01.12.2017 | Research article | Ausgabe 1/2017 Open Access

Proportion of cancer in a Middle eastern country attributable to established risk factors
- Zeitschrift:
- BMC Cancer > Ausgabe 1/2017
Background
Methods
Risk factor
|
Exposure level
|
Sources of Data
|
|
---|---|---|---|
Prevalence of exposure
|
Relative Risk
|
||
Tobacco smoking
|
Current smoker, former smoker (cessation mean 8.9 years)
|
Sibai et al. [
14] (WHO)
|
Lung [
42]
Bladder [
43]
Larynx [
42]
Esophagus [
42]
Stomach [
42]
Liver [
42]
Pancreas [
42]
Cervix [
42]
|
Body Mass Index (BMI)
|
Overweight (BMI ≥ 25 kg/m
2)
Obese (BMI ≥ 30 kg/m
2)
|
Sibai et al. [
14] (WHO)
|
Renal cell [
49]
Pancreatic [
50]
Ovarian [
51]
Breast [
29]
|
Physical Activity
|
High (7 days of 3000 MET-minutes/week OR 3 days of 1500 MET-minutes/week)
Moderate (≥3 days vigorous intensity, OR ≥5 days moderate intensity, OR ≥5 days ≥600 MET-minutes/week)
Low: less than the moderate activity
|
Sibai et al. [
14] (WHO)
|
Breast [
52]
Bladder [
53]
Gastroesophageal [
54]
Colorectal [
55]
|
Adherence to Mediterranean Diet
|
9-point scale adherence to Mediterranean diet score
Low: 0–3, moderate 4–5, and high 6–9 points.
|
Using nationally representative dietary intake data of Lebanese adults aged between 20 and 55 years (unpublished data)
|
Gastric [
56]
Colorectal [
57]
Bladder [
58]
|
Alcohol consumption
|
Heavy: More than 50 g per day
|
Sibai et al. [
14] (WHO)
|
Oropharyngeal and Esophageal [
59]
Liver [
59]
Colon [
59]
Breast [
59]
|
Infection
|
Percentage of H. Pylori infections in the Lebanese population
|
Naja et al. [
17]
|
Gastric [
60]
|
Air pollution (PM
10 PM
2.5)
|
Levels exceeding WHO standards:
PM
10: 20 μg/ m
3
PM
2.5: 10 μg/ m
3
|
Saliba et al. [
18]
Saliba et al. [
19]
|
Lung [
40]
|
Data sources
Prevalence of exposures
Risk Factor
|
Males
|
Females
|
---|---|---|
Tobacco smoking, [
14]
|
||
former smokers
|
6.9%
|
3.3%
|
current smokers
|
46.8%
|
31.6%
|
Body Mass Index (BMI) [
14]
|
||
overweight
|
30.7%
|
38.9%
|
obese
|
28.7%
|
26.5%
|
Physical activity, Low activity [
14]
|
52.4%
|
40.3%
|
Low adherence to Mediterranean diet [
15]
|
14.4%
|
12.3%
|
Alcohol [
14]
|
||
Heavy drinkers
|
12.0%
|
0.9%
|
H. Pylori infection* [
18]
|
52%
|
52%
|
85%
|
85%
|
Risk Factor
|
Cancer site
|
Males
|
Females
|
References
|
---|---|---|---|---|
Tobacco smoking (compared to non-smokers)
|
Esophagus
|
Current smokers: 2.5
Previous smokers: 2.03
|
Current smokers: 2.5
Previous smokers: 2.03
|
[
42]
|
Larynx
|
Current smokers: 6.98
Previous smokers: 2.31
|
Current smokers: 6.98
Previous smokers: 2.31
|
[
42]
|
|
Lung
|
Current smokers: 8.96
Previous smokers: 3.85
|
Current smokers: 8.96
Previous smokers: 3.85
|
[
43]
|
|
Bladder
|
Current smokers: 3.3
Previous smokers: 2.0
|
Current smokers: 3.1
Previous smokers: 1.65
|
[
42]
|
|
Stomach
|
Current smokers: 1.64
Previous smokers: 1.31
|
Current smokers: 1.64
Previous smokers: 1.31
|
[
42]
|
|
Liver
|
Current smokers: 1.56
Previous smokers: 1.49
|
Current smokers: 1.56
Previous smokers: 1.49
|
[
42]
|
|
Pancreas
|
Current smokers: 1.71
Previous smokers: 1.18
|
Current smokers: 1.71
Previous smokers: 1.18
|
[
42]
|
|
Cervix
|
Current smokers: 1.83
Previous smokers: 1.26
|
[
42]
|
||
Body Mass Index (BMI) (compared to BMI ≤ 25 kg/m
2)
|
EGCA
|
Overweight:1.71
Obese: 2.34
|
Overweight:1.71
Obese: 2.34
|
[
44]
|
Colon
|
Overweight:1.26
Obese: 1.71
|
Overweight:1.09
Obese: 1.1
|
[
45]
|
|
Rectum
|
Overweight:1.07
Obese: 1.75
|
Overweight:1
Obese: 1.12
|
[
45]
|
|
Liver
|
Overweight:1.3
Obese: 1.8
|
Overweight:1.04
Obese: 1.63
|
[
46]
|
|
Endometrium
|
Overweight:1.02
Obese: 1.19
|
[
47]
|
||
Renal cell
|
Overweight:1.22
Obese: 1.63
|
Overweight:1.38
Obese: 1.95
|
[
49]
|
|
Pancreas
|
Overweight:1.1
Obese: 1.5
|
Overweight:1.1
Obese: 1.5
|
[
50]
|
|
Ovary
|
Overweight:1.08
Obese: 1.27
|
[
51]
|
||
Breast
|
Overweight:1.02
Obese: 1.19
|
[
29]
|
||
Physical Activity (low activity compared to medium and high activity) Table
1
|
Breast
|
Low:1.16
|
[
52]
|
|
Bladder
|
Low:1.09
|
Low:1.20
|
[
53]
|
|
Gastric-esophagus
|
Low:1.15
|
Low:1.67
|
[
54]
|
|
Colon and rectum
|
Low:1.38
|
Low:1.27
|
[
55]
|
|
Adherence to Mediterranean Diet (low adherence compared to medium and high adherence) Table
1
|
Stomach
|
Low adherence:1.49
|
Low adherence:1.49
|
[
56]
|
Colon and rectum
|
Low adherence:1.12
|
Low adherence:1.13
|
[
57]
|
|
Bladder
|
Low adherence: 1.26
|
Low adherence: 1.05
|
[
58]
|
|
Alcohol consumption (High consumption compared to moderate and low consumption) Table
1
|
Oropharynx
|
High: 5.30
|
High: 5.70
|
[
59]
|
Esophagus
|
High: 4.69
|
High: 8.32
|
[
59]
|
|
Liver
|
High: 1.59
|
High: 3.89
|
[
59]
|
|
Colon and rectum
|
High:1.53
|
High:1.24
|
[
59]
|
|
Breast
|
High:1.61
|
[
59]
|
||
Infection (compared to non-infected patients)
|
Stomach
|
Infected with H. Pylori: 2.89
|
Infected with H. Pylori: 2.89
|
[
60]
|
Air pollution (exposure to PM
10 and PM
2.5)
compared to non-exposed)
|
Lung
|
PM
10: 1.08
PM
2.5: 1.09
|
PM
10: 1.08
PM
2.5: 1.09
|
[
41]
|
Statistical analysis
-
P = proportion of population at current exposure level
-
RR = the relative risk at exposure level
Risk factor
|
Percentage attributable risk factor PAF (%) in Males in 2008
|
Projected incident cases in Lebanon 2018 (rate per 100,000). Data from Shamseddine et al.
|
Number of cases in 2018 resulting from risk factors
a
|
---|---|---|---|
Tobacco smoking, former smokers and current smokers
|
Esophagus: 43%
|
0.6
|
6
|
Larynx: 74%
|
7.9
|
129
|
|
Lung: 79%
|
32.7
|
568
|
|
Bladder: 53%
|
41.2
|
480
|
|
Gastric: 24%
|
9.3
|
49
|
|
Liver: 23%
|
7.9
|
40
|
|
Pancreas: 25%
|
5.9
|
32
|
|
Body Mass Index (BMI), overweight and obese
|
Colon: 22%
|
17.1
|
83
|
Rectal: 19%
|
4.4
|
18
|
|
Liver: 24%
|
7.9
|
42
|
|
Renal cell: 20%
|
N/A
|
||
EGCA: 38%
|
N/A
|
||
Pancreatic:15%
|
5.9
|
19
|
|
Physical activity, Low activity
|
Gastroesophageal: 7%
|
N/A
|
|
Colorectal: 17%
|
Colon 17.1, Rectal
|
80
|
|
4.4
|
|||
Bladder: 4%
|
41.2
|
8
|
|
Low adherence to Mediterranean diet
|
Gastric: 7%
|
9.3
|
14
|
Colorectal: 2%
|
Colon 17.1, Rectal 4.4
|
9
|
|
Bladder: 4%
|
41.2
|
36
|
|
Alcohol, heavy drinkers
|
Oropharyngeal: 34%
|
3.7
|
28
|
Esophagus: 31%
|
0.6
|
4
|
|
Liver: 7%
|
7.9
|
12
|
|
Colorectal:6%
|
Colon 17.1, Rectal 4.4
|
28
|
|
H. Pylori infection
|
Gastric: 50%
|
9.3
|
102
|
Air pollution
a (PM
2.5 concentration above allowable levels)
|
Lung: 13%
|
32.7
|
94
|
Risk factor
|
Percentage attributable risk factor PAF (%) in Females in 2008
|
Projected incident cases in Lebanon 2018 (rate per 100,000). Data from Shamseddine et al.
|
Number of cases in 2018 resulting from risk factors
a
|
---|---|---|---|
Tobacco smoking, former smokers and current smokers
|
Esophagus: 33%
|
0.7
|
5
|
Larynx: 65%
|
2.0
|
30
|
|
Lung: 72%
|
14.3
|
237
|
|
Bladder: 40%
|
13.4
|
123
|
|
Gastric: 17%
|
7.7
|
30
|
|
Liver: 16%
|
6.6
|
24
|
|
Pancreas: 18%
|
2.3
|
10
|
|
Cervix: 21%
|
5.8
|
28
|
|
Body Mass Index (BMI), overweight and obese
|
Colon: 6%
|
10.9
|
15
|
Rectum: 3%
|
5.9
|
4
|
|
Ovary: 9%
|
22.0
|
46
|
|
Liver: 15%
|
6.6
|
23
|
|
Renal cell: 29%
|
N/A
|
||
EGCA: 39%
|
N/A
|
||
Pancreas: 15%
|
2.3
|
8
|
|
Endometrium: 32%
|
N/A
|
||
Breast: 5%
|
137.0
|
158
|
|
Physical activity, Low activity
|
Breast:6%
|
137.0
|
189
|
Gastroesophageal:21%
|
N/A
|
||
Bladder: 7%
|
13.4
|
22
|
|
Colorectal: 10%
|
Colon 10.9, Rectal 5.9
|
39
|
|
Low adherence to Mediterranean diet
|
Gastric: 6%
|
7.7
|
11
|
Colorectal: 2%
|
Colon 10.9, Rectal
|
8
|
|
Bladder: 1%
|
5.9
|
3
|
|
13.4
|
|||
Alcohol, heavy drinkers
|
Oropharyngeal: 4%
|
2.8
|
3
|
Esophagus: 6%
|
0.7
|
1
|
|
Liver: 3%
|
6.6
|
5
|
|
Colorectal:1 = 0.2%
|
Colon 10.9, Rectal
|
1
|
|
Breast:0.5%
|
5.9
137.0
|
16
|
|
H. Pylori infection
|
Gastric: 50%
|
7.7
|
89
|
Air pollution (PM
2.5 concentration above allowable levels)
|
Lung: 13%
|
14.3
|
43
|
Results
Cancer site
|
PAF (%) by risk factor
Males Females
|
Joint hazard of risk factors
|
|
---|---|---|---|
Oropharyngeal
|
Alcohol (34%)
|
Alcohol (4%)
|
|
Esophageal
|
Smoking (43%) Alcohol (31%)
|
Smoking (33%) Alcohol (6%)
|
M(76%), F (37%)
|
Laryngeal
|
Smoking (74%)
|
Smoking (65%)
|
|
Gastroesophageal
|
Low activity (7%)
|
Low activity (21%)
|
|
EGCA
|
BMI ≥25 (38%)
|
BMI ≥25 (39%)
|
|
Gastric
|
Smoking (24%)
Low Med diet (7%), H.Pylori (50%)
|
Smoking (17%)
Low Med diet (6%), H.Pylori (50%)
|
M (81%), F (73%)
|
Lung
|
Smoking (79%), Air pollution (13%)
|
Smoking (72%), air pollution (13%)
|
M (92%), F(85%)
|
Colorectal
|
BMI ≥25 (41%), Low activity (17%), Low Med diet (2%), Alcohol (6%)
|
BMI ≥25 (9%), Low activity (10%), Low Med diet (2%), Alcohol (0.2%)
|
M (66%), F(21%)
|
Liver
|
BMI ≥25 (24%), Alcohol (7%), Smoking (23%)
|
BMI ≥25 (15%), Alcohol (3%), Smoking (16%)
|
M (54%), F(34%)
|
Bladder
|
Smoking (53%), Low activity (4%), Low Med Diet (4%)
|
Smoking (40%), %), Low activity (7%), Low Med Diet (1%)
|
M (61%), F(48%)
|
Pancreas
|
BMI ≥25 (15%), Smoking (25%)
|
BMI ≥25 (15%), Smoking (18%)
|
M(40%), F(33%)
|
Renal Cell
|
BMI ≥25 (20%)
|
BMI ≥25 (29%)
|
|
Breast
|
Low activity (6%) BMI ≥ 25 (5%), Alcohol (0.5%)
|
F (12%)
|
|
Ovarian
|
BMI ≥25 (9%)
|
||
Endometrial
|
BMI ≥25 (32%)
|
||
Cervix
|
Smoking (21%)
|
F(21%)
|