Modifiable Risk Factors

Overview

Modifiable risk factors (MRFs) are behaviors and exposures that can raise or lower a person’s risk of cancer. Increased cancer risk associated with MRFs can be influenced through changes to environments, policies, and social norms that influence behaviors and exposures.

MRFs account for a large proportion of cancer incidence and mortality, yet the role of specific risk factors and how combinations of factors influence risk over time is unknown for some cancers. Novel strategies are needed to assess and influence the impact of MRFs across the life course, to effectively intervene at the individual and community levels at critical timepoints, and to design dynamic, multilevel strategies to reduce risk.

Global

11 known modifiable risk factors account for 44% of cancer deaths. Pie chart with 56% in red and 44% in blue. GBD 2019 Cancer Risk Factors Collaborators, Lancet (2022), 400(10352):563-591

GBD 2019 Cancer Risk Factors Collaborators. The global burden of cancer attributable to risk factors, 2010-19: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2022;400(10352):563-591. doi:10.1016/S0140-6736(22)01438-6

United States

Estimated proportion and number of cancer deaths attributable to evaluated risk factors in adults 30 years and older by sex, United States, 2019.

$A detailed bar chart displaying the estimated proportion and number of cancer deaths attributable to evaluated risk factors in adults 30 years and older by sex. It lists various risk factors along with their population attributable fractions (PAF) in percentages and corresponding number of attributable deaths. Color-coded horizontal bars represent PAF percentages for each factor, ranging from low to high.$ Islami F, Marlow EC, Thomson B, et al. Proportion and number of cancer cases and deaths attributable to potentially modifiable risk factors in the United States, 2019. CA Cancer J Clin. 2024; 1-28. doi:10.3322/caac.21858

The 11 MRFs included in the illustrated estimate of attributable risk are smoking, alcohol use, high body mass index (BMI), unsafe sex, high fasting plasma glucose, ambient particulate matter, occupational exposure to asbestos, diet low in whole grains, diet low in milk, and secondhand smoke. Although broadly similar, other approaches and results for specific countries can differ in their estimates of the most important MRFs. Notably, lack of physical activity is the seventh ranked MRF in the United States but does not appear in the top 11 MRFs based on the Global Burden of Diseases, Injuries, and Risk Factors Study analysis of MRFs globally. The list of the specific MRFs examined and how they are defined will influence the rankings.

Priorities

Identify research gaps and intervention needs regarding MRFs to mitigate cancer risk.
Address prioritized data, measurement, and intervention needs for risk factors with greater spatial and temporal alignment across the life course and among specific subgroups.
Support research that models effects of risk factors and interventions over the life course and across birth cohorts to investigate the impact on risk trajectories, incidence, and mortality.
Promote use of advanced statistical and computational methods to understand causal pathways of MRFs on variation in cancer risk, response to treatment, and survival.
Support research to evaluate the effects of built, natural, economic, health care, and policy environments on MRFs clusters and on response to interventions.
Develop and support an infrastructure for the efficient implementation of trials on behavioral and structural risk factor interventions.

Division of Cancer Control and Population Sciences (DCCPS) and Modifiable Risk Factors

DCCPS engages in diverse activities focused on MRFs, including contributing to the Cancer Trends Progress Report, a series of reports that describe the nation's progress against cancer through research and related efforts. Notable DCCPS branches working in this area include the following

The Modifiable Risk Factors working group was developed as part of the DCCPS six future directions to bring together diverse perspectives from all program areas in the DCCPS portfolio. The working group advances DCCPS’s leadership role in MRFs and cancer studies, research, and advocacy, while building interagency partnerships and finding new and innovative ways of compiling and sharing MRF research.