Cancer types with high numbers of driver events are largely preventable

• Published in: PeerJ (San Francisco, CA) Vol. 10; p. e12672
• Main Authors: Belikov, Aleksey V, Leonov, Sergey V
• Format: Journal Article
• Language: English
• Published: United States PeerJ. Ltd 05.01.2022; PeerJ, Inc; PeerJ Inc
• Subjects: Age composition; Age groups; Calendars; Cancer; Cell division; Disease control; Distribution (Probability theory); DNA biosynthesis; Environmental Health; Epidemiology; Epstein-Barr virus; External risk; Female; Females; Health aspects; Human papillomavirus; Humans; Incidence; Infection; Infections; Kaposis sarcoma; Lung cancer; Male; Males; Mathematical Biology; Melanoma; Modifiable risk; Neoplasms - epidemiology; Oncology; Oncology, Experimental; Population; Population attributable fraction; Preventable cause; Radiation; Risk Factors; Simulation; Smoking; Statistics; Tumors; Ultraviolet radiation; Ultraviolet Rays; Australia; United Kingdom; England; United Kingdom > UK; United States > US; Europe; Modifiable risk; Epidemiology; Population attributable fraction; External risk; Preventable cause
• ISSN: 2167-8359; 2167-8359
• DOI: 10.7717/peerj.12672

There is a long-standing debate on whether cancer is predominantly driven by extrinsic risk factors such as smoking, or by intrinsic processes such as errors in DNA replication. We have previously shown that the number of rate-limiting driver events per tumor can be estimated from the age distribution of cancer incidence using the gamma/Erlang probability distribution. Here, we show that this number strongly correlates with the proportion of cancer cases attributable to modifiable risk factors for all cancer types except the ones inducible by infection or ultraviolet radiation. The correlation was confirmed for three countries, three corresponding incidence databases and risk estimation studies, as well as for both sexes: USA, males (  = 0.80,  = 0.002), females (  = 0.81,  = 0.0003); England, males (  = 0.90,  < 0.0001), females (  = 0.67,  = 0.002); Australia, males (  = 0.90,  = 0.0004), females (  = 0.68,  = 0.01). Hence, this study suggests that the more driver events a cancer type requires, the more of its cases are due to preventable anthropogenic risk factors.