Modifying Five Lifestyle Factors Could Change the U.S. Cancer Burden

February 26, 2019 by Elisa Becze BA, ELS, Editor

Tobacco, obesity, alcohol, diet, and physical activity are major risk factors for cancer, yet all are modifiable, according to findings released in a new report from the American Cancer Society ( Reducing tobacco use is the highest priority, but interventions for all five risk factors are essential for a comprehensive U.S. cancer control plan.


Although researchers attribute smoking cessation efforts to more than half of the 26% decline in U.S. cancer mortality rates since 1991, tobacco smoke is the most common cause of cancer diagnoses (19.4%) and deaths (29.6%) in 2014. The report indicated that tobacco control can prevent more cancer deaths than any other primary prevention strategy. 

Learn more about ONS’s position on global tobacco control (, and the Society’s stance on e-cigarettes (


Obesity and overweight were responsible for 7.8% of cancer cases in 2014; the numbers were higher in women (10.9%) than in men (4.8%). As many as 60.3% of uterine cancers are attributed to excess weight, as well as more than 30% of gallbladder, liver, kidney or renal, and esophageal cancers. However, the report’s panel noted that research has yet to uncover the full impact of the obesity epidemic on the cancer burden and as more long-term findings are discovered, estimates connecting the risk factor to other cancers could continue to increase.


It’s associated with 6.4% of overall cancers in women and 4.8% in men, but the percentages skew higher when looking at individual cancers: 40.9% of oral cavity or pharynx cancers, 23.2% of larynx cancers, 21.6% of liver cancers, 21% of esophageal cancers, 16.4% of female breast cancers, and 12.8% of colorectal cancers. 


Low fruit and vegetable, fiber, and calcium consumption and too much red and processed meats were attributed to 4.2% of cancer cases. Broken down, the findings indicated that low fruit and vegetable consumption was connected to 17.6% of oral cavity or pharynx cancers and 17.4% of larynx cancers. Colorectal cancer risk was largely connected to diet: 10.3% of diagnoses were associated with low fiber, 8.2% with diets high in processed meats, 5.4% with high amounts of red meat, and 4.9% with low calcium. Similar to the findings with obesity, long-term research into the correlation of diet with cancer is ongoing, and as more emerges, estimates may increase.

Physical Activity

Overall, 4.4% of cancers in women and 1.5% of cancers in men were related to low physical activity. Associated uterine cancer rates were highest at 26.7%, followed by colorectal cancers at 6.3%. Again, research is ongoing for this risk factor and the panel suggested that the estimates will rise as more information is known. Use ONS resources to talk to your patients about physical activity during cancer (

 Although the report is intended to facilitate a comprehensive cancer control plan at the national level in the United States that could take time to develop, oncology nurses are well positioned to act now to educate patients about the top risk factors they can control. Taking steps to change behaviors now may help patients prevent a secondary cancer later. Additionally, as the most trusted profession in the United States (, nurses can take the message out into the community to inform the public about prevention strategies before they ever become patients in the oncology clinic.

Copyright © 2019 by the Oncology Nursing Society. User has permission to print one copy for personal or unit-based educational use. Contact for quantity reprints or permission to adapt, excerpt, post online, or reuse ONS Voice content for any other purpose.