What Causes Cancer?

In 2019, the American Institute for Cancer Research (AICR) commissioned its ninth edition of their Cancer Risk Awareness Survey to gauge Americans awareness of various lifestyle-related cancer risk factors. Unfortunately, there continues to be a fairly large discrepancy between what Americans believe causes cancer and the known risk factors for cancer.

The established cancer risk factors (see Chart 1) that contribute to over half of cancers include tobacco and dietary factors. The most important and best-established lifestyle-related risk factors include: overweight/obesity, cured (processed) meats, diets high in red meat, insufficient physical activity, diets low in vegetables and fruits, diets low in fiber, alcohol, and, indirectly, sugar intake.1 Table 1 lists the factors asked about in the survey and the percentage who answered “Yes” to being contributory to cancer. Table 1 also includes a rating of the actual cancer risk.

Chart 1:7

To Your Best Health,

Greg Steinke, MD, MPH


1.    2019 AICR Cancer Risk Awareness Survey. American Institute for Cancer Research. https://www.aicr.org/assets/can-prevent/docs/2019-Survey.pdf

2.    Lifestyle Cancer Risks: Separate cancer myth from cancer fact. American Institute for Cancer Research. Last updated: December 13, 2022. https://www.aicr.org/cancer-prevention/healthy-lifestyle/other-lifestyle-risks/#1579807959866-00d8c211-6932

3.    Diet, activity, and cancer. World Cancer Research Fund. https://www.wcrf.org/diet-activity-and-cancer/

4.    Nuclear power has no known increased cancer risk, while nuclear accidents are well-known to increase cancer risk. Those who work in nuclear power plants may have a small increased risk of leukemia. For a few examples of research on this see: Kim J, Bang Y, Lee WJ. Living near nuclear power plants and thyroid cancer risk: A systematic review and meta-analysis. Environ Int. 2016 Feb;87:42-8. Boice JD Jr, Cohen SS, Mumma MT, Hagemeyer DA, Chen H, Golden AP, Yoder RC, Dauer LT. Mortality from leukemia, cancer and heart disease among U.S. nuclear power plant workers, 1957-2011. Int J Radiat Biol. 2022;98(4):657-678.

5.    Viruses and bacteria that contribute to cancer include: hepatitis C, epstein-barr virus, human papilloma virus, etc.

6.    Michels N, Specht IO, Heitmann BL, Chajès V, Huybrechts I. Dietary trans-fatty acid intake in relation to cancer risk: a systematic review and meta-analysis. Nutr Rev. 2021 Jun 4;79(7):758-776. doi: 10.1093/nutrit/nuaa061. PMID: 34104953.

7.    Colditz GA et al. (2006) Epidemiology—identifying the causes and preventability of cancer?Nat. Rev. Cancer. 7: 2–9 doi:10.1038/nrc1784


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