Impact of Reducing Intake of Red and Processed Meat on Colorectal Cancer Incidence in Germany 2020 to 2050-A Simulation Study.

BACKGROUND: According to the International Agency for Research on Cancer (IARC), there is sufficient evidence for the carcinogenicity of processed meat consumption in humans, specifically regarding colorectal cancer (CRC) risk. Evidence for the carcinogenicity of red meat consumption is more limited but points in the same direction. METHODS: A macro-simulation approach was used to calculate age- and sex-specific potential impact fractions in a 30-year period (2020-2050). AIMS: We estimated numbers and proportions of future CRC cases preventable under different scenarios of reducing the intake of processed and red meat in the German population. RESULTS: Eliminating processed meat intake could reduce the burden of CRC by approximately 205,000 cases in Germany (9.6%) in 2020-2050, 2/3 among males (145,000) and 1/3 among females (60,000). Without red meat intake, approximately 63,000 CRC cases could be avoided (2.9%), 39,000 among males and 24,000 among females. Reductions in the mean consumption of both processed and red meat by one or two servings (each 11 or 22 g) per day would be expected to reduce CRC case numbers by 68,000 (3.1%) and 140,000 (6.5%), respectively. CONCLUSION: A reduction in red and processed meat intake might substantially reduce the incidence of CRC in Germany. The means of achieving such a reduction might include price and taxation policies, food labeling, and clearer risk communication aiming to reduce individual intake.

Vitamin D food fortification in European countries: the underused potential to prevent cancer deaths.

BACKGROUND: Meta-analyses of randomized controlled trials have shown that vitamin D supplementation reduces cancer mortality by 13%. Vitamin D fortification of foods may increase vitamin D levels in a similar manner as vitamin D supplementation and could achieve similar reductions in cancer mortality. Whereas some European countries already implemented widespread fortification of foods with vitamin D, in other countries only few or no foods are fortified. In this study, we estimated the reduction in cancer mortality presumably already achieved by current fortification policies in 2017 and the potential for further reductions if all countries had effective fortification. METHODS: We reviewed scientific literature, publicly available information, and contacted health authorities to obtain information on current vitamin D food fortification policies in 34 European countries. Together with country-specific cancer death statistics from Eurostat, information on life expectancy, and country-specific fortification policies, we used data from studies on supplementation and serum 25(OH)D increases and cancer mortality to estimate numbers of probably already prevented cancer deaths and numbers of potentially further preventable deaths and years of life lost. RESULTS: Current vitamin D fortification is estimated to prevent approximately 11,000 in the European Union and 27,000 cancer deaths in all European countries considered per year. If all countries considered here would implement adequate vitamin D fortification of foods, an estimated additional 129,000 cancer deaths (113,000 in the European Union) could be prevented, corresponding to almost 1.2 million prevented years of life lost (1.0 million in the EU) or approximately 9% of cancer deaths (10% in the EU). INTERPRETATION: Systematic fortification of foods might considerably reduce the burden of cancer deaths in Europe.

Impact of reducing excess body weight and physical inactivity on cancer incidence in Germany from 2020 to 2050-a simulation model.

BACKGROUND: Excess body weight and physical inactivity are key cancer risk factors contributing substantially to the cancer burden in Germany. We aimed to estimate the numbers and proportions of future cancer cases prevented under different scenarios of reducing the prevalence of excess body weight and physical inactivity in Germany. METHODS: Based on a macro-simulation approach calculating age-, sex-, and cancer-site specific potential impact fractions, we estimated for a 30-year study period (2020-2050) numbers and proportions of cancer cases prevented under different scenarios of reducing excess body weight (overweight and obesity) and increasing levels of physical activity in the German population. RESULTS: Estimates of the prevented cancer burden varied in the different scenarios. In the guideline exposure scenarios, in which the prevalence of excess body weight and insufficient levels of physical activity would be eliminated, 8.7% (men: 10.1%; women: 7.8%) of overweight/obesity-related cancer cases and 2.4% (men: 2.3%; women: 2.4%) of cancer cases related to physical inactivity were estimated to be prevented over a 30-year period. This translates to approximately 662,000 (men: 304,000; women: 358,000) and 129,000 (men: 42,000; women: 87,000) prevented cancer cases, respectively. CONCLUSION: Our results illustrate that a substantial number of future cancer cases could be prevented in the German population by reducing excess body weight and physical inactivity.

Potential of Vitamin D Food Fortification in Prevention of Cancer Deaths-A Modeling Study.

Meta-analyses of randomized controlled trials (RCTs) have estimated a 13% reduction of cancer mortality by vitamin D supplementation among older adults. We evaluated if and to what extent similar effects might be expected from vitamin D fortification of foods. We reviewed the literature on RCTs assessing the impact of vitamin D supplementation on cancer mortality, on increases of vitamin D levels by either supplementation or food fortification, and on costs of supplementation or fortification. Then, we derived expected effects on total cancer mortality and related costs and savings from potential implementation of vitamin D food fortification in Germany and compared the results to those for supplementation. In RCTs with vitamin D supplementation in average doses of 820-2000 IU per day, serum concentrations of 25-hydroxy-vitamin D increased by 15-30 nmol/L, respectively. Studies on food fortification found increases by 10-42 nmol/L, thus largely in the range of increases previously demonstrated by supplementation. Fortification is estimated to be considerably less expensive than supplementation. It might be similarly effective as supplementation in reducing cancer mortality and might even achieve such reduction at substantially larger net savings. Although vitamin D overdoses are unlikely in food fortification programs, implementation should be accompanied by a study monitoring the frequency of potentially occurring adverse effects by overdoses, such as hypercalcemia. Future studies on effectiveness of vitamin D supplementation and fortification are warranted.

Impact of tobacco control policies implementation on future lung cancer incidence in Europe: An international, population-based modeling study.

BACKGROUND: Despite recent trends in declining smoking rates, tobacco smoking remains the most preventable cause of cancer in Europe. We aimed to estimate numbers and proportions of future lung cancer cases that could be potentially prevented over a 20-year period if countries in Europe were to achieve a comprehensive implementation of tobacco control policies. METHODS: Historical data from population-based cancer incidence (or mortality) was used to predict sex-specific lung cancer incidence for 30 European countries up to 2037. Hypothetical country-specific smoking prevalence that would be expected if countries would have achieved the highest-level implementation of tobacco control policies (defined by the maximum total score of the Tobacco Control Scale, TCS) was estimated by combining national prevalence data on current smoking and data on the status of implementation of key tobacco control policies. Resulting numbers and proportions of potentially preventable lung cancer cases were estimated taking into account latency periods between changes in smoking prevalence and excess cancer risks. FINDINGS: In Europe, an estimated 1·65 million lung cancer cases (21·2%, 19·8% in men and 23·2% in women) could be prevented over a 20-year period with the highest-level implementation of tobacco control policies. Large variation was seen in European regions and countries reflecting the current level of tobacco control, with the largest potential for prevention in Western Europe (24·5%), Southern Europe (23·1%) and Eastern Europe (22·5%), and the lowest but still substantial potential for further prevention in Northern Europe (12·5%). In women, among whom lung cancer incidence is expected to increase, we estimated somewhat larger proportions of preventable lung cancer cases ranging from 9·9 to 33·9% as compared to men (8·6-28·5%). In the final year of study period (2037), these proportions even exceed 50% in women for some countries. INTERPRETATION: Improved and expanded implementation of evidence-based tobacco control policies at the most comprehensive level could reduce future lung cancer incidence considerably across Europe. FUNDING: The study was funded by the German Cancer Aid ("Deutsche Krebshilfe"), grant number 70112097.

Vitamin D supplementation to the older adult population in Germany has the cost-saving potential of preventing almost 30 000 cancer deaths per year.

Recent meta-analyses of randomized controlled trials (RCTs) have demonstrated significant reduction in cancer mortality by vitamin D supplementation. We estimated costs and savings for preventing cancer deaths by vitamin D supplementation of the population aged 50+ years in Germany. Our analysis is based on national data on cancer mortality in 2016. The number of preventable cancer deaths was estimated by multiplying cancer deaths above age 50 with the estimated proportionate reduction in cancer mortality derived by vitamin D supplementation according to meta-analyses of RCTs (13%). Saved costs were estimated by multiplying this number by estimated end-of-life cancer care costs (€40 000). Annual costs of vitamin D supplementation were estimated at 25€ per person above age 50. Comprehensive sensitivity analyses were conducted. In the main analysis, vitamin D supplementation was estimated to prevent almost 30 000 cancer deaths per year at approximate costs of €900 million and savings of €1.154 billion, suggesting net savings of €254 million. Our results support promotion of supplementation of vitamin D among older adults as a cost-saving approach to substantially reduce cancer mortality.

Impact of reducing alcohol consumption through price-based policies on cancer incidence in Germany 2020-50-a simulation study.

BACKGROUND AND AIMS: Alcohol is a major cancer risk factor and contributes considerably to the cancer burden in Germany. We aimed to provide projections of preventable cancer cases under different price-based alcohol policy scenarios. DESIGN: A macro-simulation approach was used to estimate numbers and proportions of cancer cases prevented under different price-based alcohol policy scenarios. SETTING AND PARTICIPANTS: Published price elasticities for main alcoholic beverages were applied to the mean daily intake of pure alcohol in the German population calculated from the German Health Interview and Examination Survey for Adults 2008-11 (DEGS1) to obtain hypothetical exposure distributions of alcohol consumption under different scenarios of changing price for alcoholic beverages. MEASUREMENTS: Age, sex and cancer site-specific potential impact fractions were calculated for different scenarios of changing the price of alcohol (single price increases, repeated price increases, volumetric price increase) for each year of a 30-year study period (2020-50). FINDINGS: Over a 30-year horizon, an estimated 4.7% (men = 10.1%, women = 1.4%) of alcohol-related cancer cases could be prevented in Germany, if alcohol intake above risk thresholds were reduced to levels below risk thresholds. Accordingly, the burden of new cancers would be reduced by approximately 244 000 cases (men = 200 000, women = 44 000). Of all price-based alcohol policy scenarios, a 100% price increase on alcoholic beverages was estimated to be most effective with approximately 213 000 (4.1%; men = 167 000; women = 47 000) preventable alcohol-related cancer cases, followed by 5-yearly 25% price increases (2.8%; men = 115 000, women = 29 000) and a volumetric price increase according to the beverage-specific alcohol content (1.9%; men = 72 000, women = 24 000). CONCLUSIONS: Simulations suggest that a substantial number of alcohol-related cancer cases could be avoided in Germany by applying price-based policies to reduce consumption of alcoholic beverages.

Impact of Tobacco Control Policies on Smoking-Related Cancer Incidence in Germany 2020 to 2050-A Simulation Study.

BACKGROUND: Germany is known for its weak tobacco control. We aimed to provide projections of potentially avoidable cancer cases under different tobacco control policy intervention scenarios. METHODS: To estimate numbers and proportions of potentially avoidable cancer cases under different policy intervention scenarios (cigarette price increases, comprehensive marketing ban, and plain packaging), we calculated cancer site-specific potential impact fractions by age, sex, and year of study period (2020-2050), considering latency periods between reduction in smoking prevalence and manifestation in declining cancer excess risks. To obtain estimates of future incident case numbers, we assumed a continuation of recent smoking trends, and combined German cancer registry data with forecasted population sizes, published effect sizes, and national daily smoking prevalence data. RESULTS: Over a 30-year horizon, an estimated 13.3% (men 14.0% and women 12.2%) of smoking-related cancer cases could be prevented if a combination of different tobacco control policies were to be implemented in Germany, with repeated price increases being the most effective single policy (men 8.5% and women 7.3%). Extensive sensitivity analyses indicated that the model is fairly robust. CONCLUSIONS: Our results suggest that the expected cancer incidence in Germany could be considerably reduced by implementing tobacco control policies as part of a primary cancer prevention strategy. IMPACT: Our straightforward modeling framework enables a comparison of the impact of different health policy measures. To further accelerate the currently observed tentative trend of declining smoking prevalence in Germany and thereby curtail smoking-related cancer incidence, there is a great need to urgently intensify efforts in tobacco control.

Cancers Due to Smoking and High Alcohol Consumption.

BACKGROUND: Tobacco and alcohol consumption are known causes of cancer. We set out to estimate the absolute numbers and proportions of cancer attributable to smoking and high alcohol consumption in Germany in 2018. METHODS: Numbers and proportions (population-attributable fractions, PAF) were calculated by sex and age group for ages 35 to 84 years based on population projections, national cancer incidence and exposure data, and published relative risks. RESULTS: For the year 2018 we estimated the smoking-attributable cancer burden to be 85 072 cases (men 58 760, women 26 312), corresponding to 19% of all incident cancers. The highest PAF was seen for lung cancer: 89% of male and 83% of female lung cancer cases are attributable to smoking. The cancer burden attributable to high alcohol consumption was estimated to be 9588 (men 8117, women 1471) cases (2% of all incident cancers). The highest PAF were observed for cancer of the oral cavity and pharynx (men 34%, women 6%) and squamous cell carcinoma of the esophagus (men 30%; women 5%). CONCLUSIONS: A considerable proportion of cancer cases are attributable to smoking and high alcohol consumption. More rigorous prevention efforts are required to achieve significant reductions in the prevalence of these risk factors and the attributable cancer burden.

Cancers Due to Infection and Selected Environmental Factors.

BACKGROUND: Causal relationships with the occurrence of cancer have been established for a number of infections and environmental risk factors. METHODS: Numbers and proportions (population-attributable fractions, PAF) of cancer cases attributable to these factors in Germany were calculated by sex and age groups for ages 35 to 84 years based on population projections, national cancer incidence, exposure data, and published risk estimates. RESULTS: For 2018, more than 17 600 cancer cases (4.0% of all incident cancers) were estimated to be attributable to infections. The largest contributions come from Helicobacter pylori (n = 8764) and human papillomavirus (n = 7669) infections. Infection with hepatitis B and C, human immunodeficiency virus, and human herpesvirus 8 were estimated to cause 983 cases, 144 cases, and 116 cases, respectively. More than 5400 cancer cases (1.2% of all incident cancers) were estimated to be attributable to selected environmental factors, of which the largest contributor is indoor radon (n = 3185), followed by particulate matter (n = 1049), sunbed use (n = 892), and secondhand smoke (n = 309). CONCLUSION: Of all cancers expected in 2018 in Germany, at least 5% are attributable to potentially avoidable infections and environmental factors. Further research should be directed towards more comprehensive identification and quantification of environmental risks as a basis for targeted cancer prevention.

Cancers Due to Excess Weight, Low Physical Activity, and Unhealthy Diet.

BACKGROUND: Excess weight, low physical activity, low intakes of dietary fiber, fruits, and vegetables, and high meat and salt intake increase cancer risk. METHODS: Numbers and proportions (population-attributable fractions, PAF) of incident cancer cases in Germany in 2018 attributable to these factors were estimated by sex and age groups for ages 35 to 84 years using population projections, national cancer incidence and exposure data, and published risk estimates. RESULTS: Estimated numbers (percentages) of attributable cancers were 30 567 (7%) for excess weight, 27 081 (6%) for low physical activity, 14 474 (3%) for low dietary fiber intake, 9447 (2%) for low fruit and vegetable consumption, 9454 (2%) and 1687 (0.4%) for processed meat and high red meat consumption, respectively, and 1204 (0.3%) for high salt intake. Excess weight substantially contributed to endometrial, renal, and liver cancer (PAF = 24 to 35%). Low physical activity contributed to endometrial, renal, and lung cancer (PAF = 15 to 19%), and dietary factors mainly contributed to colorectal, breast, and lung cancer (PAF = 9 to 16%). CONCLUSION: A considerable proportion of cancer cases are attributable to excess weight, physical inactivity, and unhealthy dietary habits. Major prevention efforts are needed to reduce the cancer incidence attributable to these avoidable factors.