Cancer Etiology: Agents Causally Associated with Human Cancer

Abstract

Cancer is a multifactorial and multistage process, the exact mechanisms of which are still only partially known. However, even in the absence of a complete understanding of the process of carcinogenesis, we have been able to identify several factors which modify the risk of tumour development in humans. These include both endogenous and environmental factors, ranging from exposure to a single identified chemical to the occupations we follow in order to make our living. Cancer prevention strategies may differ in different parts of the world. In Europe, lung cancer is responsible for about one fourth of all cancer deaths and most of it could be prevented by eliminating tobacco smoking. Other exposures that can be controlled include occupational exposures to agents known to cause cancer at sites such as lung, bladder, paranasal sinuses, leukaemia, lymphoma and liver, as well as exposure to sunlight, known to be associated with both non-melanocytic and melanocytic skin cancer. Liver cancer is a common cancer in other regions of the world where hepatitis B virus (HBV) infection is endemic; in these areas, fungal contamination of food is also common. While immunization against HBV may be the method of choice in the long run, reduction of exposure to aflatoxins might be a more useful intermediate goal in primary prevention because of the strong interaction between hepatitis B and aflatoxin exposure on liver cancer risk. To date, few chemical agents have been proved to be of etiological relevance to cancer in humans at sites such as the breast (with the exception of oestrogenic hormones), ovary, colon-rectum and prostate. Therefore, imaginative new approaches are needed to study the etiology of and prevention for these common cancers.