Chapter 13
Cancer Epidemiology
Although cancer arises from a complicated and an interacting web of multiple etiologies, avoiding high-risk behaviors and exposure to individual carcinogens, or cancer-causing substances, will prevent many types of cancer (Figure 13-1).1–3 Research has shown that lifestyle behaviors, dietary and environmental factors (such as exposure to ultraviolet radiation and infections), and occupational exposure contribute to the number of cancer cases and deaths.4–6 In this context, any of the following factors can contribute to the development of cancer7–9:
Tobacco, alcohol, obesity, lack of physical activity, hormones, infections, ionizing radiation, occupational hazards, reproductive factors, and ultraviolet light are key associations and causes of cancer. Studies of diet are ongoing.
• Lifestyle choices, such as nutritional intake, smoking, or alcohol use
• Environmental conditions, including exposure to sunlight, natural and medical radiation, workplace exposures, and involuntary or unknown exposures
• Lack of physical exercise and overweight/obesity
• Prescribed and illicit medications
• Socioeconomic factors that affect exposures and susceptibility
The question of estimating the environmentally attributable risk for cancer is deceptive because such estimates vary tremendously as a result of the definition of the environment used. Therefore, another way of examining what portion of cancer risk is attributable to the environment involves asking, “What is not attributable to the environment?”10 In this context, it is usually those cancers caused by highly penetrant genes; inherited mutations very rarely predispose us to cancer.11–14 The International Agency for Research on Cancer (IARC) completed a review of the more than 100 chemicals, occupations, physical agents, biologic agents, and other agents classified as carcinogenic to humans.7 Simplified tables with a list of classifications by cancer sites with sufficient or limited evidence in humans are contained in Table 13-1.
TABLE 13-1
LIST OF CLASSIFICATIONS BY CANCER SITES WITH SUFFICIENT OR LIMITED EVIDENCE IN HUMANS
| CANCER SITE | CARCINOGENIC AGENTS WITH SUFFICIENT EVIDENCE IN HUMANS | AGENTS WITH LIMITED EVIDENCE IN HUMANS |
| Lip, Oral Cavity, and Pharynx | ||
| Lip | Solar radiation | |
| Oral cavity | Alcoholic beverages Betel quid with tobacco Betel quid without tobacco Human papillomavirus type 16 Tobacco, smokeless Tobacco smoking | |
| Salivary gland | X-radiation, γ-radiation | Radioiodines, including iodine-131 |
| Tonsil | Human papillomavirus type 16 | |
| Pharynx | Alcoholic beverages Betel quid with tobacco Human papillomavirus type 16 Tobacco smoking | Asbestos (all forms) Mate drinking, hot Printing presses Tobacco smoke, secondhand |
| Nasopharynx | Epstein-Barr virus Formaldehyde Salted fish, Chinese-style Wood dust | |
| Digestive tract, upper | Acetaldehyde associated with consumption of alcoholic beverages | |
| Digestive Organs | ||
| Esophagus | Acetaldehyde associated with consumption of alcoholic beverages Alcoholic beverages Betel quid with tobacco Betel quid without tobacco Tobacco, smokeless Tobacco smoking X-radiation, γ-radiation | Dry cleaning Mate drinking, hot Pickled vegetables (traditional Asian) Rubber production industry Tetrachloroethylene |
| Stomach | Helicobacter pylori Rubber production industry Tobacco smoking X-radiation, γ-radiation | Asbestos (all forms) Epstein-Barr virus Lead compounds, inorganic Nitrate or nitrite (ingested) under conditions that result in endogenous nitrosation Pickled vegetables (traditional Asian) Salted fish (Chinese style) |
| Colon and rectum | Alcoholic beverages Tobacco smoking X-radiation, γ-radiation | Asbestos (all forms) Schistosoma japonicum |
| Anus | Human immunodeficiency virus type 1 Human papillomavirus type 16 | Human papillomavirus types 18, 33 |
| Liver and bile duct | Aflatoxins Alcoholic beverages Clonorchis sinensis Estrogen-progestogen contraceptives Hepatitis B virus Hepatitis C virus Opisthorchis viverrini Plutonium Thorium-232 and its decay products Tobacco smoking (in smokers and in smokers’ children) Vinyl chloride | Androgenic (anabolic) steroids Arsenic and inorganic arsenic compounds Betel quid without tobacco Human immunodeficiency virus type 1 Polychlorinated biphenyls Schistosoma japonicum Trichloroethylene X-radiation, γ-radiation |
| Gallbladder | Thorium-232 and its decay products | |
| Pancreas | Tobacco, smokeless Tobacco smoking | Alcoholic beverages Thorium-232 and its decay products X-radiation, γ-radiation |
| Digestive tract, unspecified | Radioiodines, including iodine-131 | |
| Respiratory Organs | ||
| Nasal cavity and paranasal sinus | Isopropyl alcohol production Leather dust Nickel compounds Radium-226 and its decay products Radium-228 and its decay products Tobacco smoking Wood dust | Carpentry and joinery Chromium (VI) compounds Formaldehyde Textile manufacturing |
| Larynx | Acid mists, strong inorganic Alcoholic beverages Asbestos (all forms) Tobacco smoking | Human papillomavirus type 16 Mate drinking, hot Rubber production industry Sulfur mustard Tobacco smoke, secondhand |
| Lung | Aluminum production Arsenic and inorganic arsenic compounds Beryllium and beryllium products Bis(chloromethyl) ether; chloromethyl methyl ether (technical grade) Cadmium and cadmium compounds Chromium (VI) compounds Coal, indoor emissions from household combustion Coal gasification Coal-tar pitch Coke production Hematite mining (underground) Iron and steel founding MOPP (vincristine-prednisone-nitrogen mustard-procarbazine mixture) Nickel compounds Painting Plutonium Radon-222 and its decay products Rubber production industry Silica dust, crystalline Soot Sulfur mustard Tobacco smoke, secondhand Tobacco smoking X-radiation, γ-radiation | Acid mists, strong inorganic Art glass, glass containers, and pressed ware (manufacture of) Biomass fuel (primarily wood), indoor emissions from household combustion of Bitumens, oxidized, and their emissions during roofing Bitumens, hard, and their emissions during mastic asphalt work Carbon electrode manufacture α-Chlorinated toluenes and benzyl chloride (combined exposure) Cobalt metal with tungsten carbide Creosotes Engine exhaust, diesel Frying, emissions from high-temperature Insecticides, nonarsenical (occupational exposures in spraying and application) Printing processes 2,3,7,8-Tetrachlorodibenzo-para-dioxin Welding fumes |
| Bone, Skin, and Mesothelium, Endothelium, and Soft Tissue | ||
| Bone | Plutonium Radium-224 and its decay products Radium-226 and its decay products Radium-228 and its decay products X-radiation, γ-radiation | Radioiodines, including iodine-131 |
| Skin (melanoma) | Solar radiation Ultraviolet-emitting tanning devices | |
| Skin (other malignant neoplasms) | Arsenic and inorganic arsenic compounds Azathioprine Coal-tar distillation Coal-tar pitch Cyclosporine Methoxsalen plus ultraviolet A Mineral oils, untreated or mildly treated Shale oils Solar radiation Soot X-radiation, γ-radiation | Creosotes Human immunodeficiency virus type 1 Human papillomavirus types 5 and 8 (in individuals with epidermodysplasia verruciformis) Nitrogen mustard Petroleum refining (occupational exposures) Ultraviolet-emitting tanning devices Merkel cell polyomavirus (MCV) |
| Mesothelium (pleura and peritoneum) | Asbestos (all forms) Erionite Painting | |
| Endothelium (Kaposi sarcoma) | Human immunodeficiency virus type 1 Kaposi sarcoma herpesvirus | |
| Soft tissue | Polychlorophenols or their sodium salts (combined exposures) Radioiodines, including iodine-131 2,3,7,8-Tetrachlorodibenzo-para-dioxin | |
| Breast and Female Genital Organs | ||
| Breast | Alcoholic beverages Diethylstilbestrol Estrogen-progestogen contraceptives Estrogen-progestogen menopausal therapy X-radiation, γ-radiation | Estrogen menopausal therapy Ethylene oxide Shiftwork that involves circadian disruption Tobacco smoking |
| Vulva | Human papillomavirus 16 | Human immunodeficiency virus type 1 |
| Vagina | Diethylstilbestrol (exposure in utero) Human papillomavirus 16 | Human immunodeficiency virus type 1 |
| Uterine cervix | Diethylstilbestrol (exposure in utero) Estrogen-progestogen contraceptives Human immunodeficiency virus type 1 Human papillomavirus types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 Tobacco smoking | Human papillomavirus types 26, 53, 66, 67, 68, 70, 73, 82 Tetrachloroethylene |
| Endometrium | Estrogen menopausal therapy Estrogen-progestogen menopausal therapy Tamoxifen | Diethylstilbestrol |
| Ovary | Asbestos (all forms) Estrogen menopausal therapy Tobacco smoking | Talc-based body powder (perineal use) X-radiation, γ-radiation |
| Male Genital Organs | ||
| Penis | Human papillomavirus type 16 | Human immunodeficiency virus type 1 Human papillomavirus type 18 |
| Prostrate | Androgenic (anabolic) steroids Arsenic and inorganic arsenic compounds Cadmium and cadmium compounds Rubber production industry Thorium-232 and its decay products X-radiation, γ-radiation | |
| Testis | Diethylstilbestrol exposure in utero | |
| Urinary Tract | ||
| Kidney | Tobacco smoking X-radiation, γ-radiation | Arsenic and inorganic arsenic compounds Cadmium and cadmium compounds Printing processes |
| Renal pelvis and ureter | Aristolochic acids, plants containing phenacetin Phenacetin, analgesic mixtures containing Tobacco smoking | Aristolochic acids |
| Urinary bladder | Aluminum production 4-Aminobiphenyl Arsenic and inorganic arsenic compounds Auramine production Benzidine Chlornaphazine Cyclophosphamide Magenta production 2-Naphthylamine | 4-Chloro-ortho-toluidine Coal-tar pitch Coffee Dry cleaning Engine exhaust, diesel Hairdressers and barbers (occupational exposure) Printing processes Soot Textile manufacturing |
| Painting Rubber production industry Schistosoma haematobium Tobacco smoking ortho-Toluidine X-radiation, γ-radiation | ||
| Eye, Brain, and Central Nervous System | ||
| Eye | Human immunodeficiency virus type 1 Ultraviolet-emitting tanning devices Welding | Solar radiation |
| Brain and central nervous system | X-radiation, γ-radiation | Radiofrequency electromagnetic fields (including from wireless phones) |
| Endocrine Glands | ||
| Thyroid | Radioiodines, including iodine-131 X-radiation, γ-radiation | |
| Lymphoid, Hematopoietic, and Related Tissue | ||
| Leukemia and/or lymphoma | Azathioprine Benzene Busulfan 1,3-Butadiene Chlorambucil Cyclophosphamide Cyclosporine Epstein-Barr virus Etoposide with cisplatin and bleomycin Fission products, including strontium-90 Formaldehyde Helicobacter pylori Hepatitis C virus Human immunodeficiency virus type 1 Human T-cell lymphotropic virus type 1 Kaposi sarcoma herpesvirus Melphalan MOPP (vincristine-prednisone-nitrogen mustard-procarbazine mixture) Phosphorus-32 Rubber production industry Semustine (methyl-CCNU) Thiotepa Thorium-23 and its decay products Tobacco smoking Treosulfan X-radiation, γ-radiation | Bis(chloroethyl)nitrosourea (BBCNU) Chloramphenicol Ethylene oxide Etoposide Hepatitis B virus Magnetic fields, extremely low frequency (childhood leukemia) Mitoxantrone Nitrogen mustard Painting (childhood leukemia from maternal exposure) Petroleum refining (occupational exposures) Polychlorophenols or their sodium salts (combined exposures) Radioiodines, including iodine-131 Radon-222 and its decay products Styrene Teniposide Tetrachloroethylene Trichloroethylene 2,3,7,8-Tetrachlorodibenzo-para-dioxin Tobacco smoking (childhood leukemia in smokers’ children) Malaria (caused by infection with Plasmodium falciparum in holoendemic areas) |
| Multiple or Unspecific Sites | ||
| Multiple sites (unspecified) | Cyclosporine Fission products, including strontium-90 X-radiation, γ-radiation (exposure in utero) | Chlorophenoxy herbicides Plutonium |
| All cancer sites (combined) | 2,3,7,8-Tetrachlorodibenzo-para-dioxin | |
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