If over 40% of cancer is attributable to lifestyle and the environment, what about the other 60%?
Alliance for Cancer Prevention
The British Journal of Cancer’s  report on the fraction of cancers attributable to lifestyle and environmental factors once again misses the mark, and yet another opportunity to address the real causes of the ever increasing rising incidence of cancer.
The Alliance for Cancer Prevention is concerned that the report places blame at the feet of the individual, instead of at the feet of government, industry and the cancer organisations, to stem the rising incidence of a largely preventable disease.
While in the report consideration is given to a small number of the confounding environmental and occupational risk factors, they are narrowly defined, inadequately addressed and their impact sorely underestimated. 
The only environmental element considered is radiation, and there is absolutely no consideration given to our exposures in the wider environment, or in our first environment, the womb. Given that childhood cancer is increasing by 3% every 3 years  and there is much evidence to suggest pre-birth exposures can dictate future cancers,  these ‘acceptable’ risk factors, do not apply to childhood cancers.
The report’s selection of risk factors is based on 3 criteria; sufficient evidence, data from population studies and achievable, modifiable risks. It is unclear and undefined how much evidence is ‘sufficient’, what evidence has been consider, by whom, and by what criteria such evidence is included in the study or dismissed. The modifiable risks seem chosen to support individual action only and not the urgent action that is needed on primary prevention by government or the cancer organisations.
The Alliance thinks that if the population studies, in the report, failed to consider the environmental and occupational risk factors, then the data would be skewed in favour of addressing the ‘acceptable’ risk factors, which are focused on individual instead of institutional action. There is no consideration given to the fact that lifestyle factors are influenced by economic and social aspects.
The risk factors used in the report are selected by ‘”internationally agreed consensus”, but there is no reference as to who this international body is, where the selection takes place or what selection criteria were used? The Alliance would like to know more.
The World Health Organisation acknowledges the environmental and occupational risk factors for cancer in the Asturias Declaration  and confirms that “Primary prevention – prevention of the exposures that cause cancer – is the single most effective means of prevention”. Yet there is not one mention of primary prevention in the entire BJC report.
Professor Richard Clapp from the Boston University School of Public Health and author of the Environmental and Occupational Causes of Cancer  observes:“Section 14 (of the BMJ’s report) reads like a riddle wrapped in a mystery inside an enigma (to borrow a phrase from Winston Churchill), with lots of uncertainties about the effect of multiple exposures, lack of information, etc. The ghost of Sir Richard Doll haunts the analyses, and his name is the first to appear in the references section. Nevertheless, despite all the limitations and probable underestimates, the author lists occupation fifth, with 11,494 cases in 2010. This strikes me as a massive annual burden on working people in the UK and well worth all reasonable efforts to reduce it”.
Professor Rory O’Neill of Stirling University notes: “Real life is more complicated. Getting cancer is a social class issue; surviving cancer is a social class issue. Until the view from the ivory towers reflects that from the tower blocks, the finger of blame will point at the victims, and not at those that really control their cancer risks”.
The Scottish Hazards Campaign asks: “If the % of causes attributable to work is greater than that % attributable to alcohol, then why are there no concrete measures to address work related causes of cancer?
The UK is still lagging behind more progressive countries in terms of addressing the primary prevention of cancer. The US Presidents Cancer Panel Report states: “Environmental health, including cancer risk, has been largely excluded from overall national policy on protecting and improving the health of Americans. It is more effective to prevent disease than to treat it, but cancer prevention efforts have focused narrowly on smoking, other lifestyle behaviours, and chemopreventive interventions.” 
The Alliance questions why: “The cancer establishments in Canada and France ’  have identified, and targeted for action, the environmental and occupational risk factors for cancer while the UK is still lagging behind, why don’t we address the other 60%”?
The Alliance is a multi-stakeholder group which includes representatives from: NGOs, Trade Unions, environmental and occupational health organisations, public health advocates and civil society groups, working together on cancer prevention. We aim to; challenge the existing perception of control and treatment of cancer being the best way forward; get equal recognition for primary prevention and ensure that the cancer establishment acknowledges the environmental and occupational risk factors for preventable cancers.
Alliance for Cancer Prevention:email@example.com
Prof Rory O’Neill: firstname.lastname@example.org
Prof Richard Clapp: email@example.com
Scottish Hazards Campaign: firstname.lastname@example.org
Notes to Editor
 British Journal of Cancer report Volume 105, Issue S2 (si-S81) Published 6 Dec 2011. http://www.nature.com/bjc/journal/v105/n2s/index.html
 WHO Asturias Declaration: A Call to Action.http://www.who.int/phe/news/events/international_conference/en/
 President’s Cancer Panel Annual Report – (US) 2008 -2009. US Dept of Health and Human Services, National Institutes of Health and the National Cancer Institute.
 Canadian Cancer Society. Environmental Risk Factors for Cancer.
 Cancer and the Environment A collective expert report by Inserm 2008.http://english.inserm.fr/thematiques/public-health/collective-expert-reports
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