Abstract
Objectives
Modifiable lifestyle, environmental, and infectious risk factors associated with cancer impact both cancer incidence and mortality at the population level. Most studies estimating this burden focus on cancer incidence. However, because these risk factors are associated with cancers of disparate mortality rates, the burden associated with cancer incidence could differ from cancer mortality. Therefore, estimating the cancer mortality attributable to these risk factors provides additional insight into cancer prevention. Here, we estimated future cancer deaths and the number of avoidable deaths in Canada due to modifiable risk factors.
Methods
The projected cancer mortality data came from OncoSim, a web-based microsimulation tool. These data were applied to the methodological framework that we previously used to estimate the population attributable risks and the potential impact fractions of modifiable risk factors on Canadian cancer incidence.
Results
We estimated that most cancer deaths will be attributed to tobacco smoking with an average of 27,900 deaths annually from 2024 to 2047. If Canada’s current trends in excess body weight continue, cancer deaths attributable to excess body weight would double from 2786 deaths in 2024 to 5604 deaths in 2047, becoming the second leading modifiable cause of cancer death. Applying targets to reduce these risk factors, up to 34,600 cancer deaths could be prevented from 2024 to 2047.
Conclusion
Our simulated results complement our previous findings on the cancer incidence burden since decreasing the overall burden of cancer will be accelerated through a combination of decreasing cancer incidence and improving survival outcomes through improved treatments.
Résumé
Objectifs
Les facteurs de risque modifiables associés au cancer (liés au mode de vie, à l’environnement, aux maladies infectieuses) ont des effets à la fois sur l’incidence du cancer et sur la mortalité par cancer à l’échelle de la population. La plupart des études qui estiment ce fardeau portent sur l’incidence du cancer. Cependant, comme les facteurs de risque susmentionnés sont associés à des cancers dont les taux de mortalité sont disparates, le fardeau associé à l’incidence du cancer pourrait différer de la mortalité par cancer. En conséquence, l’estimation de la mortalité par cancer imputable à ces facteurs de risque pourrait éclairer la prévention du cancer. Nous estimons ici les décès futurs par cancer et le nombre de décès évitables au Canada dus à des facteurs de risque modifiables.
Méthode
Les données projetées sur la mortalité par cancer proviennent d’OncoSim, un outil de microsimulation en ligne. Elles ont été appliquées au cadre méthodologique que nous avions déjà utilisé pour estimer les risques attribuables dans la population et les fractions de l’incidence potentielle des facteurs de risque modifiables sur l’incidence canadienne du cancer.
Résultats
Selon nos estimations, entre 2024 et 2047, la plupart des décès par cancer seront imputés au tabagisme, qui causera en moyenne 27 900 décès par année. Si les tendances actuelles au Canada en matière de surpoids se maintiennent, les décès par cancer attribuables au surpoids doubleraient, passant de 2 786 décès en 2024 à 5 604 en 2047, et le surpoids deviendrait la deuxième cause modifiable de décès par cancer. En appliquant des cibles de réduction de ces facteurs de risque, jusqu’à 34 600 décès par cancer pourraient être évités entre 2024 et 2047.
Conclusion
Les résultats de notre simulation confirment nos constatations antérieures sur le fardeau de l’incidence du cancer, car la diminution du fardeau global du cancer sera accélérée par une combinaison de la diminution de l’incidence du cancer et de l’amélioration des résultats de survie grâce à l’amélioration des traitements.
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References
Bowen, D. J., Kreuter, M., Spring, B., Cofta-Woerpel, L., Linnan, L., Weiner, D., Bakken, S., Kaplan, C. P., Squiers, L., Fabrizio, C., & Fernandez, M. (2009). How we design feasibility studies. American Journal of Preventive Medicine, 36(5), 452–457. https://doi.org/10.1016/j.amepre.2009.02.002.
Bray, F., & Soerjomataram, I. (2018). Population attributable fractions continue to unmask the power of prevention. British Journal of Cancer, 118(8), 1031–1032. https://doi.org/10.1038/s41416-018-0062-5.
Brenner, D. R., Poirier, A. E., Walter, S. D., King, W. D., Franco, E. L., Demers, P. A., Villeneuve, P. J., Ruan, Y., Khandwala, F., Grevers, X., Nuttall, R., Smith, L., De, P., Volesky, K., O’Sullivan, D., Hystad, P., Friedenreich, C. M., & Com, P. S. G. (2018). Estimating the current and future cancer burden in Canada: methodological framework of the Canadian population attributable risk of cancer (ComPARe) study. BMJ Open, 8(7), e022378. https://doi.org/10.1136/bmjopen-2018-022378.
Brenner, D. R., Friedenreich, C. M., Ruan, Y., Poirier, A. E., Walter, S. D., King, W. D., Franco, E. L., Demers, P. A., Villeneuve, P. J., Grevers, X., Nuttall, R., Smith, L. M., Volesky, K. D., O’Sullivan, D. E., & De, P. (2019). The burden of cancer attributable to modifiable risk factors in Canada: methods overview. Preventive Medicine, 122, 3–8. https://doi.org/10.1016/j.ypmed.2019.03.007.
Brenner, D. R., Weir, H. K., Demers, A. A., Ellison, L. F., Louzado, C., Shaw, A., Turner, D., Woods, R. R., & Smith, L. M. (2020). Projected estimates of cancer in Canada in 2020. CMAJ, 192(9), E199–e205. https://doi.org/10.1503/cmaj.191292.
Brown, B., Harris, K. J., Heil, D., Tryon, M., Cooksley, A., Semmens, E., Davis, J., & Gandhi, K. (2018). Feasibility and outcomes of an out-of-school and home-based obesity prevention pilot study for rural children on an American Indian reservation. Pilot and Feasibility Studies, 4, 129–129. https://doi.org/10.1186/s40814-018-0322-4.
Butt, P., Beirness, D., Gliksman, L., Paradis, C., & Stockwell, T. (2011). Alcohol and health in Canada: a summary of evidence and guidelines for low-risk drinking. Ottawa: Canadian Centre on Substance Abuse.
Canadian Cancer Society’s Advisory Committee. (2017). Canadian Cancer Statistics 2017. http://www.cancer.ca/Canadian-Cancer-Statistics-2017-EN.pdf. Accessed 12 Mar 2020.
Canadian Cancer Society’s Advisory Committee. (2019). Canadian Cancer Statistics 2019. https://www.cancer.ca/~/media/cancer.ca/CW/cancer%20information/cancer%20101/Canadian%20cancer%20statistics/Canadian-Cancer-Statistics-2019-EN.pdf?la=en. Accessed 12 Mar 2020.
Coldman, A., Pader, J., Gauvreau, C., Memon, S., Fitzgerald, N., Flanagan, W., Nadeau, C., Earle, C., Wolfson, M., Miller, A., & Lacombe, J. (2018). Simulating results from trials of sigmoidoscopy screening using the OncoSim microsimulation model. Journal of Cancer Policy, 15, 52–58. https://doi.org/10.1016/j.jcpo.2017.12.006.
Djuric, Z., Ellsworth, J. S., Ren, J., Sen, A., & Ruffin, M. T. T. (2010). A randomized feasibility trial of brief telephone counseling to increase fruit and vegetable intakes. Preventive Medicine, 50(5–6), 265–271. https://doi.org/10.1016/j.ypmed.2010.03.003.
Eather, N., Riley, N., Miller, A., Smith, V., Poole, A., Vincze, L., Morgan, P. J., & Lubans, D. R. (2019). Efficacy and feasibility of HIIT training for university students: the Uni-HIIT RCT. Journal of Science and Medicine in Sport, 22(5), 596–601. https://doi.org/10.1016/j.jsams.2018.11.016.
Gauvreau, C. L., Fitzgerald, N. R., Memon, S., Flanagan, W. M., Nadeau, C., Asakawa, K., Garner, R., Miller, A. B., Evans, W. K., Popadiuk, C. M., Wolfson, M., & Coldman, A. J. (2017). The OncoSim model: development and use for better decision-making in Canadian cancer control. Current oncology (Toronto, Ont.), 24(6), 401–406. https://doi.org/10.3747/co.24.3850.
Hawkes, A. L., Patrao, T. A., Green, A., & Aitken, J. F. (2012). CanPrevent: a telephone-delivered intervention to reduce multiple behavioural risk factors for colorectal cancer. BMC Cancer, 12, 560. https://doi.org/10.1186/1471-2407-12-560.
Hoffman, S. J., & Tan, C. (2015). Overview of systematic reviews on the health-related effects of government tobacco control policies. BMC Public Health, 15, 744. https://doi.org/10.1186/s12889-015-2041-6.
Hutchesson, M. J., Rollo, M. E., Krukowski, R., Ells, L., Harvey, J., Morgan, P. J., Callister, R., Plotnikoff, R., & Collins, C. E. (2015). eHealth interventions for the prevention and treatment of overweight and obesity in adults: a systematic review with meta-analysis. Obesity Reviews, 16(5), 376–392. https://doi.org/10.1111/obr.12268.
International Agency for Research on Cancer (IARC). (2004). IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Tobacco smoke and involuntary smoking. IARC Monogr Eval Carcinog Risks Hum, 83, 1–1438.
International Agency for Research on Cancer (IARC). (2010). IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Alcohol consumption and ethyl carbamate. IARC Monogr Eval Carcinog Risks Hum, 96, 3–1383.
International Agency for Research on Cancer (IARC). (2016). IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Outdoor air pollution. IARC Monogr Eval Carcinog Risks Hum, 109 . https://www.ncbi.nlm.nih.gov/books/NBK368024/. Accessed 1 Dec 2020.
Jelsma, J. G. M., Renaud, L. R., Huysmans, M. A., Coffeng, J. K., Loyen, A., van Nassau, F., Bosmans, J. E., Speklé, E. M., van der Beek, A. J., & van der Ploeg, H. P. (2019). The Dynamic Work study: study protocol of a cluster randomized controlled trial of an occupational health intervention aimed at reducing sitting time in office workers. BMC Public Health, 19(1), 188–188. https://doi.org/10.1186/s12889-019-6467-0.
Poirier, A. E., Ruan, Y., Grevers, X., Walter, S., Villeneuve, P., Friedenreich, C., & Brenner, D. (2019a). Estimates of the current and future burden of cancer attributable to active and passive tobacco smoking in Canada. Preventive Medicine, 122, 9–19. https://doi.org/10.1016/j.ypmed.2019.03.015.
Poirier, A. E., Ruan, Y., Volesky, K. D., King, W. D., O’Sullivan, D. E., Gogna, P., Walter, S. D., Villeneuve, P. J., Friedenreich, C. M., & Brenner, D. R. (2019c). The current and future burden of cancer attributable to modifiable risk factors in Canada: Summary of results. Preventive Medicine, 122, 140–147. https://doi.org/10.1016/j.ypmed.2019.04.007.
Popadiuk, C., Gauvreau, C. L., Bhavsar, M., Nadeau, C., Asakawa, K., Flanagan, W. M., Wolfson, M. C., Coldman, A. J., Memon, S., Fitzgerald, N., Lacombe, J., & Miller, A. B. (2016). Using the Cancer Risk Management Model to evaluate the health and economic impacts of cytology compared with human papillomavirus DNA testing for primary cervical cancer screening in Canada. Current Oncology, 23(Suppl 1), S56–S63. https://doi.org/10.3747/co.23.2991.
Ruan, Y., Poirier, A. E., Pader, J., Asakawa, K., Lu, C., Memon, S., Miller, A., Walter, S. D., Villeneuve, P. J., King, W. D., Volesky, K. D., Smith, L., De, P., Friedenreich, C. M., & Brenner, D. R. (2021). Estimating the future cancer management costs attributable to modifiable risk factors in Canada. Can J Public Health, 112. https://doi.org/10.17269/s41997-021-00502-x.
Sacerdote, C., Fiorini, L., Rosato, R., Audenino, M., Valpreda, M., & Vineis, P. (2006). Randomized controlled trial: effect of nutritional counselling in general practice. International Journal of Epidemiology, 35(2), 409–415. https://doi.org/10.1093/ije/dyi170.
Song, Z., & Baicker, K. (2019). Effect of a workplace wellness program on employee health and economic outcomes: a randomized clinical trial. JAMA, 321(15), 1491–1501. https://doi.org/10.1001/jama.2019.3307.
Sun, L., Zhu, Y., Qian, Q., & Tang, L. (2018). Body mass index and prognosis of breast cancer: an analysis by menstruation status when breast cancer diagnosis. Medicine, 97(26), e11220. https://doi.org/10.1097/MD.0000000000011220.
Tseng, E., Zhang, A., Shogbesan, O., Gudzune, K. A., Wilson, R. F., Kharrazi, H., Cheskin, L. J., Bass, E. B., & Bennett, W. L. (2018). Effectiveness of policies and programs to combat adult obesity: a systematic review. Journal of General Internal Medicine, 33(11), 1990–2001. https://doi.org/10.1007/s11606-018-4619-z.
World Cancer Research Fund/ American Institute for Cancer Research. (2011). Food, nutrition, physical activity, and the prevention of colorectal cancer. https://www.wcrf.org/sites/default/files/Colorectal-Cancer-2011-Report.pdf. Accessed 2 Apr 2020.
World Cancer Research Fund/ American Institute for Cancer Research. (2018a). Body fatness and weight gain and the risk of cancer. Continuous Update Project, Issue. https://www.wcrf.org/dietandcancer/exposures/body-fatness. Accessed 2 Apr 2020.
World Cancer Research Fund/ American Institute for Cancer Research. (2018b). Diet, nutrition, physical activity and cancer: a global perspective 3rd edition. Continuous Update Project, Issue. https://www.wcrf.org/dietandcancer/about. Accessed 2 Apr 2020.
World Cancer Research Fund/ American Institute for Cancer Research. (2007). Food, nutrition, physical activity, and the prevention of cancer: a global perspective. WCRF/AICR Expert Report, Issue.
World Health Organization. (2012). Target 5: reduce tobacco use. https://www.who.int/nmh/ncd-tools/target5/en/. Accessed 10 Jun 2020.
World Health Organization. (2013). Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013-2020. Geneva: World Health Organization.
Acknowledgements
We would like to give our thanks and acknowledge the support from the CPAC OncoSim team. We would also like to acknowledge Claude Nadeau from Statistics Canada for his programming advice and support.
Funding
OncoSim is led and supported by the Canadian Partnership Against Cancer, with model development by Statistics Canada, and is made possible through funding from Health Canada.
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Figure S1
(A) Projected bladder, colorectal, lung, pancreatic and prostate cancer deaths in Canadian males 35 years of age and older from 2024 (B) Projected breast, colorectal, lung, ovarian and pancreatic cancer deaths in Canadian females 35 years of age and older from 2024 (PDF 6 kb)
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Pader, J., Ruan, Y., Poirier, A.E. et al. Estimates of future cancer mortality attributable to modifiable risk factors in Canada. Can J Public Health 112, 1069–1082 (2021). https://doi.org/10.17269/s41997-020-00455-7
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DOI: https://doi.org/10.17269/s41997-020-00455-7