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The future burden of kidney and bladder cancers preventable by behavior modification in Australia: A pooled cohort study |
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| Authors: | Maarit A. Laaksonen Robert J. MacInnis Karen Canfell Graham G. Giles Peter Hull Jonathan E. Shaw Robert G. Cumming Tiffany K. Gill Emily Banks Paul Mitchell Julie E. Byles Dianna J. Magliano Vasant Hirani David Connah Claire M. Vajdic |
| Affiliation: | 1. Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, Australia;2. Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, VIC, Australia Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia;3. Cancer Research Division, Cancer Council New South Wales, Sydney, NSW, Australia School of Public Health, University of Sydney, Sydney, NSW, Australia Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia;4. Clinical Diabetes Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia;5. School of Public Health, University of Sydney, Sydney, NSW, Australia ANZAC Research Institute, University of Sydney and Concord Hospital, Sydney, NSW, Australia;6. Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia;7. ANU College of Medicine, Biology and Environment, Australian National University, Canberra, ACT, Australia;8. Centre for Vision Research, Westmead Institute for Medical Research, University of Sydney, Sydney, NSW, Australia;9. Research Centre for Generational Health and Ageing, University of Newcastle, Newcastle, NSW, Australia;10. Diabetes and Population Health Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia;11. School of Public Health, University of Sydney, Sydney, NSW, Australia School of Life and Environmental Sciences, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia;12. Cancer Voices NSW, Sydney, NSW, Australia |
| Abstract: | Substantial changes in the prevalence of the principal kidney and bladder cancer risk factors, smoking (both cancers) and body fatness (kidney cancer), have occurred but the contemporary cancer burden attributable to these factors has not been evaluated. We quantified the kidney and bladder cancer burden attributable to individual and joint exposures and assessed whether these burdens differ between population subgroups. We linked pooled data from seven Australian cohorts (N = 367,058) to national cancer and death registries and estimated the strength of the associations between exposures and cancer using adjusted proportional hazards models. We estimated exposure prevalence from representative contemporaneous health surveys. We combined these estimates to calculate population attributable fractions (PAFs) with 95% confidence intervals (CIs), accounting for competing risk of death, and compared PAFs for population subgroups. During the first 10-year follow-up, 550 kidney and 530 bladder cancers were diagnosed and over 21,000 people died from any cause. Current levels of overweight and obesity explain 28.8% (CI = 17.3–38.7%), current or past smoking 15.5% (CI = 6.0–24.1%) and these exposures jointly 39.6% (CI = 27.5–49.7%) of the kidney cancer burden. Current or past smoking explains 44.4% (CI = 35.4–52.1%) of the bladder cancer burden, with 24.4% attributable to current smoking. Ever smoking explains more than half (53.4%) of the bladder cancer burden in men, and the burden potentially preventable by quitting smoking is highest in men (30.4%), those aged <65 years (28.0%) and those consuming >2 standard alcoholic drinks/day (41.2%). In conclusion, large fractions of kidney and bladder cancers in Australia are preventable by behavior change. |
| Keywords: | kidney cancer bladder cancer risk factors population attributable fraction preventable burden |