts for most mouth
cancers.
Another risk factor is a diet low in fruits and
vegetables and
Possible risk factors are poor tooth development
and oral hygiene, trauma due to ill-fitting dentures
or jagged teeth, use of mouthwashes with high
alcohol content, and iron-deficiency anemia.
 Digestive System
Colorectal
Risk factors are : personal or family history of colorectal
polyps or inflammatory bowel disease, certain rare
hereditary conditions, and a diet high in fat and/or low
in fiber, fruits and vegetables.

Possible risk factors are : physical inactivity, alcohol

consumption, obesity, and smoking. Risk may be
reduced by estrogen replacement therapy, non-steroidal
anti-inflammatory drugs (e.g. aspirin, ibuprofen), dietary
calcium and vitamin D.
 Pancreas
Risk factors are : cigarette smoking and possibly alcohol,
coffee, or tea consumption, diabetes, chronic pancreatitis,
cirrhosis, allergies, diet high in meat or butter fat.

Stomach
Risk factors are : dietary nitrites (in pickled, salted, and
smoked foods), pernicious anemia, and diet low in fruits
and vegetables.
Possible risk factors : are infection with Helicobacter pylori,
high doses of ionizing radiation, cigarette smoking, and
genetic factors.
 Liver
Risk factors are chronic infection with hepatitis B or C
virus, cirrhosis of the liver (chronic liver injury,
usually due to alcohol abuse ), aflatoxin ingestion
(produced by a common mold that invades poorly
stored peanuts and other foods),
occupational exposure to thorium dioxide or vinyl
chloride.
Possible risk factors are use of steroids, smoking, and
some inherited metabolic diseases (e.g.
hemochromatosis).
 Esophagus
The most important risk factors are tobacco use
(cigarettes, cigars, pipes), and excessive alcohol
use along with the syndrome, Barrett's
esophagus.
Possible risk factors are obesity, inadequate diet,
poor nutrition, decreased levels of certain
nutrients (carotene, ascorbic acid, riboflavin,
niacin, thiamin, zinc, magnesium, and
selenium), and insufficient consumption of
fruits and vegetables.
 Gallbladder

The most important risk factor is gallstones ;

factors related to stone formation are
increasing age, being female (f-3: female, fat
forty) being pregnant, certain ethnicity,
obesity, use of estrogen-containing drugs and
high fat and caloric intake.
 Respiratory System
Lung
Tobacco smoking is responsible for nearly 90% of all lung
cancers.
Other contributing risk factors are smoking cigars or pipes
and environmental tobacco smoke (second-hand smoke).
High doses of ionizing radiation, residential radon exposure
and occupational exposure to mustard gas, chloromethyl
ethers, inorganic arsenic, chromium, nickel, vinyl chloride,
radon, asbestos or byproducts of fossil fuel are also
thought to increase risk.
Possible risk factors are air pollution and insufficient
consumption of fruits and vegetables.
 Larynx
Most cases are caused by cigarette smoking.
Other risk factors are alcohol and occupational
exposure to asbestos or mustard gas.
 Skin
Melanoma
- excessive exposure to ultraviolet radiation (sunlight),
- fair skin, history of severe sunburns, personal or family
history of melanoma,
- multiple moles or atypical moles (colored skin spots),
- giant congenital moles, xeroderma pigmentosum (a rare
hereditary disease),
- personal history of melanoma, and
- reduced immune function due to organ transplants or
HIV infection.
- Melanoma occurs almost exclusively among whites.
 Non-melanoma
- ultraviolet radiation (sunlight),
- fair skin,
- high doses of ionizing radiation,
- occupational exposure to arsenic,
- polycyclic hydrocarbons (coal tars, pitches, asphalt,
creosote, soot, lubricating and cutting oils)
- rare hereditary diseases such as multiple basal cell
carcinoma syndrome,
- xeroderma pigmentosum, and albinism.
Possible risk factors are burn scars, chronic infections, and
photosensitizers in tanning aids, cosmetics, and medicines.
 Breast
For women :
risk factors are family history (especially mother or sister) of breast
cancer, personal history of breast, ovarian, or endometrial cancer,
susceptibility genes (BRCA-1, BRCA-2), some forms of benign breast
disease (atypical hyperplasia), higher education and socioeconomic
status, menstruation at an early age, late menopause, never bearing
children, first child born after age 30, high doses of ionizing radiation,
long term use of post-menopause estrogens and progestins, obesity
after menopause, and excessive alcohol consumption. Possible risk
factors are dietary fat and physical inactivity.
For men :
risk factors include increasing age, family history, radiation exposure,
and having high levels of estrogen due to inherited gene mutations or
treatments. Possible risk factors include gynecomastia and obesity.
 Reproductive Organs
Prostate :
Risk factors are some types of prostatic hyperplasia
and a family history, especially a father or brother.
Possible risk factors are a diet high in animal fat,
obesity, hormonal factors, a sexually transmitted
agent, smoking, alcohol, and physical inactivity.

Black males have much higher prostate cancer rates

than white males.
 Endometrium

High cumulative exposure to estrogens including never

bearing children or bearing few children, menstruation
beginning at an early age, failure to menstruate, late
menopause, estrogen replacement therapy are major
risk factors.

Also, use of tamoxifen, infertility, obesity, diabetes,

hypertension, gallbladder disease, and Stein-Leventhal
syndrome are known risk factors. Possible risk factors are
dietary fat and hereditary non-polyposis colon cancer.
 Cervix :
Risk factors are infection with human papilloma
viruses (HPV), early age at first sexual
intercourse, many sexual partners or partners
who have had many sexual partners, multiple
births, long-term oral contraceptive use, and
cigarette smoking.
Possible risk factors are certain vitamin
deficiencies and hormonal factors.
 Urinary System
Bladder :

The most important risk factor is cigarette smoking; other risk

factors are occupational exposure to benzidine and 2-
naphthylamine and occupations in the dye, leather or rubber
industry.

Possible risk factors are heavy coffee consumption, bladder

infection with schistosoma haematobium (a parasitic flatworm),
treatment with chlornaphazine or cyclophosphamide (anti-cancer
drugs), long-term use of pain killers containing phenacetin,
urinary tract infections or low urine flow, dietary factors, tobacco
use other than cigarettes, and genetic factors.
 Kidney :
Cigarette smoking is the most important risk
factor; others are obesity, abuse of analgesics
(especially phenacetin-containing pain
relievers), and occupational exposure to
arsenic.
Possible risk factors are regular use of prescription
diuretics and increased meat consumption.
Lymphoma/Leukemia/Multiple Myeloma

Non-Hodgkin Lymphoma :
Risk factors are reduced immune function due to
organ transplants or nfection with HIV,
Epstein-Barr or human T-cell
leukemia/lymphoma virus.
Possible risk factors are occupational exposure
to pesticides, herbicides, or organic solvents.
 Hodgkin Lymphoma :
Risk factors are infectious mononucleosis and
Epstein-Barr virus infection.
Possible risk factors are family history of
Hodgkin lymphoma especially among siblings
and genetic factors.
 Multiple myeloma :
High doses of ionizing radiation is a risk factor.

Possible risk factors are repeated infections,

allergic conditions, autoimmune disease, genetic
factors, cigarette smoking, farming, and
occupational exposure to benzene.
 Other
Brain
Risk factors are genetic factors, certain rare inherited
syndromes such as neurofibromatosis, being a parent or
sibling of a child with brain cancer, high doses of ionizing
radiation, and occupational exposure to certain aromatic
hydrocarbon compounds, bis-chloromethyl ether, vinyl
chloride, and acrylonitrile.
Possible risk factors are exposure to electromagnetic
fields, exposure to farm animals and pets, severe head
trauma, loud noise, and N-nitroso compounds in the
diet, cigarettes, and alcohol.
 Thyroid :
Risk factors are high doses of ionizing radiation
and goiter.