Cancer is usually discussed in terms of treatment, the latest drugs, therapies and breakthroughs making headlines. There is less discussion of how much cancer risk is shaped long before any diagnosis, by the everyday choices, exposures and systems around us.
In this episode of the My Health Focus podcast, we explore that idea with Dr Adam Barsouk, an oncology fellow at Hopkins University in Baltimore and author of Outsmarting Cancer, who argues that as much as half of all cancers may be preventable, and asks why prevention still gets so little of our attention, funding or conversation.
This episode does not have video this week due to a recording issue on the day, so it is available as audio only.
Top 5 highlights from the conversation
1. Medicine has always treated cancer before trying to prevent it
Adam describes medicine as having spent decades in a symptom oriented, problem solution mode, reacting to cancer once it appears rather than addressing what leads to it. He points out that research funding has followed the same pattern, with smoking as the one major risk factor studied seriously for decades while other exposures went largely unexamined.
2. There is very little financial incentive to prevent cancer
Adam is direct about why prevention has lagged so far behind treatment. There are billions of pounds to be made in pharmaceuticals and targeted therapies, but very little incentive for anyone to profit from a cancer that never develops. He cites a figure of around five per cent of healthcare spending currently going into prevention, despite his estimate that prevention could address half of all cancer cases.
3. Smoking, obesity and alcohol remain the biggest known risk factors
Smoking is still the single largest contributor to cancer worldwide, according to Adam, with obesity close behind, driving chronic inflammation linked to cancers including breast, colorectal, stomach and lung cancer. Alcohol follows as the leading cause of liver cancer globally. Adam also raises less familiar exposures, including air pollution, ultra processed foods and microplastics, the last of which he says now accumulates in the body to the rough equivalent of a water bottle’s worth of plastic per person.
4. Cancer is increasingly appearing in younger, otherwise healthy people
Adam reports that cancer diagnoses in patients under fifty have more than doubled over the past thirty years, the fastest growing diagnostic group. He describes seeing patients in their thirties and forties, by his account in excellent health and training for marathons, presenting with cancers once associated almost exclusively with people decades older, a pattern he believes points to emerging risk factors still poorly understood.
5. Stigma shapes who gets blamed, and who gets research funding
Adam makes the point that an increasing number of his lung cancer patients have never smoked, yet the association with blame persists strongly enough that he believes it affects research investment too, with lung and liver cancers receiving comparatively less funding than cancers such as breast cancer. He argues that addiction itself is a medical condition rather than a simple choice, shaped by decades of aggressive marketing aimed disproportionately at people with lower income and education.
Final Thoughts
What Adam’s work points to is a persistent gap between how much is known about what drives cancer risk and how little of our collective effort, in funding, in public health messaging, in how patients are treated, has caught up with that knowledge. For anyone living with a cancer diagnosis, or supporting a loved one through one, closing that gap matters as much at a policy level as it does at an individual one.
About the expert
Adam Barsouk, MD is an oncology fellow and researcher at Johns Hopkins University, a graduate of the Hospital of the University of Pennsylvania, and author of the new release Outsmarting Cancer: Risk Reduction and the Power of Prevention. Dr. Barsouk has authored over 70 peer-reviewed publications and abstracts on cancer epidemiology and treatment, and his articles have been featured in major newspapers such as Forbes, The Wall Street Journal, The Daily Mail and more.
Read the first chapter of Dr Adam’s book ‘Outsmarting Cancer’.
Medical disclaimer
This content is for general information only and is not a substitute for professional medical advice. Always consult your GP or a qualified healthcare professional if you have any concerns about your health.