ReviewCancer Prevention

Applying What We Know to Accelerate Cancer Prevention

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Science Translational Medicine  28 Mar 2012:
Vol. 4, Issue 127, pp. 127rv4
DOI: 10.1126/scitranslmed.3003218


  • Fig. 1

    The risk of death decreases with time after smoking cessation. Reduction in mortality from lung cancer (left) and from all causes (right), according to time after cessation from smoking. Mortality reduction data (and 95% confidence intervals) are expressed as a fraction of the mortality risk of continuing smokers (set at 1.0). Adapted from (4).

  • Fig. 2

    The beneficial effects of aspirin in reducing risk of colorectal cancer show a substantial lag. Data are expressed as a fraction of reduced risk compared to untreated individuals (set at 0). Adapted from randomized controlled trials (6) and observational studies (76).


  • Table 1 Causes of cancer and potential reduction in cancer burden through preventive measures. N/A, not applicable.
    Cause*Percentage of cancer causedNumber of deaths in United StatesMagnitude of possible reduction (%)Period of time (years)Evidence example
    Smoking33188,7447510–20Comparison of lung cancer mortality by state (Fig. 1)
    Overweight and obesity20114,390502–20Bariatric surgery and sustained changes in weight and markers (62)
    Diet528,600505–20Folate and colorectal cancer (63)
    Lack of exercise528,600855–20Adolescent physical activity (18)
    Occupation528,6005020–40Asbestos workplace regulation (10)
    Viruses528,60010020–40Liver cancer reduction by vaccine (22)
    Family history528,600502–10Bilateral oophorectomy for BRCA1/2 (34); aspirin trial for Lynch syndrome (11)
    Alcohol317,200505–20Regulation (64)
    UV and ionizing radiation211,400505–40Reduced medical exposures (65)
    Prescription drugs15,720502–10Hormone therapy–related drop in breast cancer (66)
    Reproductive factors317,2000N/AN/A
    Total potential reduction = 54.5%

    *Adapted from Wolin et al. (67).

    †U.S. death estimates from the American Cancer Society (68).

    ‡Defined as sum (percentage caused by modifiable exposure × magnitude of reduction).

    • Table 2 Medical interventions proven to prevent cancer. RCT, randomized controlled trial.
      InterventionTargetMagnitude of reductionPeriod of time (years)Evidence
      AspirinTotal cancer mortality20%20Follow-up of eight RCTs (14)
      AspirinColon cancer mortality40%20Five RCTs (6) and RCT in Lynch syndrome (11)
      SERMs (tamoxifen, raloxifene)Breast cancer incidence40–50%5+RCT (5, 69)
      Salpingo-oophorectomyFamilial breast cancer50%3+Synthesis of observational data (34)
      Screening for colon cancer (sigmoidoscopy and colonoscopy)Colon cancer mortalitySigmoidoscopy, 30–40%10UK RCT sigmoidoscopy (33)
      Colonoscopy, 50%Observational data and disease modeling (70, 71)
      Vaccines (HPV and hepatitis)Cervical cancer incidence50–100%20+Modeling vaccination rates and persistence of protection (23)
      Liver cancer incidence70–100%Observational follow-up data from universal population vaccination program at birth (22, 72)
      MammographyBreast cancer mortality30%10–20RCT and modeling (73, 74)
      Spiral computed tomography for lung cancerLung cancer mortality20%6+RCT (75)

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