Attributable causes of cancer in China.
BACKGROUND
Most cancers are due to modifiable lifestyle and environmental risk factors, and are potentially preventable. No studies have provided a systematic quantitative assessment of the burden of cancer mortality and incidence attributable to known risk factors in China.


METHODS
We calculated the proportions of cancer deaths and new cases attributable to known risk factors in China, based on the prevalence of exposure around 1990 and national data on cancer mortality and incidence for the year 2005.


RESULTS
Chronic infection is the main risk factor for cancer in China, accounting for 29.4% of cancer deaths (31.7% in men and 25.3% in women), followed by tobacco smoking (22.6% with 32.7% in men and 5.0% in women), low fruit intake (13.0%), alcohol drinking (4.4%), low vegetable intake (3.6%) and occupational exposures (2.7%). The remaining factors, including environmental agents, physical inactivity, the use of exogenous hormones and reproductive factors are each responsible for <1.0%.


CONCLUSIONS
Modifiable risk factors explain nearly 60% of cancer deaths in China, with a predominant role of chronic infection and tobacco smoking. Our findings could provide a basis for cancer prevention and control programs aimed at reducing cancer risk in other developing countries.
Department of Cancer Epidemiology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; Nutritional Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, USA.
J B
JB
Wang
Department of Cancer Epidemiology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Y
Y
Jiang
Department of Cancer Epidemiology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
H
H
Liang
Departments of Occupational and Environment Health, School of Public Health, Chongqing Medical University, Chongqing.
P
P
Li
School of Public Health, Sichuan University, Chengdu, China.
H J
HJ
Xiao
Division of Pharmaceutics, College of Pharmacy, The Ohio State University, Columbus.
J
J
Ji
Department of Epidemiology, School of Public Health, Harvard University, Boston, USA.
W
W
Xiang
Department of Cancer Epidemiology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; Cancer Epidemiology Research Unit, Cancer Council NSW, Woolloomooloo, Australia.
J F
JF
Shi
Tianjin Lung Cancer Institute, General Hospital, Tianjin Medical University, Tianjin.
Y G
YG
Fan
Department of Gynecology, The People's Hospital of Xinjiang Province, Xinjiang Medical University, Ürümqi, China.
L
L
Li
Department of Cancer Epidemiology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
D
D
Wang
School of Public Health, Sichuan University, Chengdu, China.
S S
SS
Deng
National Office for Cancer Prevention and Control, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
W Q
WQ
Chen
Department of Cancer Epidemiology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
W Q
WQ
Wei
Department of Cancer Epidemiology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China. Electronic address: qiaoy@cicams.ac.cn.
Y L
YL
Qiao
The Tisch Cancer Institute and Institute for Translational Epidemiology, Mount Sinai School of Medicine, New York, USA; International Prevention Research Institute, Lyon, France.
P
P
Boffetta
D000428:Alcohol Drinking / Q000009:adverse effects; D002681:China / Q000453:epidemiology; D002908:Chronic Disease; D004781:Environmental Exposure; D005260:Female; D005502:Food; D006801:Humans; D015994:Incidence; D007239:Infections / Q000150:complications / Q000453:epidemiology; D008019:Life Style; D008297:Male; D009369:Neoplasms / Q000453:epidemiology* / Q000209:etiology*; D016273:Occupational Exposure / Q000009:adverse effects; D015995:Prevalence; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012907:Smoking / Q000009:adverse effects