Evaluation of tobacco and obesity associated cancer burden in turkey using population attributable fraction and geographical information system

Cancers are ranked second most common cause of mortality in our country. Consumption of tobacco products and obesity are among the primary risk factors for cancer progression. This study aimed to calculate the proportions of cancers that are attributable to these risk factors, and to evaluate the national risk map by assessing the geographical distributions of these cases. The prevalence of tobacco use and obesity that required for calculation of PAFs were obtained from the National Burden of Disease and Cost Effectiveness Study – 2003 report. Additionally, the estimated prevalence of tobacco smoking also derived from the incident cases according to Peto-Lopez method. The incidences of tobacco and obesity-associated cancers were obtained from the Turkish Cancer Statistics – 2016 report of the Turkish Ministry of Health, and Cancer Incidence in Five Continents – Volume XI report of the International Association for Cancer Research and International Association of Cancer Registries. The relative risks for tobacco and obesity on cancer progression were obtained from the United States Cancer Prevention Study – II data and World Cancer Research Fund reports. Using these different incidence and prevalence data, four different PAF models were calculated for tobacco-associated cancers, and two different PAF models were calculated for obesity-associated cancers, which were used for the Geographical Information System Analyses in ArcGIS Pro software (Esri Inc., USA). Areal interpolation and Anselin's Local Moran I statistics was used in GIS analyses. The proportions of PAFs for smoking-associated cancers ranged between 54.2-61.9% in men and 23.2%-30.6% in women. The PAFs for obesity associated cancers ranged between 22%-22.4% in men and 23.7%-24.3% in women. Geographical distribution patterns revealed deceased PAFs in tobacco-associated cancers for esophageal and lung cancers in east and southeast, and oral cavity and pharynx cancers in east in men; esophageal cancers in east, lung cancers in west and northwest, gastric cancers in east, oral cavity and pharynx cancers in east in women. Decreased PAFs were found for obesity-associated cancers in east for colon cancer in men, and in east and northeast for postmenopausal breast cancer in women.