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The Pulse

Big four ways to avoid the 'Big C'

by Cathy Johnson

Worried by the thought that "everything gives you cancer"? In fact the big four proven cancer
causes are lifestyle factors you can do something about.

Published 09/04/2012

Are you obsessive about eating organic food yet

resigned to the fact you smoke? Paranoid about toxins
in air pollution but unfussed about avoiding the sun?

It might seem that "everything gives you cancer" as the

singer Joe Jackson lamented. But the truth is, some
things pose a much greater risk than others and it's
important to know the difference, a leading cancer
researcher says. [Image source: iStockPhoto]
Professor Bernard Stewart, a public health expert who
heads a cancer control program in Sydney, says many people don't realise you can markedly reduce
your risk of the big C by focusing on just four key lifestyle factors.

Cutting smoking, avoiding obesity, not drinking too much alcohol and minimising our sun
exposure are the big four factors that will ultimately make a difference to reducing our cancer risk.

But too often, he says, we avoid taking action on these because we get "distracted" by other factors
we think are equally important but actually are not.

Myths and evidence

Some factors people worry about have no evidence whatsoever behind them and do not warrant
any change in our behaviour, Stewart says.

"Let's set aside complete nonsense. I'm talking about web-based rumours that there is asbestos in
tampons or that dioxin can be leached from plastic bottles containing water and left in hot cars.
These are examples of complete nonsense."

Other worries stem from reports in scientific journals that do have credibility but which merely
highlight the potential for people to be exposed to a cancer-causing agent – usually only at low
levels.

While these are important to know about, we shouldn't give them the same priority as reports that
show particular factors actually leading to humans developing cancer. These are the reports we
really need to sit up and take notice of, he says.
"The difference between avoiding cigarettes and avoiding using a hair dye is that smoking
cigarettes has not only been associated with exposure to carcinogens, it's actually been shown to
cause cancer. Whereas personal use of hair dyes has been shown to be associated with exposure to
carcinogens, particularly in formulations of hair dyes before 1980. But it has not been shown to be
associated with a burden of cancer amongst women who dye their hair."

Similarly eating organic food to avoid exposure to traces of pesticides has not been shown to
prevent cancers while reducing sun exposure has.

"Cancer is arguably the most-feared disease in the western world," he says. "I understand people
want to be fully informed about all the ways they can be exposed to nasty compounds that might
possibly cause cancer. But we need to prioritise our responses."

It's not just his hunch. Being aware of lots of potential causes of cancer has been shown to reduce
the chance of people acting on the big known causes, he says.

His comments stem from a paper he has written in the journal Lancet Oncology.

The big g est of the big : smoking

Stewart says his "big four" list of cancer causes – smoking, obesity, alcohol and sunlight – relates
specifically to Australians. It does not include infectious diseases, which are a major cause of cancer
in developing countries.

It also does not include what he calls "reproductive factors" which relate specifically to women. Not
having children, or having them later in life are examples of reproductive factors that can increase
a woman's risk of breast cancer.

"People don't alter when they have babies to influence their cancer risk. In identifying the big four,
I'm identifying the big four where you can take positive action in this country to prevent cancer."

And of those big four, smoking is the biggest as it is thought to account for as much as a third of all
cancers, Stewart says.

Next is obesity which accounts for around 15 per cent of cancers, followed by alcohol which accounts
for four per cent. Cancers caused by sun exposure are harder to quantify but would be less than
four per cent, he says.

While best known for causing lung cancer, smoking actually causes cancers at 13 other sites in the
body too – and it is a major cause in about half of these cancers. For lung cancer, it accounts for 80
per cent of cases.

For alcohol, the list is shorter but still scary. It's identified as a cause of cancers of the mouth, larynx
(voice box), pharynx (a section of the throat), oesophagus, bowel (in men) and breast.

"Initially we thought it was moderate to heavy drinking that caused breast cancer because that is
easy to detect," Stewart says. "But bigger surveys are now showing that daily intake of alcohol at
any level, effectively one alcoholic drink a day, is enough to cause a very small incidence of breast
cancer. In other words, avoiding daily alcohol is the way to go."

If obesity is an issue for you, the cancers you need to worry about most are breast and bowel.

Sun exposure is exclusively linked to skin cancer.

Taking action

Primed for action? Here's Stewart's hit list on how best to direct your efforts:

Stop smoking (call the Quitline for help from anywhere in Australia on 131 848)
Avoid daily alcohol and/or cut your alcohol intake
Monitor your weight and try to get yourself into the healthy weight range (for more
information see "Is your weight healthy?")
Avoid deliberate sun exposure (that is sunbaking) and otherwise protect your skin (by
covering up or using sunscreen) when you go in the sun

Two other factors he considers important enough to mention are:

Exercise – aim for a half hour daily walk or equivalent ("Someone who exercises is
unlikely to be obese but exercise seems to work to prevent cancers through a different
biological mechanism so I think it's worth mentioning separately.")
Take part in cancer screening where relevant (eg bowel cancer for older adults, breast
and cervical cancer for women. See here http://www.cancerscreening.gov.au/ for more
information)

It will probably always be human nature to fear the big C. But focus your time and energy on the
right factors and you can "very significantly reduce your risk," Stewart says.

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