What is a risk factor?
Anything that has been identified as increasing an individual’s chance of getting a disease is a risk factor. Factors that increase cancer risk can be external such as
personal lifestyle choices or substances such as chemicals and asbestos, present in the environment, that are known to cause cancer. Some people also have internal risk factors for cancer such as a genetic predisposition or those that develop as a result of aging.
Cancer risk factors can be divided into four categories:
- Behavioral Risk Factors-
Personal lifestyle choices that affect your cancer risk are also known as behavioral risk factors. Behavioral risk factors are those that can be modified or treated by you or your physician. These can include nutrition, physical activity, tobacco use, alcohol consumption, sexual activity and adherence to screening guidelines among others.
- Environmental Risk Factors-
Things found in your surroundings, including where you live and work, such as second hand smoke and chemicals, are environmental risk factors that can cause cancer. Action can be taken to avoid exposure to environmental risk factors like protecting yourself from the sun or checking a home for radon.
- Biological Risk Factors-
Biological risk factors are based on an individual’s physical characteristics such as gender and race. The impact of one’s individual characteristics on their risk of cancer depends on the type of cancer. Examples of characteristics that can increase your chances of getting cancer include: gender, age, race and skin complexion.
- Genetic Risk Factors-
The genes you inherit from your parents contribute to your genetic risk factors. There are hereditary factors that are more likely to increase cancer risk such as multiple cancers in one individual family member and multiple generations with similar cancers.
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What are the risk factors for cancer?
The risk factors for cancer are both external and internal and several are behavioral risk factors. The risk factors for cancer include:
- Growing older
- Tobacco
- Sunlight
- Ionizing radiation
- Certain chemicals and other substances
- Some viruses and bacteria
- Certain hormones
- Family history of cancer
- Alcohol
- Poor diet, lack of physical activity, or being overweight
Behavioral risk factors include:
- Tobacco use
- Sun exposure
- Alcohol
- Poor diet, lack of physical activity, or being overweight
Source: National Cancer Institute, Cancer Causes and Risk Factors,
http://www.cancer.gov/cancertopics/prevention-genetics-causes/causes
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Where can I get information on risk behaviors in the U.S.?
The Behavioral Risk Factor Surveillance System (BRFSS) is the world’s largest, on-going telephone health survey system, tracking health conditions and risk behaviors in
the United States yearly since 1984. Conducted by the 50 state health departments as well as those in the District of Columbia, Puerto Rico, Guam,
and the U.S. Virgin Islands with support from the CDC, BRFSS provides state-specific information about issues such as asthma, diabetes, health care access,
alcohol use, hypertension, obesity, cancer screening, nutrition and physical activity, tobacco use, and more.
The BRFSS questionnaire is comprised of core questions and optional modules. There are three types of core questions. Fixed core questions are asked every year.
Rotating core questions are asked every other year. Emerging core questions typically focus on “late-breaking” health issues. All states must ask all core questions.
The optional modules are standardized questions that are supported by the CDC that cover additional health topics or are more detailed questions on a health topic
included in the core. Each year states must choose which optional modules they will use based on the data needs of their state.
The Youth Risk Behavior Surveillance System (YRBSS) was developed in 1990 to monitor priority health risk behaviors that contribute markedly to the leading causes of
death, disability, and social problems among youth and adults in the United States. These behaviors are often established during childhood and early adolescence.
The YRBSS assesses six categories of priority health risk behaviors—behaviors that contribute to unintentional injuries and violence; tobacco use; alcohol and other
drug use; sexual behaviors that contribute to unintended pregnancy and STDs, including HIV infection; unhealthy dietary behaviors; and physical inactivity—plus
overweight and asthma.
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Where do I find it?
National Center for Chronic Disease Prevention and Health Promotion
Behavioral Risk Factor Surveillance System
http://www.cdc.gov/brfss/
Texas Behavioral Risk Factor Surveillance System
http://www.dshs.state.tx.us/chs/brfss/
Youth Risk Behavior Surveillance System
http://www.cdc.gov/healthyyouth/yrbs/index.htm
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Cancer in the BRFSS?
There are many sections of the core section of the questionnaire that would be helpful and relevant to those working in cancer control.
Some of these questions are asked every year and some are asked every other year. Topics include:
- Health Care Access
- Physical Activity
- Overweight & Obesity
- Nutrition
- Tobacco Use
- Women’s Health
- Prostate Cancer Screening
- Colorectal Cancer Screening
Additionally, state’s have optional modules of questions to include in the questionnaire. Modules used by Texas in the last five years relevant to cancer include:
- Secondhand Smoke Policy
- Smoking Cessation
- Other Tobacco Products
- Tobacco Indicators
- Human Papilloma Virus Vaccine
The State Cancer Profiles Web site is a joint collaboration between CDC and the National Cancer Institute (NCI), whose aim is to provide
dynamic views of cancer statistics for prioritizing cancer control efforts at the national, state, and county level. The State Cancer Profiles
site includes the measures on the BRFSS site as well as other measures that are integral to comprehensive cancer control planning and implementation.
These can be found at http://www.statecancerprofiles.cancer.gov/risk/risk.html.
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How can I use it?
BRFSS may be used to identify emerging health problems; establish and track health objectives; develop, implement, and evaluate a broad array of disease prevention activities; and support health-related legislative efforts.
Federal, state, and local health officials and researchers use this information to track health risks, identify emerging problems, prevent disease, and improve treatment.
Texas has used the system to:
- Determine the prevalence of risk behaviors related to chronic diseases.
- Provide data on progress toward Healthy People 2010 and Texas Healthy People Year 2010 objectives in the areas of physical activity, Pap smear and mammography use, hypertension, obesity, fatty food consumption, HIV/AIDS, alcohol abuse, and smoking.
- Document the need for and monitor the progress of prevention programs, including those targeting tobacco use and breast and cervical cancer.
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Where can I get more information on the risk factors for cancer?
National Cancer Institute
Cancer Causes and Risk Factors
http://www.cancer.gov/cancertopics/prevention-genetics-causes/causes
American Cancer Society
http://www.cancer.org
The University of Texas M. D. Anderson Cancer Center
http://www.mdanderson.org
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Risk Factors for Major Cancers
Breast Cancer
Risk Factors for Breast Cancer
Risk factors for breast cancer include (in alphabetical order):
- Age - Most breast cancer is diagnosed in women over age 50. After being a woman, age is the most influential risk factor. As you age, your risk increases.
- Family history - Your risk is higher if you have a family history of breast and/or ovarian cancer; especially if it was your mother, sister or daughter.
- Gender - Being a woman is the main risk factor for breast cancer and women are 100 times more likely than men to get breast cancer
- Genetics - Inherited alterations in the BRCA1 and BRCA2 genes, as well as others, increase breast cancer risk.
- Lifestyle factors - Alcohol use, obesity or weight gain after menopause, a high-fat diet and physical inactivity can also increase a woman’s risk of breast cancer.
- Medical history - A woman who has had breast cancer in one breast is much more likely to develop a second breast cancer in the opposite breast. Women who have had an abnormal breast biopsy or benign breast diseases requiring biopsy may have an increased risk. Women who have had radiation to the chest for another cancer are also at increased risk. And, women who were given DES to prevent miscarriage may also be at increased risk.
- Reproductive and menstrual history - Having your period early, starting menopause late and/or not having children or having them after the age of 30 increases breast cancer risk. Undergoing postmenopausal hormone therapy for several years has also shown to increase a woman’s risk.
Breast Cancer and the BRFSS
Questions related to breast cancer are answered in the Women’s Health core section of the BRFSS questionnaire.
BRFSS survey questions regarding breast cancer include:
- A mammogram is an x-ray of each breast to look for breast cancer. Have you ever had a mammogram?
- How long has it been since you had your last mammogram?
- A clinical breast exam is when a doctor, nurse, or other health professional feels the breasts for lumps. Have you ever had a clinical breast exam?
- How long has it been since your last breast exam?
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Cervical Cancer
Risk Factors for Cervical Cancer
Risk factors for cervical cancer include (in alphabetical order):
- History of multiple sexual partners, high-risk male partners or first intercourse at an early age
- Immuno-compromised
- Lack of regular Pap tests
- Multiparity
- Oral contraceptive use (more than five years)
- Prenatal DES exposure
- Sexually transmitted disease, including HPV or HIV
- Smoking
Cervical Cancer and the BRFSS
Questions related to cervical cancer are answered in the Women’s Health core section of the BRFSS questionnaire.
BRFSS survey questions regarding cervical cancer include:
- A Pap test is a test for cancer of the cervix. Have you ever had a Pap test?
- How long has it been since you had your last Pap test?
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Colorectal Cancer
Risk Factors for Colorectal Cancer
Risk factors for colorectal cancer include (in alphabetical order):
- Age - Over 90% of those diagnosed with colorectal cancer are over the age of 50.
- Family history - An increased risk of colorectal cancer is associated with a family history of colorectal cancer or adenomatous polyps, particularly in close relatives such as parent, sibling or child.
- Genetics - Certain genetic changes can increase a person’s risk of colorectal cancer through inherited colorectal cancer syndromes associated with the genetic susceptibility.
- Lifestyle factors - A diet high in fat, particularly from animal sources, cigarette smoking and alcohol consumption may increase risk of colorectal cancer. Being overweight and physical inactivity are also risk factors.
- Medical history - A personal history of colorectal cancer, colorectal polyps, ulcerative colitis and/or Crohn’s disease can increase the risk of colorectal cancer.
Colorectal Cancer and the BRFSS
Questions related to colorectal cancer are asked in the optional module on Colorectal Cancer Screening of the BRFSS questionnaire.
BRFSS survey questions regarding colorectal cancer include:
- A blood stool test is a test that may use a special kit at home to determine whether the stool contains blood. Have you ever had this test using a home kit?
- How long has it been since you had your last blood stool test using a home kit?
- Sigmoidoscopy and colonoscopy are exams in which a tube is inserted in the rectum to view the colon for signs of cancer or other health problems. Have you ever had either of these exams?
- How long has it been since you had your last sigmoidoscopy or colonoscopy?
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Lung Cancer
Risk Factors for Lung Cancer
Risk factors for lung cancer include (in alphabetical order):
- Air pollution
- Asbestos, arsenic and radon exposure
- Environmental tobacco smoke
- Family history
- Occupational and industrial exposure to cancer causing agents (such as diesel exhaust, uranium, vinyl chloride)
- Over 65 years of age
- Personal history
- Radiation therapy to the chest
- Tobacco smoking
Lung Cancer and the BRFSS
Questions related to lung cancer are asked in both the Tobacco Use core section and in several optional modules of the BRFSS questionnaire.
BRFSS survey questions regarding lung cancer include:
Tobacco Use
- Have you smoked at least 100 cigarettes in your entire life?
- Do you now smoke cigarettes every day, some days, or not at all?
- During the past 12 months, have you stopped smoking for one day or longer because you were trying to quit smoking?
Secondhand Smoke Policy
- Which statement best describes the rules about smoking inside your home?
- While working at your job, are you indoors most of the time?
- Which of the following best describes your place of work’s official smoking policy for indoor public or common areas, such as lobbies, rest rooms, and lunch rooms?
- Which of the following best describes your place of work’s official smoking policy for work areas?
Smoking Cessation
- About how long has it been since you last smoked cigarettes?
- In the past 12 months, how many times have you seen a doctor, nurse, or other health professional to get any kind of care for yourself?
- In the past 12 months, on how many visits were you advised to quit smoking by a doctor, or other health provider?
- On how many visits did your doctor, nurse, or other health professional recommend or discuss medication to assist you with quitting smoking, such as nicotine gum, patch, nasal spray, inhaler, lozenge, or prescription medication such as Wellbutrin/Zyban/Bupropion?
- On how many visits did your doctor or health provider recommend or discuss methods and strategies other than medication to assist you with quitting smoking?
Other Tobacco Products
- Have you ever used or tried any smokeless tobacco products such as chewing tobacco or snuff?
- Do you currently use chewing tobacco or snuff every day, some days, or not at all?
- Do you currently use any tobacco products other than cigarettes, such as cigars, pipes, bidis, kreteks, or any other tobacco product?
Tobacco Indicators
- How old were you the first time you smoked a cigarette, even one or two puffs?
- How old were you when you first started smoking cigarettes regularly?
- About how long has it been since you last smoked cigarettes regularly?
- In the past 12 months, have you seen a doctor, nurse or other health professional to get any kind of care for yourself?
- In the past 12 months, has a doctor, nurse, or other health professional advised you to quit smoking?
- Which statement best describes the rules about smoking inside your home?
- While working at your job, are you indoors most of the time?
- Which of the following best describes your place of work’s official smoking policy for indoor public or common areas, such as lobbies, rest rooms, and lunch rooms?
- Which of the following best describes your place of work’s official smoking policy for work areas?
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Prostate Cancer
Risk Factors for Prostate Cancer
Risk factors for prostate cancer include (in alphabetical order):
- Age - Men over 50 years of age have the greatest risk. Age is the main risk for prostate cancer.
- Diet - Men who eat a diet high in fat and animal meat may be at increased risk.
- Family history - A man’s risk is greater if his brother or father with prostate cancer.
- Race/ethnicity - African-American men have a higher risk of prostate cancer than other men.
Prostate Cancer and the BRFSS
Questions related to prostate cancer are asked in the optional module on Prostate Cancer Screening of the BRFSS questionnaire.
BRFSS survey questions regarding prostate cancer include:
- A Prostate-Specific Antigen test, also called a PSA test, is a blood test used to check men for prostate cancer. Have you ever had a PSA test?
- How long has it been since you had your last PSA test?
- A digital rectal exam is an exam in which a doctor, nurse, or other health professional places a gloved finger into the rectum to feel the size, shape, and hardness of the prostate gland. Have you ever had a digital rectal exam?
- How long has it been since your last digital rectal exam?
- Have you ever been told by a doctor, nurse, or other health professional that you had prostate cancer?
- Has your (male relative) ever been told by a doctor that he had prostate cancer?
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Skin Cancer
Risk Factors for Skin Cancer
Risk factors for skin cancer include (in alphabetical order):
- Exposure to ultraviolet radiation
- Fair complexion
- Family history of skin cancer
- Geography – living in the southern states
- Occupational exposure to coal, tar, pitch, creosote, arsenic or radium
- Sunburns before age 18
Skin Cancer and the BRFSS
Two questions related to sunburn experiences were asked in the core section (i.e., the survey questions administered in all states) as part of the questionnaire in 1999, 2003, and 2004.
The BRFSS survey questions regarding skin cancer included:
- The next question is about sunburns, including any time that even a small part of your skin was red for more than 12 hours. Have you had a sunburn within the past 12 months. If answered yes, respondents where then asked;
- Including times when even a small part of your skin was red for more than 12 hours, how many sunburns have you had within the past 12 months?
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Sources
National Cancer Institute
http://www.cancer.gov
National Cancer Institute
Cancer Causes and Risk Factors
http://www.cancer.gov/cancertopics/prevention-genetics-causes/causes
American Cancer Society
http://www.cancer.org
The University of Texas M. D. Anderson Cancer Center
http://www.mdanderson.org
National Center for Chronic Disease Prevention and Health Promotion
Behavioral Risk Factor Surveillance System
http://www.cdc.gov/brfss/
Texas Behavioral Risk Factor Surveillance System
http://www.dshs.state.tx.us/chs/brfss/
Youth Risk Behavior Surveillance System
http://www.cdc.gov/healthyyouth/yrbs/index.htm
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