title: The economic burden of cancers attributable to tobacco smoking, excess weight, alcohol use, and physical inactivity in Canada.
abstract: OBJECTIVE
  The purpose of the present study was to calculate the proportion of cancers in Canada attributable to tobacco smoking (ts), alcohol use (au), excess weight (ew), and physical inactivity (pia); to explore variation in the proportions of those risk factors (rfs) over time by sex and province; to estimate the economic burden of cancer attributable to the 4 rfs; and to calculate the potential reduction in cancers and economic burden if all provinces achieved rf prevalence rates equivalent to the best in Canada.
  
  
  METHODS
  We used a previously developed approach based on population-attributable fractions (pafs) to estimate the cancer-related economic burden associated with the four rfs. Sex-specific relative risk and age- and sex-specific prevalence data were used in the modelling. The economic burden was adjusted for potential double counting of cases and costs.
  
  
  RESULTS
  In Canada, 27.7% of incident cancer cases [95% confidence interval (ci): 22.6% to 32.9%] in 2013 [47,000 of 170,000 (95% ci: 38,400-55,900)] were attributable to the four rfs: ts, 15.2% (95% ci: 13.7% to 16.9%); ew, 5.1% (95% ci: 3.8% to 6.4%); au, 3.9% (95% ci: 2.4% to 5.3%); and pia, 3.5% (95% ci: 2.7% to 4.3%). The annual economic burden attributable to the 47,000 total cancers was $9.6 billion (95% ci: $7.8 billion to $11.3 billion): consisting of $1.7 billion in direct and $8.0 billion in indirect costs. Applying the lowest rf rates to each province would result in an annual reduction of 6204 cancers (13.2% of the potentially avoidable cancers) and a reduction in economic burden of $1.2 billion.
  
  
  CONCLUSIONS
  Despite substantial reductions in the prevalence and intensity of ts, ts remains the dominant risk factor from the perspective of cancer prevention in Canada, although ew and au are becoming increasingly important rfs.
authors.affiliation: School of Population and Public Health, University of British Columbia, Vancouver, BC;;
authors.forename: H
authors.initials: H
authors.lastname: Krueger
authors.forename: E N
authors.initials: EN
authors.lastname: Andres
authors.affiliation: School of Population and Public Health, University of British Columbia, Vancouver, BC;;
authors.forename: J M
authors.initials: JM
authors.lastname: Koot
authors.forename: B D
authors.initials: BD
authors.lastname: Reilly
keywords: Economic burden of disease; alcohol use; obesity; overweight; physical inactivity; risk factors; smoking