Preventing Cancer: The Seven Essentials

Raymond N. DuBois, MD, PhD, FAACR

To learn more about cancer prevention and risk reduction, we talked to Raymond N. DuBois, MD, PhD, FAACR, co-editor in chief of the American Association for Cancer Research (AACR)’s journal Cancer Prevention Research and Dean of the College of Medicine at the Medical University of South Carolina. 

Dr. DuBois is internationally renowned for his research on the role of inflammation in the progression of colorectal cancer. He was elected a Fellow of the AACR Academy in the inaugural class of 2013 for his groundbreaking research and was named a member of the National Academy of Medicine in 2019.  He currently directs the Hollings Cancer Center in Charleston, South Carolina. 

Dr. Dubois is the Chair and President of the AACR Foundation and was the 2008-2009 AACR President.

AACR: What are the key things people can do to prevent cancer?

Dr. DuBois: There are at least seven nuggets of advice that physicians working in cancer prevention give their patients and others about decreasing their risk for cancer:

  • First of all, don’t use tobacco in any form whatsoever. Tobacco use not only causes lung cancer, but it is also associated with head and neck cancers and oral cancers. We’ve also discovered that tobacco use increases risk for colorectal, breast, and other cancers. So that’s number one.
  • Second, eat a healthy diet. That means eating the right proportions of meats, vegetables, and fruit and limiting your consumption of “junk food” – processed foods that contain large amounts of fat, salt, sugar, and additives. There are many different types of diets out there right now; the Mediterranean diet seems to be the healthiest and is very popular. People who consume healthy diets are less likely to develop colon, breast, and other cancers. 
  • The third recommendation is to maintain a healthy weight and be physically active.
  • Fourth, protect yourself from the sun. That could include not only sunscreen but proper clothing (including hats and sunglasses) if you’re out. People should avoid going outside during the times of the day when the sun is the strongest. The incidence of various types of skin cancers, including melanoma, increases with more direct sun exposure.
  • Fifth, get vaccinated. There are two particular vaccines that are important for cancer. The hepatitis B vaccine helps prevent liver cancer caused by that virus, and human papillomavirus, or HPV, vaccine prevents cervical cancer, head and neck cancer, and other types of cancer. 
  • Sixth, a recommendation we always give people that we see in clinics and health care centers is to avoid risky behaviors such as practicing unsafe sex and sharing needles.
  • And finally, it’s always a great idea to get regular medical care, such as routine physical exams and screenings for various types of cancers.

AACR: How should individuals assess their own particular risk?

Dr. DuBois: Well, obviously, you know if you’re eating poorly, or you’re not exercising at all, or you’re smoking, you know that’s going to increase your risk. But there are other areas I think people should also look into, especially with regard to their immediate family history. If a lot of cancer has appeared among your immediate ancestors, then that is a concern, and that needs to be looked into with the help of a genetic counselor or someone who can collect that information and determine whether there is a real familial risk. 

If you have a strong family history of cancer, especially if cancer appeared in relatives when they were at a younger age, it might indicate you should consider genetic testing. Genetic testing will determine if you’ve actually inherited a mutation in a gene that increases your lifetime risk for getting cancer. These are called familial cancer syndromes. Luckily, they don’t cause the majority of cancers, but they can occur up to 10 percent of the time, especially in colon cancer, but in other cancers as well. If you have a high incidence of cancer in your family history and find out you have inherited a particular mutation, you can then seek medical guidance about what to do next – to follow it vigilantly with routine exams, to begin a lifestyle change to lower your risk, or to actually undergo preventive and interceptive procedures. These are important individual choices that genetic counselors can assist with.

AACR: Suppose you’re healthy and you see your doctor once a year. What should you do at those visits?

Dr. DuBois: Before you leave your doctor’s office, just ask whether you should be getting any recommended cancer screenings, and if so, make sure your care provider receives all the data from any testing that is done.  

This also gives you a chance to have a discussion with your care provider and address any issues or concerns about your cancer risk. Again, the goal here is to prevent all cancer that can be prevented with our current technology. 

AACR: Is colonoscopy almost the ultimate form of prevention because you can actually remove precancerous polyps? 

Dr. DuBois: Certainly, with regard to most colon cancers there is a process whereby cancer develops from precancerous “adenomas” that can transform into malignant cells if left alone. What happens is once a polyp (called an adenoma) is detected during a colonoscopy, your gastroenterologist can simply remove it during the procedure. Your provider will then send the tissue to the pathology lab to determine whether any cancer cells are present. If all cells in the lesion are benign, or if all the malignant cells are contained within the polyp, then that individual’s chance of getting colorectal cancer has been significantly reduced by removing those premalignant lesions from the colon. This is a good example of a way to intercept the cancerization process before it is allowed to develop and spread to other parts of your body.

AACR: What proportion of cancers could be prevented if people did all the recommended screenings? 

Dr. DuBois: It’s estimated that 30 to 50 percent of cancers could be prevented if people who are at risk for cancer modified or avoided key risk factors and underwent evidence-based prevention strategies, such as various cancer screenings. The cancer burden can also be reduced significantly by earlier detection and better management of patients who develop cancer.

It was estimated in 2020 that more than 600,000 people died from cancer in the U.S.  If we could prevent 40 percent of cancer deaths, which could amount to almost a quarter of a million people a year, it would have a tremendous impact on our health system, our economy, and the lives of our families and loved ones. So, I hope more people will become advocates and practitioners of cancer prevention strategies, because rarely in medicine do we see something that has such an enormous “bang for the buck.”

For more on cancer prevention, please see this 2021 Forecast post on the AACR’s Cancer Research Catalyst blog in which Dr. DuBois discusses Cancer Prevention and Early Detection.

“The payoffs of cancer prevention are huge,” Dr. DuBois said. 

Test your knowledge and learn more about cancer risk reduction, take the AACR’s Cancer Prevention Quiz here