Overview

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Overview


Key policy priorities in summary

  • Implement a comprehensive national obesity prevention strategy
    • Strategies should prioritise high-risk groups especially Indigenous Australians and lower socioeconomic groups
  • Create environments that support healthy food choices
    • Develop national food and nutrition action plan to improve the availability, accessibility and affordability of health foods, consistent with Australian Dietary Guidelines
    • Improve Health Star Rating system and make it mandatory to facilitate healthier food choices
    • Restrict exposure of children to the marketing of unhealthy foods
  • Create environments that support physical activity
    • Develop a national active transport strategy
  • Develop economic interventions for preventive health
    • Increase taxes on energy dense and nutrient poor food products including introducing a 20% health levy on sugar-sweetened beverages

Collectively, the independent risk factors of overweight and obesity, physical inactivity, and inadequate diet are second only to tobacco as modifiable risk factors for cancer.[1][2] Healthy eating and physical activity protect against certain cancers both directly, and indirectly, through their impact on maintaining a healthy body weight.

Addressing these risk factors is an important objective for reducing Australia’s cancer burden given obesity and overweight have reached record levels in the Australian population. Two in three (67%) Australians aged 18 years and over are overweight or obese[3] and one in four (25%) Australian children are overweight or obese.[3]

The World Cancer Research Fund (WCRF) systematically reviews global evidence on diet, weight, and physical activity in relation to cancer risk according to levels of evidence. There is convincing evidence that overweight and obesity increase the risk of cancers of the oesophagus, pancreas, bowel, breast (post-menopausal), endometrium, kidney and liver.[4] Furthermore, there is probable evidence that overweight and obesity increase the risk of cancers of mouth, pharynx, larynx, ovary, prostate, gallbladder and stomach.[4] Physical activity has been shown to convincingly protect against bowel cancer and probably protect against breast (post-menopausal) and endometrium cancers.[4] Dietary factors probably protect against cancers of the bowel.[4] Further to this, the International Agency for Research on Cancer (IARC) has shown there is sufficient evidence that high body mass increases the risk of 13 types of cancer.[5]

In 2015, the Australian Institute for Health and Welfare found 7.8% of total cancer burden (number of years of life lost due to cancer) was attributable to high body mass followed by physical inactivity (2.9% of total burden).[6] In 2015, Cancer Council commissioned a study to quantify the numbers of cancer cases attributable to modifiable factors in Australia. The study found that 3.4% of cancers in 2010 were attributable to overweight/obesity[7] and 1.6% of cancers were due to insufficient physical activity.[8] Dietary factors were attributable for 6.1% of cancers with inadequate fibre intake accounting for 18% of bowel[9] and red and processed meat consumption accounting for a further 18% of bowel cancers diagnosed in Australians in 2010.[10] For further information on the link between tobacco smoke and cancer risk (not covered in this chapter), see the Tobacco control chapter of the National Cancer Control Policy.

Table 1 shows the estimated number of cancers diagnosed in Australia in 2010 attributable to these modifiable risk factors. The separate estimates for each risk factor cannot be added or combined due to the complex relationships between them.

Table 1 Estimated cancers diagnosed in Australia in 2010 by modifiable lifestyle risk factors[7][8][9][10]

Risk factor Site Cancers attributable (n)
Overweight and obesity Oesophagus 213
Bowel 1,332
Gall bladder 45
Pancreatic 205
Breast (postmenopausal) 971
Endometrium 595
Ovary 47
Kidney 509
All cancers 3,917
Inadequate intake of fruit Oral cavity and pharynx 180
Oesophagus 219
Stomach 130
Larynx 37
Lung 989
All cancers 1,555
Inadequate intake of non-starchy vegetables Oral cavity and pharynx 190
Oesophagus 51
Stomach 32
Larynx 38
All cancers 311
Inadequate fibre Bowel 2,609
Meat (red and processed) Bowel 2,614
Combined dietary All cancers 7,089
Insufficient physical activity Colon 707
Breast (postmenopausal) 971
Endometrium 136
All cancers 1,814

n = number

In 2017, a new estimate of numbers of cancer deaths attributable to modifiable factors in Australia in 2013 was published. Dietary factors were found to be the second highest cause of cancer deaths (2,329 deaths) followed by overweight/obesity (1,990 deaths).[11]

As well as being a direct cause of several cancers[4][12], alcohol consumption may indirectly increase cancer risk by contributing to obesity and overweight. For further information on the link between alcohol consumption and cancer risk (not covered in this chapter), see the Alcohol chapter of the National Cancer Control Policy.

This chapter of Cancer Council Australia’s National Cancer Control Policy discusses: the public policy context and effective policy interventions that can reduce the prevalence of these cancer risk factors. The chapter also summarises Cancer Council Australia’s recommended, evidence-based policy priorities for reducing the cancer burden in Australia attributable to obesity and overweight, physical inactivity and inadequate diet. The impact in Australia of cancers related to obesity and overweight, physical inactivity, and inadequate diet and evidence on the links between these factors and cancer are also covered.

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References

  1. World Cancer Research Fund, American Institute for Cancer Research. Food, nutrition, physical activity, and the prevention of cancer: a global perspective. Washington DC: AICR; 2007.
  2. Whiteman DC, Webb PM, Green AC, Neale RE, Fritschi L, Bain CJ, et al. Cancers in Australia in 2010 attributable to modifiable factors: summary and conclusions. Aust N Z J Public Health 2015 Oct;39(5):477-84 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26437735.
  3. 3.0 3.1 Australian Bureau of Statistics. National Health Survey: First Results, 2017-18. Canberra: ABS; 2018. Report No.: Catalogue No. 4364.0.55.001. Available from: https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4364.0.55.001~2017-18~Main%20Features~Overweight%20and%20obesity~90.
  4. 4.0 4.1 4.2 4.3 4.4 World Cancer Research Fund International. Diet, Nutrition, Physical Activity and Cancer: a Global Perspective - The Third Expert Report. [homepage on the internet] London, UK: World Cancer Research Fund International; 2018 Available from: https://www.wcrf.org/dietandcancer.
  5. Lauby-Secretan B, Scoccianti C, Loomis D, Grosse Y, Bianchini F, Straif K, et al. Body Fatness and Cancer--Viewpoint of the IARC Working Group. N Engl J Med 2016 Aug 25;375(8):794-8 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/27557308.
  6. Australian Institute of Health and Welfare. Australian Burden of Disease Study: impact and causes of illness and death in Australia 2015. Canberra: AIHW; 2019. Report No.: Series no. 19. Cat. no. BOD 22. Available from: https://www.aihw.gov.au/reports/burden-of-disease/burden-disease-study-illness-death-2015/contents/table-of-contents.
  7. 7.0 7.1 Kendall BJ, Wilson LF, Olsen CM, Webb PM, Neale RE, Bain CJ, et al. Cancers in Australia in 2010 attributable to overweight and obesity. Aust N Z J Public Health 2015 Oct;39(5):452-7 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26437731.
  8. 8.0 8.1 Olsen CM, Wilson LF, Nagle CM, Kendall BJ, Bain CJ, Pandeya N, et al. Cancers in Australia in 2010 attributable to insufficient physical activity. Aust N Z J Public Health 2015 Oct;39(5):458-63 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26437732.
  9. 9.0 9.1 Nagle CM, Wilson LF, Hughes MC, Ibiebele TI, Miura K, Bain CJ, et al. Cancers in Australia in 2010 attributable to inadequate consumption of fruit, non-starchy vegetables and dietary fibre. Aust N Z J Public Health 2015 Oct;39(5):422-8 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26437726.
  10. 10.0 10.1 Nagle CM, Wilson LF, Hughes MC, Ibiebele TI, Miura K, Bain CJ, et al. Cancers in Australia in 2010 attributable to the consumption of red and processed meat. Aust N Z J Public Health 2015 Oct;39(5):429-33 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26437727.
  11. Wilson LF, Antonsson A, Green AC, Jordan SJ, Kendall BJ, Nagle CM, et al. How many cancer cases and deaths are potentially preventable? Estimates for Australia in 2013. Int J Cancer 2018 Feb 15;142(4):691-701 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/28983918.
  12. International Agency for Research on Cancer. IARC monographs on the evaluation of carcinogenic risks to humans, volume 44: alcohol drinking. Lyon, France: International Agency for Research on Cancer; 1988 Available from: http://monographs.iarc.fr/ENG/Monographs/vol44/mono44.pdf.

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