Future Direction: Modifiable Risk Factors

Population Approaches to Reducing Alcohol-related Cancer Risk

Alcohol is a well-established human carcinogen; its consumption is associated with both increased cancer risk and cancer recurrence. To address this cancer-related risk factor, DCCPS released a NOFO titled Population Approaches to Reducing Alcohol-related Cancer Risk (PAR-23-244). The NOFO funds multilevel research with two distinct goals: (1) to disseminate effective messaging to increase knowledge and awareness of the risk of cancer attributable to alcohol use, and (2) to identify intervention and policy approaches that influence alcohol-related social norms and reduce consumption. The ultimate goal is to improve the evidence base for population and policy approaches to cancer control addressing alcohol, focusing on populations experiencing disparities, ultimately resulting in a shift to lower levels of alcohol consumption at the population level to reduce cancer risk.

This NOFO also is an example of progress in the area of Evidence-based Cancer Control Policy Research. The funding opportunity, with the first application due February 5, 2024, builds upon proven tobacco-related policies and demonstrates DCCPS’s commitment to reducing alcohol-related cancer risk. DCCPS staff contributed to the review (with the Centers for Disease Control and Prevention, Office of the Surgeon General, and the Substance Abuse and Mental Health Services Administration) of a petition to Congress calling for changes to alcohol labeling and the addition of cancer-related health warnings to alcohol-containing beverage containers. Future opportunities revolve around research gaps in connecting cancer prevention and control to alcohol policy and evaluating whether increasing knowledge and attention to this issue can reduce the burden of alcohol-related cancer.

Advancing Methods for Integrated Analysis of 24-hour Behavioral Patterns: The Role of Diet, Physical Activity, and Sleep

Diet, physical activity/sedentary behavior, and sleep are modifiable risk factors that play a role in the etiology and prevention of many chronic diseases, including overweight/obesity, diabetes, cardiometabolic diseases, and cancer. Many NIH-supported studies have collected data on these behaviors in relation to a variety of health outcomes. It is becoming clear that the timing of these behaviors, relative to the 24-hour day and each other, is critical for understanding their health effects. Yet, we have a limited understanding of how the interactions of these modifiable risk factors across the day impact health, especially in diverse populations. Building on the Biden-Harris Administration National Strategy on Hunger, Nutrition, and Health (PDF, 0.8MB), DCCPS efforts are underway to support using data science approaches to integrate these behaviors across the 24-hour day and examine their relationship with health outcomes.

Food is Medicine Research Opportunities

Better integration of nutrition into health, especially in populations that have historically experienced health inequities and disparities related to food and nutrition, is another key component of the Biden-Harris Administration National Strategy on Hunger, Nutrition, and Health (PDF, 0.8MB). The Food is Medicine research programs are part of a whole-of-government approach, including work with the Cancer Moonshot Prevention and Screening Task Force to end hunger, improve nutrition and physical activity, reduce diet-related diseases and disparities, and decrease the impact of preventable cancers. DCCPS scientists’ leadership and engagement in the Food is Medicine initiative aims to promote meaningful improvements in food security, health biomarkers (e.g., body mass index and hemoglobin A1C), cost of care, and health quality indicators (e.g., hospital readmissions for the same diagnosis). The goal is to address inequities in food, nutrition, and health based on race, ethnicity, poverty, and other SDOH by building sustainable clinical-community partnerships that can reinforce and act as an effective bridge between healthcare systems and patients to improve an individual’s dietary and lifestyle behaviors. Through the Request for Information (RFI): Food is Medicine Research Opportunities (NOT-OD-23-107), NCI and other federal departments and agencies have sought input on research opportunities that will optimize, implement, and disseminate information on regionally and culturally appropriate—as well as linguistically sensitive—Food is Medicine activities. This information will be used by the federal government, including NCI, for research planning and strategies for implementing Food is Medicine activities.

Advancing Systems Epidemiology to Address Modifiable Cancer Risk Factors

Systems epidemiology offers a comprehensive and holistic approach to studies of cancer and cancer-related risk factors in populations. Systems epidemiology considers various features from multiple domains (e.g., environment, genetics, sociodemographic, and clinical), assesses the inter-relationships among risk factors, considers changes over time, and investigates how these changes ultimately affect cancer risk and outcomes over the life course. This approach offers a framework to account for the complexity of cancer and cancer risk factors, contributing to a broader understanding of the disease and its determinants. In 2023, DCCPS coordinated a collection of seven papers that described investments in systems epidemiology, identified gaps in the cancer systems epidemiology portfolio, and highlighted the need to encourage more cancer systems epidemiology research. A particular focus on systems modeling across the life course was recommended, which will explore how cancer-related modifiable risk factors change over the life course for different birth cohorts, ultimately leading to an understanding of the impact of interventions to change risk factor trajectories and identification of the downstream implications of risk factor interventions on cancer incidence and mortality.

Community-engaged Initiatives for Obesity Policy: Lessons Learned for Healthy Childhood Growth

Obesity is secondary only to tobacco use as an important modifiable risk factor for cancer. Reducing the prevalence of childhood obesity is a critical step in addressing obesity and its relationship to cancer in later life. Addressing obesity in children will require multilevel efforts involving the engagement of a wide range of public and private sector partners to collaborate on bold systemic solutions that address structural racism, poverty, food insecurity, and other challenges. Through the National Collaborative on Childhood Obesity Research, DCCPS is working with federal partners and other experts to develop three think tanks to discuss international, national, and local public health policy efforts to inform the next steps in childhood obesity research and practice. In these meetings, researchers and practitioners will discuss lessons learned from tobacco, alcohol, sugar-sweetened beverages, food package labeling, and other public health policy efforts to inform community-engaged initiatives for obesity policy. The workshops will build on earlier collaborative activities related to public health policy research and practice, such as the Healthy Community Study; Snap-Ed Toolkit; Time-Sensitive Obesity Policy Research Initiatives; Creating Thriving, Activity-Friendly Communities Toolkit; and Lessons Learned from Global Efforts: Childhood Obesity. Ultimately, DCCPS envisions a broad-based initiative focused on implementing and evaluating interventions that target multiple influences on childhood obesity, from the individual and family to community levels, focusing on policy and stakeholder engagement to address obesity and related cancer risk factors.

Planning for the Future

Up to 50% of cancers are attributable to modifiable risk factors such as tobacco use, physical inactivity, poor diet, alcohol use, poor sleep hygiene, and low adherence rates to medical regimens such as recommended cancer screenings. Effectively addressing these risk factors and ultimately reducing cancer risk will require recognition of the multiple levels of influence on cancer risk and the need for interventions that integrate individual, family, community, environmental, healthcare practitioner, and policy approaches, as well as efforts that focus on populations experiencing disparities and inequities in cancer risk and outcomes. Increasing the use of evidence-based interventions in communities and healthcare settings, given multiple co-occurring behaviors, can translate to better outcomes for all populations. Future opportunities also include investigating the effects of policies and population-level approaches targeting modifiable cancer risk factors, and implementing and evaluating multilevel interventions to modify cancer risk behaviors and reduce cancer risk. Efforts to better understand how cancer risk factors relate to each other and the risk of various cancers across the lifespan will further inform efforts to target and modify these behaviors more precisely, ultimately favorably altering cancer risk and outcomes.