AHS Cancer Study - July 2015

Cancer Incidence Attributable to Modifiable Risk Factors in
Alberta, Canada in 2012
FINAL REPORT
Produced by the Department of Cancer Epidemiology and Prevention Research

for the Alberta Cancer Prevention Legacy Fund
Dr. Anne Grundy, Postdoctoral Fellow (Epidemiology)

Abbey Poirier, Epidemiology Research Associate
Farah Khandwala, Statistical Analyst
Dr. Christine Friedenreich, Scientific Leader
Dr. Darren Brenner, Research Scientist
July 10, 2015
Table of Contents
EXECUTIVE SUMMARY ............................................................................................................................. 3
GENERAL INTRODUCTION........................................................................................................................ 6
CHAPTER 1
Cancer Incidence Attributable to Active and Passive Tobacco Exposure in Alberta, Canada
in 2012 ............................................................................................................................ 16
1.1
Cancer Incidence Attributable to Active Tobacco Smoking in Alberta, Canada in 2012

.............................................................................................................................. 23
1.2
Cancer Incidence Attributable to Passive Tobacco Exposure in Alberta, Canada in

2012....................................................................................................................... 55
CHAPTER 2
Cancer Incidence Attributable to Overweight and Obesity in Alberta, Canada in 2012 ...... 62
CHAPTER 3
Cancer Incidence Attributable to Inadequate Physical in Alberta, Canada in 2012 ............ 92
CHAPTER 4
Cancer Incidence Attributable to Alcohol Consumption in Alberta, Canada in 2012 ........ 112
CHAPTER 5
Cancer Incidence Attributable to Insufficient Fruit and Vegetable Consumption in Alberta,

Canada in 2012 .............................................................................................................. 126
CHAPTER 6
Cancer Incidence Attributable to Red and Processed Meat Consumption in Alberta,

Canada in 2012 .............................................................................................................. 155
CHAPTER 7
Cancer Incidence Attributable to Insufficient Fibre Consumption in Alberta, Canada in

2012 .............................................................................................................................. 192
CHAPTER 8
Cancer Incidence Attributable to Excess Salt Intake in Alberta, Canada in 2012 .............. 214
CHAPTER 9
Cancer Incidence Attributable to Suboptimal Vitamin D Intake in Alberta, Canada in 2012

...................................................................................................................................... 225
CHAPTER 10
Cancer Incidence Attributable to Insufficient Dietary Calcium Intake in Alberta, Canada in

2012 .............................................................................................................................. 259
CHAPTER 11 Cancer Incidence Attributable to Oral Contraceptive Pills and Hormone Replacement
Therapy Use in Alberta, Canada in 2012......................................................................... 275
CHAPTER 12 Cancer Incidence Attributable to Infections in Alberta, Canada in 2012 ......................... 295
CHAPTER 13 Cancer Incidence Attributable to Ultraviolet Light Exposure in Alberta, Canada in 2012 309
CHAPTER 14 Cancer Incidence Attributable to PM2.5 Air Pollution in Alberta, Canada in 2012 ............ 318
CHAPTER 15 Lung Cancer Incidence Attributable to Radon Exposure in Alberta, Canada in 2012 ....... 326
CHAPTER 16 Bladder Cancer Incidence Attributable to Disinfection By-Products in Drinking Water in
Alberta, Canada in 2012 ................................................................................................ 334
CHAPTER 17 Justification for Risk Factor Removal or Omission from ACPLF PAR-Alberta Project ........ 340
CHAPTER 18 Summary ....................................................................................................................... 345
APPENDIX A Additional Tables for Cancer Incidence Attributable to Alcohol Consumption in Alberta,
Canada in 2012 .............................................................................................................. 355
APPENDIX B
Additional Tables for Cancer Incidence Attributable to Insufficient Fruit and Vegetable
Consumption in Alberta, Canada in 2012 ....................................................................... 364
EXECUTIVE SUMMARY
Executive Summary
Cancer Incidence Attributable to Modifiable Risk Factors in Alberta, Canada in 2012 describes
the results of a project that the cancer burden attributable to 24 modifiable lifestyle and environmental
risk factors in the province of Alberta. The cancer risk factors included in this project were identified
through the International Agency for Research on Cancer (IARC) Monograph Series, the World Cancer
Research Fund (WCRF) Report and the peer-reviewed epidemiologic literature. The selected exposures
can be classified into the categories of tobacco consumption and exposure, environmental factors (air,
water and soil contaminants), infectious agents, hormone therapies, dietary intake characteristics and
energy imbalance. The population attributable risk (PAR) was used to provide an estimate of the
proportion of the cancer burden in Alberta that can be attributed to these 24 risk factors and therefore
represent the proportion of cancer that could theoretically be prevented by removal of the exposure in
the province. This is the first time that a comprehensive estimation of cancer burden associated with
these modifiable lifestyle and environmental risk factors, has been estimated in Alberta.
Three main types of data were required to estimate the individual PARs associated with each
risk factor at each relevant cancer site: the magnitude of the risk association between individual risk
factors and cancer sites; the prevalence (%) of the risk factor among adults in Alberta; and age-sex-sitespecific cancer incidence in Alberta in 2012. Risk estimates used to quantify the magnitude of the
association between risk factors and individual cancer sites were obtained from reports from
international collaborative groups (IARC, WCRF) and a review of the peer-reviewed epidemiologic
literature. Prevalence data for the risk factors of interest were obtained from Statistics Canada surveys,
publically available government databases, the published peer-reviewed literature and consultation with
relevant experts. Cancer incidence data for Alberta were obtained from the Alberta Cancer Registry for
the year 2012, the most recent year for which data were available. Risk estimate and prevalence data
were combined to provide estimates of the population attributable cancer risk for each risk factor and
these PAR estimates were combined with cancer incidence data to estimate the number of cases of each
cancer type that could be attributed to individual risk factors in 2012. PAR estimates for individual risk
factors were combined to estimate the overall proportion of cancer in Alberta in 2012 that could be
attributed to the full set of 24 modifiable risk factors.
Of the 24 modifiable risk factors included in this project, active tobacco consumption (15.7%),
physical inactivity (7.2%) and excess body weight (4.3%) were the leading causes of cancer in Alberta in
2012. Overall the 24 modifiable lifestyle and environmental risk factors examined here were together
responsible for 42.3% or 6,699 excess cases of incident cancer in 2012. Considering men and women
separately, 40.2% of cancers in men (3,278 cases) and 43.9% of cancers in women (3,372 cases) could be
attributed to the included risk factors. The cancer sites where the largest proportions of cancer
incidence could be explained by these 24 modifiable risk factors were cervix (100%), lung (85.1%), larynx
(81.4%), endometrium (80.1%) and esophagus (79.9%). Active tobacco smoking was the most important
risk factor for each of lung, laryngeal and esophageal cancers, whereas the burden of endometrial
cancer was most attributable to physical inactivity and excess body weight. The burden of cervical
cancer was entirely attributed to Human Papillomavirus (HPV) infection, as HPV infection is seen in all
cervical cancer cases and is required for the development of cervical cancer. Physical inactivity and
excess body weight were also leading causes of breast and colorectal cancers, which were two of the
most common types of cancer diagnosed in Alberta in 2012.
4
Among environmental exposures, natural UV exposure in relation to malignant melanoma and

residential radon in relation to lung cancer were the most important cancer risk factors in Alberta.
Specifically, the estimated proportion of malignant melanoma attributable to natural UV exposure
ranged from 13% (based on the proportion of Albertans reporting at least one sunburn over their
lifetime) to 82.1% (when comparing number of melanomas diagnosed on skin that is regularly
exposed/unexposed to sunlight), which corresponds to 0.5% - 3.1% of all cancers diagnosed in Alberta.
Residential radon exposure was responsible for 16.7% of lung cancers in Alberta, where these
proportions differed for ever and never smokers with an estimated 15.7% of lung cancers attributable to
radon exposure among ever smokers and 24.2% among never smokers. These estimates translated to
2.0% of all cancers diagnosed in Alberta when smoking status was not considered. While these
estimates suggest radon exposure is more important among never smokers, given that approximately
90% of lung cancers are diagnosed in ever smokers, the actual number of lung cancer cases attributable
to radon exposure among smokers is higher.
Overall, the findings of this project indicate that the risk factors responsible for the greatest
proportions of cancer in Alberta in 2012 (active tobacco consumption, physical inactivity, excess body
weight) represent important targets for cancer prevention. Second, the fact that all cases of cervical
cancer can be considered attributable to HPV infection highlights the importance of stopping the spread
of HPV infection. In particular, this emphasizes the potential cancer prevention benefits associated with
widespread uptake of the HPV vaccine. While the results of this project demonstrate the impact of
environmental risk factors on the overall cancer burden is smaller than for behavioural risk factors such
as smoking and physical inactivity, these risk factors are important in relation to individual cancer types.
Furthermore, the most important environmental risk factors (residential radon and UV exposure) may
be the most amenable to prevention activities. Finally, we estimate that approximately 40% of Albertas
cancer burden can be attributed to the 24 cancer risk factors included in this project. Given that these
are all potentially modifiable characteristics, changes in their prevalence towards levels associated with
minimal cancer risk have the potential to substantially influence the number of cancers diagnosed in
Alberta. As such, the findings of the project described in this report provide quantifiable estimates of the
impact of these cancer risk factors and will aid in setting priorities for cancer prevention.
GENERAL INTRODUCTION
GENERAL INTRODUCTION
Background and Rationale for the Population Attributable Risk Alberta Project
The population attributable risk (PAR) is a measure that can be used to estimate the proportions
and numbers of cases of cancer that can be attributed to an individual risk factor. This measure
corresponds to the theoretical proportion of cancers that could be prevented if an individual risk factor
was removed from the population. These PAR estimates can inform public health planning and cancer
prevention programs by identifying the risk factors that have the largest impact on cancer incidence.
To date, research that has attempted to estimate these PARs for modifiable risk factors for
cancer in Canada, and more specifically Alberta, has been limited. In 2009, the economic burden of
occupational cancers for Alberta was estimated, although no population based estimates for nonoccupational exposures were included in this effort [1]. In Canada there have been other risk factorspecific efforts to estimate population attributable cancer risks. Specifically, in 2014 Dr. Brenner
estimated that 3.5% of new cancer cases in Canada could be attributed to overweight/obesity and 7.9%
to physical inactivity [2]. Cancer Care Ontario has estimated that in Ontario, 15% of incident cancers
could be attributed to smoking [3], 2 4% to alcohol consumption [4] and 4% to overweight and obesity
[5]. Finally, there have been a number of efforts to estimate the proportion of lung cancer mortality that
could be attributed to residential radon exposure both for Canada [6-8] and Ontario [9], where
estimates range from 8% - 16% for Canada [6-8] and 13.6% for Ontario [9]. However, despite these
existing studies, no work has been done that focuses specifically on modifiable lifestyle and
environmental cancer risk factors for cancer outside of the occupational context in Alberta.
Outside of Canada, in 2010 Parkin et al. published a series of reports quantifying the burden of
cancer attributable to modifiable exposures in the United Kingdom [10-25]. These reports covered a
wide range of risk factors and overall estimated that exposure to less than optimum levels of the 14
risk factors included in the analysis was responsible for 42.7% of cancers in the United Kingdom in 2010,
with estimates of 45.3% for men and 40.1% for women [25]. To our knowledge, no similar systematic
assessment of the cancer burden in Alberta attributable to modifiable cancer risk factors has been
conducted.
Since information concerning the fraction of cancer attributable to individual risk factors is
important for both resource allocation and the implementation of population-based cancer prevention
strategies, additional research that quantifies the proportion of cancer attributable to individual cancer
risk factors in Alberta is needed. The Alberta Cancer Prevention Legacy Fund has a mandate to identify
cancer prevention priorities and implement preventive interventions across Alberta and PAR estimates
for modifiable cancer risk factors are needed to inform these activities. As such, the research described
7
in this report details the results of the Population Attributable Risk Alberta project, which was a
systematic effort to estimate the PAR associated with modifiable lifestyle and environmental cancer risk
factors in Alberta. Risk factors were selected for inclusion in this project on the basis of a literature
review of three main sources: 1) the International Agency for Research on Cancer (IARC) Monograph
Series; 2) the World Cancer Research Fund (WCRF) Report [26] and; 3) recent meta-analyses, large
prospective cohort studies and/or the current epidemiologic peer-reviewed literature. A complete list of
the risk factors included in the project described in the following chapters is found in Table I.1.
Evaluations of exposures occurring in an occupational setting were considered to be outside of the
scope of the project, as work quantifying the burden of cancer attributable to occupational exposures is
currently being conducted by the Occupational Cancer Research Centre at Cancer Care Ontario in
Toronto and their work will include Alberta-specific analyses (P. Demers, personal communication). The
data presented in the following chapters provides information on which modifiable risk factors make the
greatest contribution to Albertas cancer burden and quantifies the proportion of cancers in Alberta that
can be considered preventable.
Overview of Methods for the Population Attributable Risk Alberta Project
For all exposures included in the Population Attributable Risk Alberta project, three sources of
data were required to calculate population attributable risk (PAR) estimates: 1) the prevalence of the
exposure among adults in Alberta; 2) the magnitude of the risk association between the exposure and
cancer site and; 3) cancer incidence data for those cancer sites in Alberta.
Risk Estimates
A detailed literature review of reports from international collaborative groups (e.g. IARC, WCRF),
along with a review of the current peer-reviewed literature in PubMed was conducted to extract risk
estimates for each exposure and cancer site of interest. When risk estimates were available from
multiple sources, they were prioritized according the process described in Figure I.1. This strategy
assumed that risk estimates reflect biological relationships independent of the population of study, such
that results from populations outside of Alberta or Canada would be applicable to the Alberta
population. In the end this process produced a single risk estimate for each exposure/cancer site pair,
stratified by gender, which was used in the estimation of PARs.
Exposure Prevalence Data
Prevalence data for the exposures of interest were collected at the provincial level, as well as by
Alberta Health Services (AHS) Zone. Prevalence data were obtained from a search of: 1) results from
8
Statistics Canada surveys; 2) publically available government databases; 3) published peer-reviewed

literature; and 4) consultation with relevant experts. Data sources for estimation of exposure prevalence
were selected according to the hierarchy shown in Figure I.2.
Since the effect of exposure on cancer risk is assumed to be the product of previous exposure, a
biologically meaningful latency period was identified for all exposures from the peer-reviewed
epidemiologic literature. The average time between exposure and cancer diagnosis as assessed in highquality cohort studies was used to estimate an appropriate latency period. The quality of cohort studies
was evaluated based on the size of the cohort, methods of exposure assessment and follow-up time,
where large cohorts with detailed exposure and longer follow-up were considered to be of highest
quality. This latency information was then compared with the time period for which high-quality
exposure prevalence data were available. Where possible, prevalence estimates corresponding to the
midpoint of the range of potential latency periods identified from cohort studies were selected for
analysis. For example, if cohort studies identified potential latency periods as between nine and 13
years, exposure prevalence data incorporating an 11 year latency period were selected for analysis if
available. When high-quality prevalence data within the range of latency periods for a given exposure
could not be identified, the closest available estimates were used.
Cancer Incidence Data
Cancer incidence data for the year 2012 for Alberta were obtained from the Alberta Cancer
Registry and used for all exposures, as these are the most recent available data. Cases were classified
using the International Classification of Diseases for Oncology Third Edition (ICD-O-3) and the IARC rules
for determining multiple primary sites.
Estimation of Population Attributable Risks

To estimate the PARs, Equation 1 was used with various modifications depending on the
exposure of interest. Exposure specific methods are described in more detail in each individual chapter.
1: =
Pe = Prevalence of exposure
( 1)
1 + [ ( 1)]
RR = relative risk
The total number of attributable cancers at each site for each exposure were obtained by
multiplying the estimated PAR value by the total number of incident cancers at that site in 2012. Where
possible, PAR estimates and subsequent estimations of attributable cancers were stratified by age and
sex. Given the confidential nature of these data, any site-specific incident cancers with a total of less
than five cases were suppressed (displayed as <5). In addition, any numbers in tables in the following
chapters that would allow the calculation of incident cancer cases summing to less than five were also
suppressed.
REFERENCES
1.
Orenstein M, Chen J, Dall T, Curley P. The economic burden of occupational cancers in Alberta.
Calgary: 2009.
2.
Brenner DR. Cancer incidence due to excess body weight and leisure-time physical inactivity in
Canada: Implications for prevention. Preventive Medicine. 2014;66(0):131-9.
3.
Cancer Care Ontario. Cancer Risk Factors in Ontario: Tobacco. Toronto, Canada, 2014.
4.
Cancer Care Ontario. Cancer Risk Factors in Ontario: Alcohol. Toronto, Canada, 2014.
5.
Cancer Care Ontario. Cancer Risk Factors in Ontario: Healthy Weights, Healthy Eating and Active
Living. Toronto, Canada, 2015.
6.
Brand KP, Zielinski JM, Krewski D. Residential Radon in Canada: An Uncertainty Analysis of
Population and Individual Lung Cancer Risk. Risk Analysis. 2005;25(2):253-69.
7.
Chen J, Tracy BL. Canadian Population Risk of Radon Induced Lung Cancer. Canadian Journal of
Respiratory Therapy. 2005;41:19-27.
8.
Chen J, Moir D, Whyte J. Canadian population risk of radon induced lung cancer: a re-assessment
based on the recent cross-Canada radon survey. Radiation Protection Dosimetry. 2012;152(1-3):913.
9.
Peterson E, Aker A, Kim J, Li Y, Brand K, Copes R. Lung cancer risk from radon in Ontario, Canada:
how many lung cancers can we prevent? Cancer Causes Control. 2013;24(11):2013-20.
10. Parkin DM. 1. The fraction of cancer attributable to lifestyle and environmental factors in the UK in
2010. Br J Cancer. 2011;105 Suppl 2:S2-5.
11. Parkin DM. 2. Tobacco-attributable cancer burden in the UK in 2010. Br J Cancer. 2011;105(S2):S6S13.
12. Parkin DM, Boyd L. 4. Cancers attributable to dietary factors in the UK in 2010. Br J Cancer.
2011;105(S2):S19-S23.
10
13. Parkin D. 3. Cancers attributable to consumption of alcohol in the UK in 2010. British Journal of
Cancer. 2011;105:S14-S8.
14. Parkin DM. 5. Cancers attributable to dietary factors in the UK in 2010. Br J Cancer.
2011;105(s2):s24-S6.
15. Parkin DM, Boyd L. 6. Cancers attributable to dietary factors in the UK in 2010. Br J Cancer.
2011;105(S2):S27-S30.
16. Parkin DM. 7. Cancers attributable to dietary factors in the UK in 2010. Br J Cancer.
2011;105(S2):S31-S3.
17. Parkin DM, Boyd L. 8. Cancers attributable to overweight and obesity in the UK in 2010. Br J Cancer.
2011;105(S2):S34-S7.
18. Parkin DM. 9. Cancers attributable to inadequate physical exercise in the UK in 2010. Br J Cancer.
2011;105(S2):S38-S41.
19. Parkin DM. 10. Cancers attributable to exposure to hormones in the UK in 2010. Br J Cancer.
2011;105(S2):S42-S8.
20. Parkin DM. 11. Cancers attributable to infection in the UK in 2010. Br J Cancer. 2011;105(S2):S49S56.
21. Parkin DM, Darby SC. 12. Cancers in 2010 attributable to ionising radiation exposure in the UK. Br J
Cancer. 2011;105(S2):S57-S65.
22. Parkin DM, Mesher D, Sasieni P. 13. Cancers attributable to solar (ultraviolet) radiation exposure in
the UK in 2010. Br J Cancer. 2011;105(S2):S66-S9.
23. Parkin DM. 14. Cancers attributable to occupational exposures in the UK in 2010. Br J Cancer.
2011;105(S2):S70-S2.
24. Parkin DM. 15. Cancers attributable to reproductive factors in the UK in 2010. Br J Cancer.
2011;105(S2):S73-S6.
25. Parkin DM, Boyd L, Walker LC. 16. The fraction of cancer attributable to lifestyle and environmental
factors in the UK in 2010. Br J Cancer. 2011;105 Suppl 2:S77-81.
26. World Cancer Research Fund/American Institute for Cancer Research. Food, Nutrition, Physical
Activity, and the Prevention of Cancer: a Global Perspective. Washington, DC: AICR, 2007.
11
Table I.1. Exposure and Cancer Site Associations of Interest to be Included in this Project
Exposure
Cancer types consistently associated with

exposure
Tobacco Consumption and Exposure

Active exposure
Lung
Oral cavity and pharynx
Oesophagus
Stomach
Liver
Pancreas
Colorectum
Larynx
Cervix
Ovarian (mucinous)
Urinary bladder
Kidney
Acute myeloid leukemia
Passive exposure
Lung
Oesophagus
Larynx
Environmental factors (Air, Water, Soil Pollutants, Radiation)
Air pollution
PM 2.5
Lung
Radon
Lung
UV Exposure
Melanoma
Disinfection byproducts
Bladder
Infectious agents
Human papillomavirus
Cervix
Vagina
Penis
Anus
Vulva
Oropharynx
Helicobacter Pylori
Stomach
Gastric mucosa-associated lymphoid tissue (MALT)
lymphoma.
Epstein Barr Virus
Hepatitis B Virus
Hepatitis C Virus
non-Hodgkin lymphoma
Hodgkin lymphoma
Burkitt's lymphoma
Nasopharyngeal carcinoma
Liver
Liver
12
Hormone therapies
Oral contraceptive use
Hormone Replacement Therapy
Breast
Endometrium
Ovary
Breast
Endometrium
Ovary
Dietary intake
Low vegetables intake
(non-starchy)
Low fruit intake
High Alcohol Intake
High red meat intake

High process meat intake
Low fibre intake
Low vitamin D (Plasma 25-hydroxyvitamin D)
High salt intake
Low dietary calcium intake
Energy Imbalance
Overweight/Obesity
2
(>25 kg/m )
Physical inactivity

Oesophagus
Stomach
Larynx
Oesophagus
Stomach
Larynx
Lung
Mouth
Pharynx
Larynx
Liver
Colorectum
Breast (pre & post-menopause)
Colorectum
Colorectum
Colorectum
Colorectum
Breast
Stomach
Colorectum
Breast (post-menopausal)
Colorectum
Oesophagus (adenocarcinoma)
Kidney
Endometrium
Gall bladder
Pancreas
Breast (post-menopausal)
Colorectum
Endometrium
Lung
Ovary
Prostate
13
Risk Estimates from International Collaborative Panels

Risk Estimates from High Quality* Meta-Analyses (2005
2014)
Risk Estimates from High Quality* Pooled Analyses of
Large Prospective Studies (2005 2014)
No Pooled or Meta-Analysis Results Available
quantitatively combine results from individual high quality** cohort and

l di
*Quality determined using STrengthening the Reporting of OBservational
studies in Epidemiology (STROBE) guidelines for cohort and case-control
studies and Meta-analysis Of Observational Studies in Epidemiology (MOOSE)
guidelines for meta-analysis
Figure I.1. The Process flow employed for selecting risk estimates used in this project.
14
Alberta Health Services

CARcinogen Exposure (CAREX) a multi-institution research project dedicated to generating evidence
based carcinogen surveillance in Canada (www.carexcanada.ca)
3
The Tomorrow Project is a large prospective cohort study currently being conducted in Alberta to study
health outcomes including cancer. The project, which began in 2000, is recruiting adults aged 35 69
who will be followed for up to 50 years.
2
Figure I.2. The hierarchy for selection of exposure prevalence estimates
15
CHAPTER 1
Cancer Incidence Attributable to Active and Passive

Tobacco Exposure in Alberta, Canada in 2012
16
SUMMARY
The prevalence of current smokers in Alberta ranged from 12% - 31% in women and 14% - 40%
in men. The prevalence of former smokers ranged from 29% - 40% in women and 28% - 68% in men.
Approximately 78 % and 73% of lung cancer in men and women, respectively could be attributed to
current or former active tobacco smoking. Population attributable risk (PAR) estimates for the other
active tobacco-related cancer sites ranged from approximately 4% for ovarian cancer to 74% for
laryngeal cancer. Approximately 2% of incident lung cancers in never smoking men and women could be
attributed to passive tobacco exposure at home, in a vehicle or in a public place. Overall, approximately
37% of tobacco-related cancers in Alberta in 2012 were attributable to active tobacco smoking. This
equates to 16% of all incident cancers in Alberta in 2012 (Table 1.1).
METHODS OVERVIEW
Active and passive (second-hand smoke) tobacco exposures were analyzed independently using
separate data sources to calculate PARs of cancer in Alberta. These PAR estimates represent the
proportion of cancer at each individual cancer site that can be attributed to either active or passive
tobacco exposure. Three sources of data were required to calculate these PAR estimates: the prevalence
of active or passive tobacco smoking in Alberta, the magnitude of the relative risk (RR) between active
or passive tobacco smoking and the cancer sites of interest and cancer incidence data for those cancer
sites in Alberta. Data from the Canadian Community Health Survey (CCHS) were obtained for active and
passive tobacco exposure prevalence estimates. The cycle of the CCHS used corresponded to the
midpoint of the latency period suggested by cohort studies for each cancer site of interest (Table 1.2).
As Alberta Health Services zone data were not available for Cycle 1.1 (2000/2001) of the CCHS, PAR
calculations by zone for cancer sites using exposure data from Cycle 1.1 were performed using CCHS
Cycle 2.1 (2003), as this was the earliest date for which such data were available. The relative risks for
the associations between active and passive tobacco exposure and the cancer sites of interest are
shown in Table 1.3.
Active Tobacco Exposure
In the CCHS, current smokers are defined as those who smoked cigarettes daily or occasionally
at the time of the interview, while former smokers are those who did not smoke at the time of the
interview and had smoked more than 100 cigarettes in their lifetime. For the current analyses, active
smoking included both current and former smokers. Analyses for current and former smokers
separately were also completed. Never smokers were defined as those who did not smoke at the time of
the interview and had smoked less than 100 cigarettes in their lifetime. The proportions of Albertans
17
who were current or former smokers in 2000/2001 are shown in Table 1.1.1 and Figure 1.1.1.
Prevalence by Alberta health Services (AHS) Zone for the year 2003 are shown in Table 1.1.2 and Table
1.1.2.
PARs associated with active tobacco consumption were estimated according to equation 1.1:
1.1: =
( ) +
1 + ( ) +
where represents the prevalence of current smokers and represents the prevalence of
former smokers. Excess relative risks (ERRs) for both current and former smokers were calculated as the
RR 1. PARs were estimated using Equation 1.1 and then combined with cancer incidence data from the
year 2012 from the Alberta Cancer Registry for all included cancer sites to estimate the number of
excess attributable cancer cases. PAR estimates as well as the number of cancer cases attributable to
active tobacco smoking for each specific cancer site are shown in Table 1.1.3. PARs for active smoking
for each AHS zone are presented in Tables 1.1.4 1.1.8. PARs for current and former smoking exposure
separately are presented in Tables 1.1.9 and 1.1.10 respectively. Table 1.1.11 shows estimates of PAR
for Alberta similar to Table 1.1.3 including 95% confidence intervals to demonstrate the precision of our
estimates. For lung cancer specifically, the PARs and number of attributable cases are shown in Table
1.1.12, with results by AHS zone in Tables 1.1.13 1.1.17 and results for current and former smoking
separately in Table 1.1.18. The total number of cancer cases at each site attributable to active tobacco
smoking and other causes are shown in Figure 1.1.3.
Passive Tobacco Exposure
Data on the prevalence of passive smoking in never smokers were used for the current
analyses. Passive smokers (any exposure) were defined as those who were regularly exposed to tobacco
smoke in their home, a vehicle, or a public place. Prevalence and PAR estimates are also presented
separately for those exposed at home. The proportions of Albertans exposed to second-hand smoke are
shown in Table 1.2.1 (Figure 1.2.1) and by AHS zone in Table 1.2.2 (Figure 1.2.2).
PARs associated with passive tobacco exposure were estimated using Equation 1. To estimate
the cases of lung cancer attributable to passive tobacco exposure, an approximation of 10% of incident
lung cancer cases in the year 2012 from the Alberta Cancer Registry was used to represent the
proportion of lung cancer occurring in never smokers. This value was then multiplied by the PAR to
estimate the number of incident lung cancer cases attributable to passive tobacco exposure in Alberta in
18
2012. Estimates of PAR for Alberta as well as the number of lung cancer cases attributable to passive
tobacco exposure are shown in Table 1.2.3 and Table 1.2.4 by AHS Zone.
19
Table 1.1
Summary of cases and proportions of cancer in Alberta in 2012 attributable to active and passive tobacco exposurea
Exposure
Active
Tobacco
Smoking
Passive
Tobacco
Exposure
Cancer Site
Lung
Colorectum
Kidney
Pancreas
Oral Cavity and Pharynx
Bladder
Stomach
Liver
Ovary
Esophagus
Myeloid Leukemia
Cervix
Larynx
Total
Men
Women
Excess
Excess
Excess
Observed
%
Observed
%
Observed
%
Attributable
Attributable
Attributable
e
Casesc
Attributable
Cases
Attributable
Cases
Attributable
Casesd
Cases
Cases
1952
1475
75.6
953
739
77.5
999
733
73.4
1951
223
11.4
1105
141
12.7
846
85
10.1
482
95
19.7
326
69
21.1
156
28
18
379
73
19.3
171
36
20.9
208
37
17.7
373
159
42.6
273
123
45
100
39
38.7
354
147
41.6
280
125
44.7
74
28
37.8
255
53
20.9
158
36
23
97
18
18.9
217
57
26.4
148
42
28.6
69
17
24.1
189
7
3.6
189
7
3.6
183
83
45.4
151
73
48.1
32
14
42.8
176
22
12.3
99
14
13.8
77
8
10.8
132
34
25.9
132
34
25.9
76
56
74.3
64
49
76.5
12
8
70.8
All Associated Cancers
6719
2485
37.0
3728
1446
38.8
2991
1056
35.3
All Cancers
15836
2485
15.7
8155
1446
17.7
7681
1056
13.7
139
2.4
69
2.3
70
2.4
139
2.4
69
2.3
70
2.4
Lung
f
All Cancersg
15836
3
8155
2
7681
2
a. Data on prevalence of tobacco exposure from the Canadian Community Health Survey. Current smokers are defined as those who smoked cigarettes daily or
occasionally at the time of the interview. Former smokers are those who did not smoke at the time of the interview and had smoked more than 100 cigarettes
in their lifetime. Passive smokers were defined as those who were regularly exposed to tobacco smoke in their home, a vehicle, or a public place.
b. Cancer incidence data for the year 2012 from the Alberta Cancer Registry.
c. Number of observed cancer cases in Alberta in 2012 at individual cancer sites.
d. Number of cancer cases at individual cancer sites that can be attributed to active/passive tobacco exposure.
e. Proportion of cancers at individual cancer sites attributable to active/passive tobacco exposure. Calculated as excess attributable cases/observed cases.
f. All associated cancers includes all cancers known to be associated with active or passive tobacco exposure (as listed in the current table).
g. All cancers includes all incident cancer cases in Alberta for all ages in 2012.
20
Table 1.2
Predetermined latency periods by cancer site and cycle of prevalence data used for active and
passive tobacco exposure
Exposure
Cancer site
Active tobacco
exposure
Lung
Oral Cavity and pharynx
Larynx
Esophagus
Stomach
Liver
Pancreas
Colorectum
Ovary
Cervix
Kidney
Myeloid Leukemia
Bladder
Lung
Passive tobacco
exposure
CCHS, Canadian Community Health Survey
Corresponding CCHS cycle (year)

1.1 (2000/2001)
1.1 (2000/2001)
3.1 (2005)
1.1 (2000/2001)
3.1 (2005)
1.1 (2000/2001)
1.1 (2000/2001)
1.1 (2000/2001)
1.1 (2000/2001)
4.1 (2007)
1.1 (2000/2001)
1.1 (2000/2001)
1.1 (2000/2001)
2.1 (2003)
21
Table 1.3
Relative risks of cancers for current and former active tobacco smokers compared to never smokers
Cancer site
Active tobacco
Lung
Oral Cavity and
pharynx
Larynx
Esophagus
Stomach
Liver
Pancreas
Colorectum
Ovary
Cervix
Kidney
Myeloid
Leukemia
Bladder
Passive tobacco
Lung
Period/place of
exposure
Men
Women
All
Source
Current
Former
Current
Former
Current
Former
Current
Former
Current
Former
Current
Former
Current
Former
Current
Former
Current
Former
Current
Former
Current
Former
Current
Former
Current
Former
9.9
2.52
1.7
1.8
1.6
1.4
1.2
1.6
2.8
-
7.6
2.3
1.4
1.5
1.7
1.1
1.2
1.1
1.1
2.2
1.3
1.4
2.7
-
9.0
3.8
3.6
1.2
7.0
4.6
2.5
2.0
1.6
1.3
1.6
1.5
1.7
1.2
1.2
1.2
1.5
1.2
1.1
1.3
2.8
1.7
Gandini et al., 2008
Ever exposed
Exposed at home
1.34
1.19

Tsoi et al., 2009
Hamajima et al., 2002
Kim et al., 2014
22
1.1
Cancer Incidence Attributable to Active Tobacco Smoking in Alberta,

Canada in 2012
23
Table 1.1.1
Prevalence of current smokers and former smokers in Alberta, Canadian Community Health Survey,
2000-2001
Age (years)
Prevalence (95% CI)

Current Smokers
Former Smokers
Men
20-34
35-44
45-64
65
39.5 (36.1,42.9)
34.4 (30.8,37.9)
28.9 (25.9,31.9)
13.5 (10.5,16.5)
28.3 (25.5,31.2)
38.3 (35.0,41.7)
49.1 (45.5,52.6)
68.5 (64.2,72.7)
Women
20-34
35-44
45-64
65
31.0 (27.7,34.2)
29.7 (26.4,33.1)
26.0 (23.2,28.8)
12.4 (9.9,14.9)
28.5 (25.7,31.4)
35.1 (31.9,38.3)
40.1 (36.9,43.3)
38.7 (35.1,42.3)
35.4 (33.0,37.7)
32.1 (29.6,34.6)
27.5 (25.4,29.5)
12.9 (10.9,14.9)
28.4 (26.4,30.5)
36.7 (34.3,39.1)
44.6 (42.3,47.0)
52.2 (49.4,55.0)
Total
20-34
35-44
45-64
65
CI, confidence intervals
24
Table 1.1.2
Prevalence of current and former smokers in Alberta by health region (zone), Canadian Community Health Survey, 2003
Prevalence (95% CI)
South Zone
Age (years)
Calgary Zone
Central Zone
Edmonton Zone
North Zone
Current
Former
Current
Former
Current
Former
Current
Former
Current
Former
20-34
27.7
(18.6,36.9)
34.1
(25.3,42.9)
32.9
(26.4,39.5)
35.0
(28.2,41.9)
36.6
(28.9,44.4)
31.6
(23.9,39.4)
28.6
(20.9,36.3)
34.4
(26.2,42.5)
41.2
(34.2,48.3)
32.1
(25.8,38.4)
35-44
40.8
(27.0,54.5)
42.7
(29.0,56.1)
23.1
(15.7,30.5)
45.0
(37.1,53.0)
28.6
(20.6,36.6)
45.9
(36.7,55.1)
28.0
(19.3,36.6)
40.2
(31.2,49.2)
39.3
(31.2,47.3)
38.9
(31.2,46.7)
45-64
26.2
(18.4,34.1)
49.1
(40.0,58.3)
20.2
(13.8,26.6)
55.7
(48.2,63.2)
30.2
(23.7,36.6)
49.0
(41.5,56.4)
28.9
(22.8,34.9)
49.7
(42.3,57.0)
26.9
(22.2,31.7)
50.1
(43.9,56.3)
65
13.0
(6.9,19.1)
69.0
(59.8,78.2)
13.3
(6.9,19.7)
65.3
(56.4,74.3)
9.5
(5.0,14.0)
76.8
(70.7,83.0)
10.0
(4.4,15.6)
73.8
(65.4,82.1)
12.6
(7.0,18.3)
74.3
(66.8,81.9)
20-34
21.9
(15.4,28.5)
40.1
(30.9,49.2)
23.3
(17.6,29.1)
34.7
(28.7,40.7)
30.5
(24.3,36.7)
28.4
(22.2,34.7)
30.7
(24.4,37.0)
26.5
(20.8,32.1)
28.5
(23.3,33.8)
35.4
(29.3,41.5)
35-44
34.5
(22.2,46.8)
37.6
(23.9,51.4)
21.2
(15.0,27.5)
39.8
(31.7,47.8)
31.1
(21.3,40.8)
35.3
(25.8,44.8)
26.1
(16.8,35.3)
39.1
(28.6,49.5)
32.4
(24.6,40.1)
39.6
(31.4,47.8)
45-64
19.1
(12.9,25.3)
33.8
(25.8,41.9)
16.4
(11.4,21.3)
45.4
(38.6,52.1)
28.3
(22.9,33.7)
44.8
(39.2,50.4)
19.1
(13.8,24.4)
38.3
(31.4,45.2)
24.5
(19.8,29.3)
51.8
(45.8,57.8)
65
8.6
(4.4,12.8)
30.7
(23.3,38.0)
10.3
(5.6,15.0)
46.6
(38.3,54.8)
12.8
(8.0,17.5)
32.7
(26.8,38.7)
13.8
(6.8,20.8)
40.4
(32.7,48.1)
12.0
(7.1,16.9)
39.9
(31.8,48.0)
20-34
25.1
(19.3,30.9)
36.8
(30.4,43.1)
28.2
(24.0,32.4)
34.9
(30.3,39.4)
33.6
(28.9,38.3)
30.0
(25.1,35.0)
29.6
(24.1,35.1)
30.4
(25.4,35.4)
35.1
(30.7,39.5)
33.7
(29.3,38.1)
35-44
37.4
(28.5,46.3)
40.0
(30.4,49.7)
22.2
(17.1,27.3)
42.5
(36.8,48.2)
29.8
(23.5,36.0)
40.8
(34.2,47.5)
27.0
(20.6,33.5)
39.6
(32.8,46.5)
35.9
(30.4,41.3)
39.3
(33.7,44.9)
45-64
22.7
(17.6,27.8)
41.5
(35.4,47.6)
18.3
(14.1,22.5)
50.6
(45.5,55.7)
29.3
(24.8,33.7)
46.9
(42.2,51.6)
24.0
(20.0,28.0)
44.0
(38.9,49.1)
25.8
(22.4,29.2)
50.9
(46.6,55.2)
65
10.6
(6.7,14.4)
47.9
(41.8,54.1)
11.6
(7.6,15.6)
54.9
(48.8,61.0)
11.3
(8.0,14.6)
53.3
(48.3,58.3)
12.1
(7.5,16.7)
55.1
(49.0,61.3)
12.3
(8.7,16.0)
57.1
(51.2,63.0)
Men
Women
Total
CI, confidence interval

25
Table 1.1.3
Age at
Exposure
Cancer cases and proportions attributable to active smoking in Alberta (2012)

Age at
Outcome
Lung
Obs.
PAR
Cases
EAC

Esophagus
Age at
Obs.
Age at
Obs.
PAR EAC
PAR
Outcome Cases
Outcome Cases
Stomach
Age at
Obs.
EAC
PAR
Outcome Cases
EAC
Age at
Outcome
Liver
Obs.
PAR
Cases
EAC
Men
20-34
30-44
13
79.8
10
30-44
24
51.6
12
30-44
<5
46.9
<5
25-39
23.9
30-44
<5
26.5
<5
35-44
45-54
51
79.3
40
45-54
62
48.8
30
45-54
21
47.7
10
40-49
<5
24.2
<5
45-54
20
27.6
45-64
55-74
558
78.7
439
55-74
153
45.4
69
55-74
89
48.4
43
50-69
74
23.9
18
55-74
92
28.7
26
65
75
331
75.2
249
75
34
32.0
11
75
37
47.6
18
70
77
22
17
75
34
29.1
10
Total
Total
953
739
Total
273
123
Total
< 152
< 76
Total
< 161
< 41
Total
< 151
20-34
30-44
76.6
30-44
12
45.9
30-44
<5
43.1
<5
25-39
19.7
30-44
<5
23.9
<5
35-44
45-54
76
77.1
59
45-54
14
45.2
45-54
<5
44.7
<5
40-49
13
21.9
45-54
25.3
45-64
55-74
574
76.3
438
55-74
42
42.5
18
55-74
20
44.5
50-69
29
21
55-74
43
25.5
11
65
75
341
67.6
231
75
32
28.0
75
36.9
70
50
16.8
75
18
20.6
Total
Total
999
733
Total
100
39
Total
32
14
Total
97
18
Total
< 72
20-34
30-44
21
78.4
16
30-44
36
49
18
30-44
<5
25-39
10
21.9
30-44
<5
25.2
35-44
45-54
127
78.3
99
45-54
76
47.1
36
45-54
< 26
46.2 < 15
40-49
< 18
23.1
<8
45-54
26
26.4
45-64
55-74
1132
77.6
878
55-74
195
44.0
86
55-74
109
46.6
51
50-69
103
22.5
24
55-74
135
27.1
37
65
75
672
71.5
481
75
66
29.8
20
75
44
42.2
19
70
127
19.3
25
75
52
24.7
14
Total
Total
1952
1475
Total
373
159
Total
< 184
< 90
Total
< 258
< 59
Total
< 218
< 47
Women
< 22
Total
45.2
57
EAC, excess attributable risk; Obs. Cases, observed cases; PAR, population attributable risk (%)
Notes:
Cases represent the total number of cases of each cancer type in 2012
PAR represents the proportion (%) of cancer cases attributable to active smoking
Excess attributable cases represent the number of cases attributable to active smoking in 2012
Results by zone are included in Tables 1.1.4-1.1.8
26
Table 1.1.3
Age at
Exposure
Continued
Pancreas
Age at
Obs.
PAR
Outcome Cases
EAC
Colorectum
Age at
Obs.
PAR
Outcome Cases
Larynx
Age at
Obs.
EAC
PAR
Outcome Cases
EAC
Age at
Outcome
Bladder
Obs.
PAR
Cases
EAC
Age at
Outcome
Kidney
Obs.
PAR
Cases
EAC
Men
20-34
30-44
<5
24.7
<5
30-44
37
11.5
25-39
30-44
30-44
28
21.6
35-44
45-54
19
23.6
45-54
125
12.1
15
40-49
76.4
45-54
16
46.9
45-54
56
21.5
12
45-64
55-74
83
22.5
19
55-74
605
12.8
77
50-69
37
76.9
28
55-74
147
46.4
68
55-74
188
21.4
40
65
75
65
17.9
12
75
338
13.1
44
70
21
75.8
16
75
117
42.3
49
75
54
19.4
11
Total
Total
< 172
< 40
Total
1105
141
Total
64
49
Total
280
125
Total
326
20-34
30-44
<5
21.2
<5
30-44
35
10.2
25-39
30-44
30-44
14
18.9
35-44
45-54
26
21.3
45-54
108
10.9
12
40-49
45-54
<5
43.8
<5
45-54
28
19.5
45-64
55-74
96
20.3
19
55-74
377
11
42
50-69
73.7
55-74
32
42.8
14
55-74
81
19.1
15
65
75
85
13.5
11
75
326
8.6
28
70
68.7
75
39
33.2
13
75
33
13.9
Total
Total
< 212
< 41
Total
846
85
Total
12
Total
< 76
< 32
Total
156
20-34
30-44
23
30-44
72
10.9
25-39
30-44
30-44
42
20.3
35-44
45-54
45
22.5
10
45-54
233
11.5
27
40-49
75.4
45-54
< 21
45.4
< 13
45-54
84
20.6
17
45-64
55-74
179
21.4
38
55-74
982
11.9
117
50-69
42
75.4
32
55-74
179
44.7
80
55-74
269
20.3
55
65
75
150
15.6
23
75
664
10.7
71
70
28
72.4
20
75
156
37.7
59
75
87
16.5
14
Total
Total
379
72
Total
1951
223
Total
76
56
Total
< 356
< 157
Total
482
69
Women
28
Total
95
27
Table 1.1.3
Age at
Exposure
Continued
Myeloid Leukemia
Age at
Obs.
PAR
Outcome
Cases
EAC
Age at
Outcome
Cervix
Obs.
Cases
PAR
EAC
Age at
Outcome
Ovary
Obs.
Cases
PAR
EAC
Men
20-34
30-44
10
10.1
35-44
45-54
15
11.8
45-64
55-74
47
13.7
65
75
27
16.5
Total
Total
99
20-34
30-44
9.5
25-39
49
25.3
12
30-44
15
3.4
35-44
45-54
13
10.8
40-49
30
28.3
45-54
41
3.7
45-64
55-74
27
11.6
50-69
38
27.7
11
55-74
85
3.8
65
75
28
10.4
70
15
18.3
75
48
Total
Total
77
Total
132
34
Total
189
20-34
30-44
19
9.8
25-39
49
25.3
12
30-44
15
3.4
35-44
45-54
28
11.3
40-49
30
28.3
45-54
41
3.7
45-64
55-74
74
12.7
50-69
38
27.7
11
55-74
85
3.8
65
75
55
13.2
70
15
18.3
75
48
Total
Total
176
22
Total
132
34
Total
189
14
Women
Total
28
Table 1.1.4
Age at
Exposure
Other cancer (not including lung cancer) cases observed in the South Zone health region (2012) and proportions attributable to active smoking
Age at
Obs.
PAR
Outcome Cases
Esophagus
Stomach
Age at
Obs.
Age at
Obs.
PAR
PAR
Outcome Cases
Outcome Cases
Liver
Age at
Obs.
PAR
Outcome Cases
Pancreas
Age at
Obs.
Outcome Cases
PAR
Colorectum
Age at
Obs.
Outcome Cases
PAR
Men
20-34
30-44
<5
43.6
30-44
25-39
30-44
30-44
30-44
10.5
35-44
45-54
53
45-54
40-49
45-54
45-54
<5
26.6
45-54
11
13.7
45-64
55-74
43.2
55-74
12
47.3
50-69
24.2
55-74
27.9
55-74
11
21.4
55-74
56
12.3
65
75
31.4
75
<5
47.5
70
12
21.5
75
<5
29.1
75
17.7
75
27
13.1
Total
Total
< 24
Total
< 17
Total
19
Total
< 12
Total
< 23
Total
99
20-34
30-44
<5
38.8
30-44
25-39
30-44
30-44
30-44
<5
10.4
35-44
45-54
<5
48.8
45-54
40-49
45-54
<5
27.4
45-54
23.6
45-54
13
12
45-64
55-74
<5
35.6
55-74
<5
38.8
50-69
<5
21.3
55-74
<5
21.4
55-74
16.3
55-74
45
65
75
21.6
75
30.8
70
14.2
75
16.6
75
10.4
75
20
6.8
Total
Total
<5
Total
<5
Total
< 14
Total
<5
Total
21
Total
< 83
20-34
30-44
<5
41.6
30-44
25-39
30-44
30-44
30-44
< 10
10.4
35-44
45-54
< 12
50.8
45-54
40-49
45-54
<5
28.8
45-54
< 10
25
45-54
24
12.8
45-64
55-74
< 11
39.7
55-74
< 17
43.4
50-69
< 12
22.8
55-74
< 12
24.8
55-74
19
18.9
55-74
101
10.7
65
75
26.4
75
<5
39.5
70
21
17.7
75
<5
22.7
75
15
13.8
75
47
9.7
Total
Total
24
Total
15
Total
< 33
Total
14
Total
< 44
Total
< 182
Women
Total
Obs. Cases, observed cases; PAR, population attributable risk (%)
Note: Estimates for lung cancer in the South Zone are shown in Table 1.13
29
Table 1.1.4
Age at
Exposure
Continued
Larynx
Age at
Obs.
PAR
Outcome Cases
Bladder
Kidney
Age at
Obs.
Age at
Obs.
PAR
PAR
Outcome Cases
Outcome Cases
Myeloid Leukemia
Age at
Obs.
PAR
Outcome Cases
Age at
Outcome
Cervix
Obs.
Cases
PAR
Age at
Outcome
Ovary
Obs.
Cases
PAR
Men
35-44
25-39
40-49
30-44
45-54
<5
50.7
30-44
45-54
<5
5
18.7
24.2
30-44
45-54
<5
<5
10.5
13.2
45-64
50-69
45
42.1
75
23
<5
20.6
19.4
55-74
75
13
10
55-74
70
77.3
-
55-74
65
<5
-
75
<5
<5
13.5
16.5
Total
Total
<5
Total
< 28
Total
31
Total
45-64
25-39
40-49
50-69
30-44
45-54
55-74
30-44
45-54
55-74
<5
<5
7
17.6
21.5
15.5
30-44
45-54
55-74
<5
9.8
25-39
40-49
50-69
6
<5
<5
24.3
33.4
30.6
30-44
45-54
55-74
<5
7
4.1
3.1
65
70
75
75
75
70
75
Total
Total
8
< 20
2.3
Total
0
11
17.5
Total
<5
5
8.3
Total
<5
12
10.8
Total
20-34
25-39
30-44
30-44
<5
18.2
30-44
<5
10.9
25-39
24.3
30-44
35-44
45-64
40-49
50-69
45-54
55-74
< 10 22.7
30 18.2
5
14.9
45-54
55-74
< 5 12.4
< 10 11.7
< 10 12.2
40-49
50-69
70
<5
<5
0
33.4
30.6
17.5
45-54
55-74
70
75.6
-
45-54
55-74
65
<5
-
75
<5
7
8
4.1
3.1
2.3
Total
11
Total
< 20
20-34
Women
20-34
35-44
Total
36.8
< 5 27.2
< 10
Total
75
< 5 48.7
18 41.2
< 15 34.7
75
Total
<5
Total
33
Total
Total
43
75
Total
12
30
Table 1.1.5
Age at
Exposure
Other cancer (not including lung cancer) cases observed in the Calgary Zone health region (2012) and proportions attributable to active smoking
Age at
Obs.
PAR
Outcome Cases
Esophagus
Stomach
Age at
Obs.
Age at
Obs.
PAR
PAR
Outcome Cases
Outcome Cases
Liver
Age at
Obs.
PAR
Outcome Cases
Pancreas
Age at
Obs.
Outcome Cases
PAR
Colorectum
Age at
Obs.
Outcome Cases
PAR
Men
20-34
30-44
35-44
45-54
45-64
55-74
65
75
Total
Total
10
19
47.6
40.3
30-44
73
8
110
38.2
31.5
55-74
<5
7
15
39.8
38.1
33.5
30-44
25.8
75
45-54
75
Total
<5
44.8
25-39
26 46.7
12 46.6
< 43
50-69
<5
<5
8
25-39
40-49
70
Total
<5
-
23.4
-
30-44
24
22
24 20.8
< 53
55-74
<5
<5
10
30-44
45-54
75
Total
<5
5
26.2
25.9
30-44
<5
5
22.7
19.5
30-44
39 27.9
10 28.3
< 59
55-74
32
27
< 69
19.5
17.4
55-74
<5
<5
17
30-44
7
37
18
16.4
30-44
13.5
75
Total
24
68
45-54
75
Total
10
39
11.4
11.3
190
110
349
12.3
12.6
17
46
116
9.8
10.2
10.3
9.5
Total
99
278
45-54
75
Total
Women
20-34
30-44
35-44
45-54
45-64
55-74
65
75
Total
Total
10
< 37
20-34
30-44
< 15
35-44
45-54
45-64
55-74
65
75
45-54
55-74
41.4
42.1
41.6
40-49
50-69
18.4
20.9
19.9
55-74
55-74
45-54
55-74
Total
Total
44.1
30-44
<5
43.9
25-39
21
30-44
24.8
30-44
<5
20.6
30-44
27
10.7
26
39.3
45-54
43.5
40-49
<5
21
45-54
< 10
25
45-54
12
18.8
45-54
85
10.8
88
18
36
28.4
55-74
34 44.3
< 17 42.5
50-69
34
38
21
19
55-74
25.9
25
55-74
75
69
51
18
15.3
55-74
75
56
19
75
306
209
11.3
10.9
Total
< 87
Total
< 137
Total
627
75
Total
9
22.2
< 36
45-54
< 5 38.8
< 23
70
14 17.4
< 29
45-54
23.1
23.9
23.9
75
Total
75
70
Total
Total
< 147
57
Total
Total
< 81
Note: Estimates for lung cancer in the Calgary Zone are shown in Table 1.1.14
31
Table 1.1.5
Age at
Exposure
Continued
Larynx
Age at
Obs.
PAR
Outcome Cases
Bladder
Kidney
Age at
Obs.
Age at
Obs.
PAR
PAR
Outcome Cases
Outcome Cases
Myeloid Leukemia
Age at
Obs.
PAR
Outcome Cases
Age at
Outcome
Cervix
Obs.
Cases
PAR
Age at
Outcome
Ovary
Obs.
Cases
PAR
Men
20-34
25-39
30-44
30-44
13
20.5
30-44
<5
11.0
35-44
40-49
<5
73.4
45-54
42.3
45-54
17
18.9
45-54
<5
12.5
45-64
50-69
13
75.1
55-74
42
43.1
55-74
70
19.6
55-74
18
14.4
65
70
74.7
75
44
41.4
75
23
18.9
75
15.8
Total
Total
< 26
Total
93
Total
123
Total
31
20-34
25-39
30-44
30-44
<5
17.2
30-44
<5
10.3
25-39
13
20.5
30-44
3.4
35-44
40-49
45-54
<5
39.8
45-54
11
17.3
45-54
11.2
40-49
13
23.1
45-54
13
3.5
45-64
50-69
<5
72.7
55-74
13
38.2
55-74
26
16.6
55-74
12.1
50-69
17
22.8
55-74
35
3.6
65
70
<5
69.6
75
11
34.1
75
12
14.5
75
12
11.9
70
20.8
75
15
3.3
Total
Total
Total
< 29
Total
< 54
Total
< 35
Total
47
Total
69
20-34
25-39
73.2
30-44
30-44
< 18
19.0
30-44
10.7
25-39
13
20.5
30-44
3.4
35-44
40-49
<5
73.4
45-54
< 12
41.1
45-54
28
18.1
45-54
< 14
11.9
40-49
13
23.1
45-54
13
3.5
45-64
50-69
< 18
74.0
55-74
55
40.8
55-74
96
18.1
55-74
27
13.3
50-69
17
22.8
55-74
35
3.6
65
70
< 13
72.1
75
55
37.5
75
35
16.5
75
17
13.7
70
20.8
75
15
3.3
Total
Total
27
Total
< 122
Total
< 177
Total
< 65
Total
47
Total
69
Women
Total
32
Table 1.1.6
Age at
Exposure
Other cancer (not including lung cancer) cases observed in the Central Zone health region (2012) and proportions attributable to active smoking
Age at
Obs.
PAR
Outcome Cases
Esophagus
Stomach
Age at
Obs.
Age at
Obs.
PAR
PAR
Outcome Cases
Outcome Cases
Liver
Age at
Obs.
PAR
Outcome Cases
Pancreas
Age at
Obs.
Outcome Cases
PAR
Colorectum
Age at
Obs.
Outcome Cases
PAR
Men
20-34
30-44
<5
49.9
30-44
<5
46.7
25-39
<5
23.2
30-44
26.5
30-44
30-44
11.5
35-44
45-54
10
45.0
45-54
<5
47.4
40-49
45-54
<5
27.8
45-54
<5
22.0
45-54
20
12.3
45-64
55-74
16
46.4
55-74
12
48.9
50-69
25.0
55-74
29.0
55-74
23.1
55-74
87
12.9
65
75
<5
27.7
75
48.3
70
11
21.6
75
<5
30.0
75
11
17.0
75
51
13.6
Total
Total
29
Total
19
Total
< 25
Total
14
Total
< 23
Total
163
20-34
30-44
<5
45.5
30-44
25-39
30-44
<5
23.7
30-44
30-44
35-44
45-54
<5
46.3
45-54
40-49
<5
25.8
45-54
45-54
<5
22.0
45-54
11.2
45-64
55-74
<5
44.7
55-74
47.0
50-69
<5
24.0
55-74
27.4
55-74
11
21.8
55-74
54
12.1
65
75
<5
27.9
75
<5
34.6
70
<5
17.2
75
<5
18.8
75
14
12.9
75
56
7.8
Total
Total
10
Total
< 10
Total
Total
Total
< 30
Total
115
20-34
30-44
<5
47.8
30-44
<5
44.8
25-39
<5
22.3
30-44
<5
25.1
30-44
30-44
10.8
35-44
45-54
< 15
45.6
45-54
<5
46.4
40-49
<5
25.9
45-54
<5
26.8
45-54
22.0
45-54
25
11.7
45-64
55-74
< 21
45.6
55-74
17
48.0
50-69
< 14
24.5
55-74
14
28.3
55-74
18
22.5
55-74
141
12.5
65
75
< 10
27.9
75
< 10
41.8
70
< 16
19.4
75
24.5
75
25
14.9
75
107
10.6
Total
Total
39
Total
26
Total
< 35
Total
21
Total
49
Total
278
Women
Total
Note: Estimates for lung cancer in the Central Zone are shown in Table 1.1.15
33
Table 1.1.6
Age at
Exposure
Continued
Larynx
Age at
Obs.
PAR
Outcome Cases
Bladder
Kidney
Age at
Obs.
Age at
Obs.
PAR
PAR
Outcome Cases
Outcome Cases
Myeloid Leukemia
Age at
Obs.
PAR
Outcome Cases
Age at
Outcome
Cervix
Obs.
Cases
PAR
Age at
Outcome
Ovary
Obs.
Cases
PAR
Men
20-34
25-39
30-44
30-44
<5
21.2
30-44
<5
10.6
35-44
40-49
<5
78.2
45-54
<5
45.6
45-54
10
20.9
45-54
<5
13.0
45-64
50-69
<5
77.7
55-74
18
47.0
55-74
21
21.8
55-74
<5
13.8
65
70
<5
75.6
75
16
41.9
75
11
19.4
75
<5
17.8
Total
Total
Total
< 39
Total
< 47
Total
10
20-34
25-39
30-44
30-44
<5
18.7
30-44
<5
9.4
25-39
27.6
30-44
35-44
40-49
45-54
<5
44.6
45-54
<5
20.0
45-54
<5
11.0
40-49
<5
32.5
45-54
3.8
45-64
50-69
55-74
<5
45.2
55-74
13
20.6
55-74
12.8
50-69
33.0
55-74
10
4.2
65
70
<5
69.3
75
31.6
75
12.9
75
<5
9.1
70
<5
18.8
75
2.7
Total
Total
<5
Total
11
Total
24
Total
15
Total
17
Total
24
20-34
25-39
30-44
30-44
20.0
30-44
10.0
25-39
27.6
30-44
35-44
40-49
<5
78.3
45-54
<5
45.1
45-54
< 15
20.4
45-54
<5
12.0
40-49
<5
32.5
45-54
3.8
45-64
50-69
<5
77.2
55-74
< 23
46.1
55-74
34
21.2
55-74
< 12
13.3
50-69
33.0
55-74
10
4.2
65
70
<5
72.6
75
22
36.9
75
16
16.1
75
13.4
70
<5
18.8
75
2.7
Total
Total
< 12
Total
46
Total
< 71
Total
25
Total
17
Total
24
Women
Total
34
Table 1.1.7
Age at
Exposure
Other cancer (not including lung cancer) cases observed in the Edmonton Zone health region (2012) and proportions attributable to active smoking
Age at
Obs.
PAR
Outcome Cases
Esophagus
Stomach
Age at
Obs.
Age at
Obs.
PAR
PAR
Outcome Cases
Outcome Cases
Liver
Age at
Obs.
PAR
Outcome Cases
Pancreas
Age at
Obs.
Outcome Cases
PAR
Colorectum
Age at
Obs.
Outcome Cases
PAR
Men
20-34
30-44
44.3
30-44
<5
43.9
25-39
<5
24.5
30-44
<5
24.7
30-44
30-44
10
10.6
35-44
45-54
22
44.2
45-54
13
45.5
40-49
<5
25.8
45-54
26.1
45-54
21.2
45-54
35
11.4
45-64
55-74
43
45.4
55-74
32
48.6
50-69
27
24.9
55-74
28
28.8
55-74
21
22.6
55-74
206
12.8
65
75
12
28.0
75
13
47.6
70
22
23.0
75
29.5
75
15
16.9
75
109
13.3
Total
Total
86
Total
< 63
Total
53
Total
< 50
Total
44
Total
360
20-34
30-44
<5
45.6
30-44
25-39
<5
18.5
30-44
30-44
<5
20.8
30-44
12
9.8
35-44
45-54
42.6
45-54
40-49
20.1
45-54
45-54
20.2
45-54
33
10.9
45-64
55-74
22
35.9
55-74
40.5
50-69
19.9
55-74
16
22.8
55-74
31
16.8
55-74
114
9.7
65
75
14
29.9
75
<5
38.4
70
17
16.5
75
21.6
75
31
14.5
75
125
9.1
Total
Total
< 45
Total
< 10
Total
< 38
Total
22
Total
< 76
Total
284
20-34
30-44
< 14
44.9
30-44
<5
43.1
25-39
21.6
30-44
<5
23.9
30-44
<5
20.8
30-44
22
10.2
35-44
45-54
26
43.3
45-54
13
44.8
40-49
< 12
23.1
45-54
25.7
45-54
17
20.7
45-54
68
11.1
45-64
55-74
65
41.0
55-74
37
44.8
50-69
36
22.4
55-74
44
25.9
55-74
52
19.8
55-74
320
11.3
65
75
26
29.1
75
< 18
42.8
70
39
19.5
75
14
25.2
75
46
15.5
75
234
11.0
Total
Total
< 131
Total
68
Total
< 92
Total
< 72
Total
< 120
Total
644
Women
Total
Note: Estimates for lung cancer in the Edmonton Zone are shown in Table 1.1.16
35
Table 1.1.7
Age at
Exposure
Continued
Larynx
Age at
Obs.
PAR
Outcome Cases
Bladder
Kidney
Age at
Obs.
Age at
Obs.
PAR
PAR
Outcome Cases
Outcome Cases
Myeloid Leukemia
Age at
Obs.
PAR
Outcome Cases
Age at
Outcome
Cervix
Obs.
Cases
PAR
Age at
Outcome
Ovary
Obs.
Cases
PAR
Men
20-34
25-39
30-44
30-44
19.0
30-44
<5
10.6
35-44
40-49
<5
77.7
45-54
<5
44.0
45-54
16
19.7
45-54
11.8
45-64
50-69
12
77.7
55-74
56
46.5
55-74
52
21.5
55-74
15
13.8
65
70
76.5
75
37
41.5
75
13
19.1
75
13
17.2
Total
Total
< 25
Total
< 98
Total
87
Total
< 39
20-34
25-39
30-44
30-44
<5
18.4
30-44
<5
9.0
25-39
14
27.3
30-44
3.3
35-44
40-49
45-54
45-54
18.9
45-54
<5
11.4
40-49
26.8
45-54
12
3.8
45-64
50-69
<5
72.1
55-74
10
38.0
55-74
24
16.3
55-74
10.8
50-69
27.4
55-74
25
3.3
65
70
<5
68.4
75
15
34.9
75
14.7
75
10.8
70
18.5
75
14
3.1
Total
Total
<5
Total
25
Total
< 44
Total
19
Total
36
Total
56
20-34
25-39
30-44
30-44
< 11
18.7
30-44
<5
9.8
25-39
14
27.3
30-44
3.3
35-44
40-49
<5
75.2
45-54
<5
43.3
45-54
22
19.3
45-54
< 11
11.6
40-49
26.8
45-54
12
3.8
45-64
50-69
< 17
75.2
55-74
66
42.6
55-74
76
19.0
55-74
22
12.3
50-69
27.4
55-74
25
3.3
65
70
< 13
72.6
75
52
37.9
75
22
16.7
75
21
13.8
70
18.5
75
14
3.1
Total
Total
26
Total
< 123
Total
< 131
Total
< 58
Total
36
Total
56
Women
Total
36
Table 1.1.8
Age at
Exposure
Other cancer (not including lung cancer) cases observed in the North Zone health region (2012) and proportions attributable to active smoking
Age at
Obs.
PAR
Outcome Cases
Esophagus
Stomach
Age at
Obs.
Age at
Obs.
PAR
PAR
Outcome Cases
Outcome Cases
Liver
Age at
Obs.
PAR
Outcome Cases
Pancreas
Age at
Obs.
Outcome Cases
PAR
Colorectum
Age at
Obs.
Outcome Cases
PAR
Men
20-34
30-44
<5
52.8
30-44
25-39
30-44
30-44
<5
25.7
30-44
12.3
35-44
45-54
<5
51.9
45-54
<5
49.8
40-49
45-54
29.1
45-54
<5
25.7
45-54
20
12.9
45-64
55-74
15
43.9
55-74
47.9
50-69
25.9
55-74
28.4
55-74
12
21.8
55-74
66
12.6
65
75
31.4
75
48.8
70
23.6
75
30.3
75
18.2
75
41
13.7
Total
Total
28
Total
< 17
Total
15
Total
22
Total
19
Total
134
20-34
30-44
<5
44.3
30-44
25-39
30-44
30-44
30-44
<5
10.8
35-44
45-54
45-54
<5
47.2
40-49
<5
25.2
45-54
<5
27.3
45-54
<5
23
45-54
11
12.0
45-64
55-74
<5
42.0
55-74
<5
47.4
50-69
24.2
55-74
<5
28.1
55-74
20.9
55-74
48
12.5
65
75
<5
27.5
75
70
18.0
75
<5
20.8
75
13.5
75
26
8.7
Total
Total
Total
<5
Total
< 16
Total
Total
< 22
Total
< 90
20-34
30-44
49.1
30-44
25-39
24.7
30-44
26.6
30-44
<5
23.5
30-44
< 12
11.6
35-44
45-54
<5
49.8
45-54
<5
48.5
40-49
<5
25.9
45-54
< 10
28.2
45-54
<5
24.4
45-54
31
12.5
45-64
55-74
< 20
43.0
55-74
< 12
47.7
50-69
12
25.1
55-74
< 14
28.3
55-74
21
21.4
55-74
114
12.5
65
75
< 11
29.5
75
43.6
70
14
20.9
75
< 13
25.9
75
13
15.9
75
67
11.3
Total
Total
36
Total
17
Total
< 31
Total
29
Total
< 41
Total
< 224
Women
Total
Note: Estimates for lung cancer in the North Zone are shown in Table 1.1.17
37
Table 1.1.8
Age at
Exposure
Continued
Larynx
Age at
Obs.
PAR
Outcome Cases
Bladder
Kidney
Age at
Obs.
Age at
Obs.
PAR
PAR
Outcome Cases
Outcome Cases
Myeloid Leukemia
Age at
Obs.
PAR
Outcome Cases
Age at
Outcome
Cervix
Obs.
Cases
PAR
Age at
Outcome
Ovary
Obs.
Cases
PAR
Men
20-34
25-39
30-44
30-44
<5
22.7
30-44
<5
11.0
35-44
40-49
<5
78.3
45-54
<5
49.4
45-54
23.2
45-54
<5
12.3
45-64
50-69
78.6
55-74
18
45.6
55-74
22
21.0
55-74
13.8
65
70
<5
77.5
75
10
43.1
75
20.1
75
<5
17.5
Total
Total
10
Total
< 33
Total
< 40
Total
15
20-34
25-39
30-44
30-44
<5
19.1
30-44
<5
10.8
25-39
10
34.2
30-44
<5
3.7
35-44
40-49
45-54
45-54
21.1
45-54
40-49
37.9
45-54
4.1
45-64
50-69
<5
77.1
55-74
55-74
11
20.4
55-74
<5
13.9
50-69
<5
33.9
55-74
4.4
65
70
<5
70.5
75
<5
33.3
75
<5
14.0
75
<5
10.6
70
<5
24.9
75
<5
3.0
Total
Total
<5
Total
<5
Total
24
Total
Total
21
Total
22
20-34
25-39
30-44
30-44
< 10
21.1
30-44
<5
10.9
25-39
10
34.2
30-44
<5
3.7
35-44
40-49
<5
77.9
45-54
<5
47.9
45-54
14
22.2
45-54
<5
12.2
40-49
37.9
45-54
4.1
45-64
50-69
< 11
77.9
55-74
18
45.1
55-74
33
20.7
55-74
< 14
13.8
50-69
<5
33.9
55-74
4.4
65
70
<5
74.5
75
< 15
38.6
75
< 10
17.1
75
14.2
70
<5
24.9
75
<5
3.0
Total
Total
< 15
Total
34
Total
< 64
Total
20
Total
21
Total
22
Women
Total
38
Table 1.1.9
Age at
Exposure
Other cancer (not including lung cancer) cases observed in Alberta (2012) and proportions attributable to current smoking
Age at
Obs.
PAR
Outcome Cases
Esophagus
Stomach
Age at
Obs.
Age at
Obs.
PAR
PAR
Outcome Cases
Outcome Cases
Age at
Outcome
Liver
Obs.
PAR
Cases
Pancreas
Age at
Obs.
Outcome Cases
PAR
Colorectum
Age at
Obs.
Outcome Cases
PAR
Men
20-34
30-44
24
50.4
30-44
<5
37.2
25-39
17.7
30-44
<5
18.1
30-44
<5
21.7
30-44
37
7.3
35-44
45-54
62
46.9
45-54
21
34.0
40-49
<5
17.8
45-54
20
16.2
45-54
19
19.4
45-54
125
6.4
45-64
55-74
153
42.6
55-74
89
30.2
50-69
74
13.4
55-74
92
13.9
55-74
83
16.8
55-74
605
5.5
65
75
34
25.8
75
37
16.8
70
77
7.4
75
34
7.0
75
65
8.6
75
338
2.6
Total
Total
273
Total
< 152
Total
< 161
Total
< 151
Total
< 172
Total
1105
20-34
30-44
12
44.3
30-44
<5
31.7
25-39
12.9
30-44
<5
14.8
30-44
<5
17.8
30-44
35
5.8
35-44
45-54
14
43.3
45-54
<5
30.8
40-49
13
14.0
45-54
14.3
45-54
26
17.2
45-54
108
5.6
45-64
55-74
42
40.1
55-74
20
28.1
50-69
29
12.0
55-74
43
12.7
55-74
96
15.4
55-74
377
4.9
65
75
32
24.2
75
15.7
70
50
7.0
75
18
6.5
75
85
8.0
75
326
2.4
Total
Total
100
Total
32
Total
97
Total
< 72
Total
< 212
Total
846
20-34
30-44
36
47.6
30-44
34.7
25-39
10
15.4
30-44
<5
16.5
30-44
19.9
30-44
72
6.6
35-44
45-54
76
45.2
45-54
< 26
32.5
40-49
< 18
16.0
45-54
26
15.2
45-54
45
18.3
45-54
233
6.0
45-64
55-74
195
41.4
55-74
109
29.2
50-69
103
12.7
55-74
135
13.3
55-74
179
16.1
55-74
982
5.2
65
75
66
24.9
75
44
16.2
70
127
7.1
75
52
6.7
75
150
8.3
75
664
2.5
Total
Total
373
Total
< 184
Total
< 258
Total
< 218
Total
379
Total
1951
Women
Total

Notes:
PAR represents the proportion (%) of cancer cases attributable to current smoking
Results based on current smoking only
Estimates for lung cancer are shown in Table 1.1.18
39
Table 1.1.9
Age at
Exposure
Continued
Larynx
Age at
Obs.
PAR
Outcome Cases
Bladder
Kidney
Age at
Obs.
Age at
Obs.
PAR
PAR
Outcome Cases
Outcome Cases
Myeloid Leukemia
Age at
Obs.
PAR
Outcome Cases
Age at
Outcome
Cervix
Obs.
Cases
PAR
Age at
Outcome
Ovary
Obs.
Cases
PAR
Men
20-34
25-39
30-44
30-44
28
17.0
30-44
10
3.4
35-44
40-49
66.9
45-54
16
37.8
45-54
56
15.2
45-54
15
3.0
45-64
50-69
37
59.1
55-74
147
33.8
55-74
188
13.1
55-74
47
2.5
65
70
21
42.6
75
117
19.3
75
54
6.6
75
27
1.2
Total
Total
64
Total
280
Total
326
Total
99
20-34
25-39
30-44
30-44
14
13.9
30-44
2.7
25-39
49
20.8
30-44
15
1.8
35-44
40-49
45-54
<5
34.5
45-54
28
13.4
45-54
13
2.6
40-49
30
23.8
45-54
41
1.8
45-64
50-69
56.0
55-74
32
31.5
55-74
81
11.9
55-74
27
2.3
50-69
38
21.4
55-74
85
1.5
65
70
41.2
75
39
18
75
33
6.1
75
28
1.1
70
15
9.6
75
48
0.7
Total
Total
12
Total
< 76
Total
156
Total
77
Total
132
Total
189
20-34
25-39
30-44
30-44
42
15.5
30-44
19
3.1
25-39
49
20.8
30-44
15
1.8
35-44
40-49
64
45-54
< 21
36.2
45-54
84
14.3
45-54
28
2.8
40-49
30
23.8
45-54
41
1.8
45-64
50-69
42
57.7
55-74
179
32.7
55-74
269
12.5
55-74
74
2.4
50-69
38
21.4
55-74
85
1.5
65
70
28
41.8
75
156
18.6
75
87
6.3
75
55
1.1
70
15
9.6
75
48
0.7
Total
Total
76
Total
< 356
Total
482
Total
176
Total
132
Total
189
Women
Total
40
Table 1.1.10
Age at
Exposure
Other cancer (not including lung cancer) cases observed in Alberta (2012) and proportions attributable to former smoking

Age at
Obs.
PAR
Outcome Cases
Esophagus
Stomach
Age at
Obs.
Age at
Obs.
PAR
PAR
Outcome Cases
Outcome Cases
Liver
Age at
Obs.
PAR
Outcome Cases
Pancreas
Age at
Obs.
Outcome Cases
PAR
Colorectum
Age at
Obs.
Outcome Cases
PAR
Men
20-34
30-44
24
4.8
30-44
<5
22.6
25-39
9.0
30-44
<5
12.2
30-44
<5
4.8
30-44
37
4.8
35-44
45-54
62
6.4
45-54
21
28.3
40-49
<5
9.3
45-54
20
15.8
45-54
19
6.4
45-54
125
6.4
45-64
55-74
153
8.1
55-74
89
33.6
50-69
74
13.8
55-74
92
19.4
55-74
83
8.1
55-74
605
8.1
65
75
34
11
75
37
41.4
70
77
16.9
75
34
25.1
75
65
11
75
338
11.0
Total
Total
273
Total
< 152
Total
< 161
Total
< 151
Total
< 172
Total
1105
20-34
30-44
12
4.9
30-44
<5
22.7
25-39
8.9
30-44
<5
12.3
30-44
<5
4.9
30-44
35
4.9
35-44
45-54
14
5.9
45-54
<5
26.6
40-49
13
10.5
45-54
14.7
45-54
26
5.9
45-54
108
5.9
45-64
55-74
42
6.7
55-74
20
29.2
50-69
29
11.4
55-74
43
16.4
55-74
96
6.7
55-74
377
6.7
65
75
32
6.5
75
28.5
70
50
11.3
75
18
15.9
75
85
6.5
75
326
6.5
Total
Total
100
Total
32
Total
97
Total
< 72
Total
< 212
Total
846
20-34
30-44
36
4.9
30-44
22.6
25-39
10
8.9
30-44
<5
12.2
30-44
4.9
30-44
72
4.9
35-44
45-54
76
6.2
45-54
< 26
27.4
40-49
< 18
9.9
45-54
26
15.2
45-54
45
6.2
45-54
233
6.2
45-64
55-74
195
7.4
55-74
109
31.5
50-69
103
12.6
55-74
135
17.9
55-74
179
7.4
55-74
982
7.4
65
75
66
8.6
75
44
35.0
70
127
14
75
52
20.4
75
150
8.6
75
664
8.6
Total
Total
373
Total
< 184
Total
< 258
Total
< 218
Total
379
Total
1951
Women
Total

Notes:
PAR represents the proportion (%) of cancer cases attributable to former smoking
Results based on former smoking only
Estimates for lung cancer are shown in Table 1.1.18
41
Table 1.1.10
Age at
Exposure
Continued
Larynx
Age at
Obs.
PAR
Outcome Cases
Bladder
Kidney
Age at
Obs.
Age at
Obs.
PAR
PAR
Outcome Cases
Outcome Cases
Myeloid Leukemia
Age at
Obs.
PAR
Outcome Cases
Age at
Outcome
Cervix
Obs.
Cases
PAR
Age at
Outcome
Ovary
Obs.
Cases
PAR
Men
20-34
25-39
30-44
30-44
28
6.6
30-44
10
7.1
35-44
40-49
54.7
45-54
16
21.6
45-54
56
8.7
45-54
15
9.4
45-64
50-69
37
65.3
55-74
147
26.1
55-74
188
10.9
55-74
47
11.7
65
70
21
70.5
75
117
33
75
54
14.6
75
27
15.6
Total
Total
64
Total
280
Total
326
Total
99
20-34
25-39
30-44
30-44
14
6.7
30-44
7.1
25-39
49
7.1
30-44
15
1.7
35-44
40-49
45-54
<5
20.2
45-54
28
8.1
45-54
13
8.7
40-49
30
7.6
45-54
41
2.1
45-64
50-69
60.3
55-74
32
22.4
55-74
81
9.1
55-74
27
9.8
50-69
38
9.9
55-74
85
2.3
65
70
60.0
75
39
21.8
75
33
8.8
75
28
9.5
70
15
10.5
75
48
2.3
Total
Total
12
Total
< 76
Total
156
Total
77
Total
132
Total
189
20-34
25-39
30-44
30-44
42
6.6
30-44
19
7.1
25-39
49
7.1
30-44
15
1.7
35-44
40-49
56.4
45-54
< 21
20.9
45-54
84
8.4
45-54
28
9.0
40-49
30
7.6
45-54
41
2.1
45-64
50-69
42
63.0
55-74
179
24.3
55-74
269
10.0
55-74
74
10.7
50-69
38
9.9
55-74
85
2.3
65
70
28
65.6
75
156
27.3
75
87
11.5
75
55
12.4
70
15
10.5
75
48
2.3
Total
Total
76
Total
< 356
Total
482
Total
176
Total
132
Total
189
Women
Total
42
Table 1.1.11
Cancer cases observed in Alberta (2012) and proportions attributable to active smoking
Age at
Exposure
Age at
Outcome
Cancer Site
Total
Obs.
Cases
Total PAR
(95% CI)
20-34
30-44
30-44
30-44
25-39
30-44
30-44
30-44
25-39
25-39
30-44
30-44
30-44
30-44
Lung
Esophagus
Stomach
Liver
Pancreas
Colorectum
Larynx
Cervix
Ovary
Bladder
Kidney
Myeloid leukemia
21
36
5
10
<5
5
72
49
15
42
19
45-54
45-54
45-54
40-49
45-54
45-54
45-54
40-49
40-49
45-54
45-54
45-54
45-54
Lung
Esophagus
Stomach
Liver
Pancreas
Colorectum
Larynx
Cervix
Ovary
Bladder
Kidney
Myeloid leukemia
127
76
25
< 18
26
45
233
6
30
41
< 21
84
28
35-44
45-64
Lung
1132
55-74
Oral
cavity
and
pharynx
195
55-74
Esophagus
109
55-74
Stomach
103
50-69
Liver
135
55-74
Pancreas
179
55-74
Colorectum
982
55-74
Larynx
42
50-69
Cervix
38
50-69
Ovary
85
55-74
Bladder
179
55-74
Kidney
269
55-74
Myeloid leukemia
74
55-74
CI, confidence interval; PAR, population attributable risk
Men
Obs.
Cases
Men PAR
(95% CI)
78.4 (73.3,82.8)
49.0 (37.5,59.4)
45.2 (38.5,51.5)
21.9 (16.1,27.7)
25.2 (15.1,35.1)
23.0 (18.0,27.9)
10.9 (7.7,14.1)
74.1 (62.4,84.2)
25.3 (9.3,44.4)
3.4 (1.0,5.9)
45.4 (37.6,52.9)
20.3 (15.2,25.5)
9.8 (0,59.1)
13
24
<5
5
<5
<5
37
-
79.8 (74.8,84.1)
51.6 (39.7,61.9)
46.9 (40.1,53.7)
23.9 (17.3,30.3)
26.5 (16.1,36.4)
24.7 (19.4,29.8)
11.5 (8.1,15.0)
76.1 (64.4,86.0)
28
10
47.4 (39.4,55.2)
21.6 (16.3,27.1)
10.1 (0,59.5)
78.3 (73.4,82.6)
47.1 (35.1,58.1)
46.2 (39.9,52.2)
23.1 (17.1,29.2)
26.4 (15.2,37.9)
22.5 (17.4,27.6)
11.5 (8.3,14.6)
75.4 (64.5,85.0)
28.3 (10.1,48.6)
3.7 (1.1,6.5)
45.4 (37.9,52.6)
20.6 (15.5,25.5)
11.3 (0,63.5)
51
62
21
<5
20
19
125
6
79.3 (74.4,83.5)
48.8 (36.0,59.8)
47.7 (41.5,53.8)
24.2 (17.8,30.8)
27.6 (16.0,39.0)
23.6 (18.3,28.9)
12.1 (8.7,15.4)
76.4 (64.6,85.9)
16
56
15
46.9 (39.2,54.2)
21.5 (16.3,26.7)
11.8 (0,64.7)
77.6 (72.6,81.9)
44.0 (31.1,56.0)
46.6 (40.7,52.2)
22.5 (16.7,28.3)
27.1 (14.2,39.8)
21.4 (16.0,26.8)
11.9 (8.7,15.1)
75.4 (66.2,83.8)
27.7 (11.6,47.2)
3.8 (1.1,6.6)
44.7 (37.6,51.4)
20.3 (15.3,25.2)
12.7 (0,68.8)
558
153
89
74
92
83
605
37
78.7 (73.8,83.0)
45.4 (32.1,57.6)
48.4 (42.4,54.2)
23.9 (17.7,30.0)
28.7 (15.2,41.8)
22.5 (16.7,28.1)
12.8 (9.4,16.2)
76.9 (67.7,84.9)
147
188
47
46.4 (38.9,53.3)
21.4 (16.2,26.5)
13.7 (0,70.9)
Women
Obs.
Cases
Women PAR
(95% CI)
8
12
<5
5
<5
<5
35
49
15
14
9
76.6 (71.2,81.3)
45.9 (34.5,56.7)
43.1 (36.7,49.5)
19.7 (14.5,25.0)
23.9 (14.1,34.1)
21.2 (16.3,25.8)
10.2 (7.3,13.2)
71.7 (60.3,82.2)
25.3 (9.3,44.4)
3.4 (1.0,5.9)
43.0 (35.3,50.5)
18.9 (14.0,23.8)
9.5 (0,57.7)
76
14
4
13
6
26
108
30
41
<5
28
13
77.1 (71.7,81.6)
45.2 (33.1,56.3)
44.7 (38.4,50.9)
21.9 (16.0,27.8)
25.3 (14.3,36.5)
21.3 (16.3,26.3)
10.9 (7.9,14.0)
28.3 (10.1,48.6)
3.7 (1.1,6.5)
43.8 (36.3,50.9)
19.5 (14.7,24.3)
10.8 (0,63.2)
574
42
20
29
43
96
377
5
38
85
32
81
27
76.3 (71.0,80.9)
42.5 (29.7,54.3)
44.5 (38.4,50.3)
21.0 (15.4,26.5)
25.5 (13.4,37.9)
20.3 (15.1,25.4)
11.0 (8.1,14.1)
73.7 (63.9,82.7)
27.7 (11.6,47.2)
3.8 (1.1,6.6)
42.8 (35.5,49.7)
19.1 (14.5,23.8)
11.6 (0,66.9)
43
Table 1.1.11
Age at
Exposure
65
Continued
Age at
Outcome
Total PAR
(95% CI)
Men
Obs.
Cases
Men PAR
(95% CI)
Women
Obs.
Cases
Cancer Site
Total
Cases
Women PAR
(95% CI)
75
Lung
672
71.5 (64.8,77.3)
331
75.2 (68.5,80.8)
341
67.6 (60.4,73.9)
75
66
29.8 (13.6,45.6)
34
32.0 (10.9,50.2)
32
28.0 (14.1,41.8)
75
Esophagus
44
42.2 (36.4,47.8)
37
47.6 (41.3,53.5)
36.9 (31.0,42.6)
75
Stomach
127
19.3 (13.7,24.7)
77
22.0 (15.6,28.4)
50
16.8 (11.7,22.0)
75
Liver
52
24.7 (9.2,39.3)
34
29.1 (10.1,45.8)
18
20.6 (8.3,33.5)
75
Pancreas
150
15.6 (9.6,21.3)
65
17.9 (10.8,24.9)
85
13.5 (8.8,18.6)
75
Colorectum
664
10.7 (7.7,13.7)
338
13.1 (9.5,16.7)
326
8.6 (6.2,11.2)
75
Larynx
28
72.4 (63.8,80.0)
21
75.8 (68.0,82.7)
68.7 (59.2,77.7)
75
Cervix
15
18.3 (9.5,30.4)
75
Ovary
48
3.0 (0.7,5.4)
75
Bladder
156
37.7 (30.5,44.6)
117
42.3 (34.6,49.4)
39
33.2 (26.6,40.0)
75
Kidney
87
16.5 (11.7,21.1)
54
19.4 (13.7,25.0)
33
13.9 (9.9,17.9)
75
Myeloid leukemia
55
13.2 (0,71.6)
27
16.5 (0,76.9)
28
10.4 (0,64.7)
Notes:
This table duplicates Table 1.1.3, with the addition of 95% confidence intervals
PAR represents the proportion (%) of cancer cases attributable to active smoking
44
Table 1.1.12
Proportions and cases of lung cancer attributable to current or former active smoking
in Alberta (2012)
Age at Exposure
Age at Outcome
Observed Cases
PAR (95% CI)
EAC (95% CI)
Men
20-34
30-44
13
79.8 (74.8,84.1)
35-44
45-54
51
79.3 (74.4,83.5)
45-64
55-74
558
78.7 (73.8,83.0)
65
75
331
75.2 (68.5,80.8)
Total
Total
953
Women
20-34
30-44
8
76.6 (71.2,81.3)
35-44
45-54
76
77.1 (71.7,81.6)
45-64
55-74
574
76.3 (71.0,80.9)
65
75
341
67.6 (60.4,73.9)
Total
Total
999
Total
20-34
30-44
21
78.4 (73.3,82.8)
35-44
45-54
127
78.3 (73.4,82.6)
45-64
55-74
1132
77.6 (72.6,81.9)
65
75
672
71.5 (64.8,77.3)
Total
Total
1952
CI, confidence interval; EAC, Excess attributable cases; PAR, population attributable risk
10 (5,16)
40 (29,52)
439 (395,483)
249 (216,282)
739
6 (2,11)
59 (46,73)
438 (392,483)
231 (198,264)
733
16 (10,24)
99 (82,118)
878 (804,951)
481 (425,535)
1475
Notes:
Cases represent the total number of cases of lung cancer in 2012

PAR represents the proportion (%) of lung cancer cases attributable to active smoking
Excess attributable cases represent the number of lung cancer cases attributable to
active smoking in 2012
Results by zone are included in Tables 1.1.13-1.1.17
45
Table 1.1.13
Proportions and cases of lung cancer attributable to active smoking in the

South Zone health region, Alberta in 2012
Age at Exposure
Age at Outcome
Observed Cases
PAR (95% CI)
Men
20-34
30-44
35-44
45-54
8
81.7 (75.2,86.6)
45-64
55-74
56
77.7 (71.3,82.9)
65
75
35
75.0 (67.0,81.1)
Total
Total
99
Women
20-34
30-44
35-44
45-54
5
79.2 (71.7,84.7)
45-64
55-74
46
71.3 (63.4,77.6)
65
75
37
60.9 (50.3,69.8)
Total
Total
88
Total
20-34
30-44
35-44
45-54
13
80.5 (74.7,85.0)
45-64
55-74
102
74.9 (68.7,80.3)
65
75
72
68.8 (60.8,75.7)
Total
Total
187
EAC (95% CI)

7 (2,11)
44 (32,56)
26 (18,35)
76
4 (1,8)
33 (23,43)
23 (15,31)
59
10 (5,16)
76 (61,93)
50 (38,63)
136
46
Table 1.1.14
Proportions and cases of lung cancer attributable to active smoking in the Calgary
Zone health region, Alberta in 2012
Age at Exposure
Age at Outcome
Observed Cases
PAR (95% CI)
EAC (95% CI)
Men
<5
78.3 (72.8,83.0)
<5
20-34
30-44
12
75.7 (68.7,81.3)
9 (4,15)
35-44
45-54
150
76.2
(69.6,81.7)
114
(94,135)
45-64
55-74
108
74.5 (66.5,80.7)
80 (63,98)
65
75
<
275
< 208
Total
Total
Women
<5
74.0 (67.2,79.5)
<5
20-34
30-44
25
73.8 (66.7,79.8)
18 (11,26)
35-44
45-54
162
72.2
(64.9,78.4)
117
(97,138)
45-64
55-74
96
68.2 (59.1,75.7)
66 (50,81)
65
75
<
288
< 206
Total
Total
Total
6
76.4 (71.0,81.2)
5 (1,9)
20-34
30-44
37
74.9 (68.6,80.3)
28 (19,37)
35-44
45-54
312
74.4
(67.8,79.8)
232
(200,264)
45-64
55-74
204
71.3 (63.5,77.8)
146 (121,170)
65
75
559
410
Total
Total
47
Table 1.1.15
Proportions and cases of lung cancer attributable to active smoking in the Central
Age at Exposure
Age at Outcome
Observed Cases
PAR (95% CI)
EAC (95% CI)
Men
5
79.2 (73.1,84.1)
<5
20-34
30-44
6
78.2 (71.9,83.2)
5 (2,9)
35-44
45-54
83
79.2 (73.5,83.7)
66 (51,81)
45-64
55-74
32
74.7 (66.7,80.8)
24 (16,33)
65
75
126
< 99
Total
Total
Women
<5
76.4 (70.2,81.7)
<5
20-34
30-44
11
77.7 (70.9,83.2)
9 (4,14)
35-44
45-54
95
77.9 (72.3,82.6)
74 (59,90)
45-64
55-74
45
66.1 (57.3,73.5)
30 (21,40)
65
75
< 156
< 117
Total
Total
Total
< 10
77.9 (72.3,82.7)
< 10
20-34
30-44
17
77.9 (72.0,82.7)
13 (7,20)
35-44
45-54
178
78.6 (73.4,83.1)
140 (118,163)
45-64
55-74
77
70.7 (63.2,77.1)
54 (42,68)
65
75
<
282
< 217
Total
Total
48
Table 1.1.16 Proportions and cases of lung cancer attributable to active smoking in the
Edmonton Zone health region, Alberta in 2012
Age at Exposure
Age at Outcome
Observed Cases
PAR (95% CI)
Men
<5
76.5 (69.9,81.9)
20-34
30-44
18
77.1 (70.4,82.5)
35-44
45-54
187
78.8 (73.2,83.4)
45-64
55-74
120
74.4 (66.0,80.8)
65
75
< 330
Total
Total
Women
<5
76.2 (70.0,81.5)
20-34
30-44
27
76.1 (68.7,81.8)
35-44
45-54
189
72.3 (65.2,78.3)
45-64
55-74
134
69.2 (59.6,76.7)
65
75
< 355
Total
Total
Total
5
76.3 (70.4,81.4)
20-34
30-44
45
76.6 (70.6,81.7)
35-44
45-54
376
76.0 (70.3,80.9)
45-64
55-74
254
71.7 (63.6,78.0)
65
75
680
Total
Total
EAC (95% CI)

<5
14 (8,21)
147 (125,171)
89 (71,108)
< 255
<5
21 (13,29)
137 (114,161)
93 (74,112)
< 256
4 (1,8)
34 (24,45)
286 (250,322)
182 (153,211)
506
49
Table 1.1.17
Proportions and cases of lung cancer attributable to active smoking in the North
Age at Exposure
Age at Outcome
Observed Cases
PAR (95% CI)
EAC (95% CI)
Men
<5
80.7 (75.5,85.1)
<5
20-34
30-44
7
80.9 (75.5,85.3)
6 (2,10)
35-44
45-54
82
78.1 (72.7,82.7)
64 (50,79)
45-64
55-74
36
75.7 (68.1,81.6)
27 (18,37)
65
75
< 130
< 102
Total
Total
Women
<5
76.6 (70.7,81.5)
<5
20-34
30-44
8
78.8 (72.9,83.6)
6 (2,11)
35-44
45-54
82
77.4 (71.6,82.3)
63 (50,78)
45-64
55-74
29
67.7 (58.7,74.7)
20 (13,27)
65
75
< 124
< 95
Total
Total
Total
<5
79.0 (73.9,83.4)
<5
20-34
30-44
15
79.9 (74.8,84.2)
12 (6,18)
35-44
45-54
164
77.8 (72.4,82.3)
128 (107,149)
45-64
55-74
65
72.3 (64.9,78.5)
47 (35,60)
65
75
<
249
< 192
Total
Total
50
Table 1.1.18
Age at
Exposure
Proportions and cases of lung cancer attributable to current or former smoking in

Alberta (2012)
Age at
Outcome
Men
Current Smokers
Observed
Cases
Former Smokers
PAR (95% CI)
EAC (95% CI)
PAR (95% CI)
EAC(95% CI)
30-44
45-54
55-74
75
Total
13
51
558
331
953
75.9 (68.7,81.4)
73.2 (65.8,79.3)
69.7 (61.7,76.3)
51.8 (41.4,61.3)
10 (5,16)
37 (27,48)
389 (336,439)
171 (134,209)
608
44.6 (33.4,55.3)
52.2 (40.3,62.5)
58.3 (46.6,68.5)
66.1 (54.8,74.9)
6 (3,10)
27 (18,36)
325 (255,389)
219 (176,257)
577
30-44
45-54
55-74
75
Total
8
76
574
341
999
71.2 (63.2,77.6)
70.3 (62.3,76.8)
67.4 (59.2,74.3)
49.7 (39.6,59.0)
6 (2,10)
53 (41,67)
387 (332,439)
169 (132,207)
615
44.8 (33.5,55.6)
50.0 (37.9,60.5)
53.3 (41.5,64.0)
52.4 (40.4,62.8)
4 (1,7)
38 (26,50)
306 (235,374)
179 (135,221)
527
21
73.8 (66.7,79.6)
15 (9,23)
44.7 (33.4,55.5)
30-44
127
71.9 (64.2,78.1)
91 (73,109)
51.1 (39.2,61.5)
45-54
35-44
1132
68.6 (60.8,75.4) 777 (677,867)
56.0 (44.1,66.0)
55-74
45-64
672
50.7 (41.1,59.3) 340 (273,406)
59.8 (48.3,69.1)
75
65
1952
1224
Total
Total
CI, confidence interval; EAC, excess attributable cases; PAR, population attributable risk
9 (5,14)
65 (47,83)
634 (497,755)
402 (319,473)
1110
20-34
35-44
45-64
65
Total
Women
20-34
35-44
45-64
65
Total
Total
20-34
Notes:
PAR represents the proportion (%) of lung cancer cases attributable to current or former smoking
Excess attributable cases represent the number of lung cancer cases attributable to current or
former smoking in 2012
51
Figure 1.1.1
Prevalence of current and former smokers in Alberta by age group, Canadian Community
Health Survey, 2000
52
A, South Zone; B, Calgary Zone; C, Central Zone; D, Edmonton Zone; E, North Zone
Figure 1.1.2
Prevalence of active smokers in Alberta by age group and Alberta Health Services region,
Canadian Community Health Survey, 2003
53
Figure 1.1.3
Cancer cases attributable to smoking and other known and unknown cancer causes
54
1.2
Cancer Incidence Attributable to Passive Tobacco Exposure in Alberta,

Canada in 2012
55
Table 1.2.1
Prevalence of passive tobacco exposure in Alberta never smokers, Canadian Community

Health Survey, 2003
Age (years)
Men
Women
Total
Any Exposure
Prevalence (95% CI)

Exposed at Home
20-34
35-49
50-64
65
39.0 (33.7,44.3)
25.3 (20.3,30.3)
20.9 (15.3,26.4)
11.1 (6.5,15.7)
7.8 (4.2,11.5)
3.7 (1.6,5.7)
5.8 (3.0,8.7)
3.2 (1.0,5.3)
20-34
35-49
50-64
65
26.0 (21.9,30.2)
20.8 (15.6,26.0)
14.4 (10.7,18.2)
11.4 (8.2,14.6)
6.9 (4.5,9.4)
4.9 (2.4,7.4)
5.1 (2.5,7.7)
5.2 (2.6,7.8)
32.3 (28.9,35.8)
23.0 (19.4,26.6)
17.0 (13.8,20.1)
11.3 (8.7,13.9)
7.4 (5.2,9.5)
4.3 (2.7,5.9)
5.4 (3.5,7.3)
4.6 (2.7,6.6)
20-34
35-49
50-64
65
Notes:
Any exposure includes exposure at home, in a vehicle or a public place
56
Table 1.2.2
Prevalence of passive tobacco exposure in Alberta never smokers by Alberta Health

Services Zone, Canadian Community Health Survey, 2003
Prevalence of Any Exposure (95% CI)
Age (years)
South Zone
Calgary Zone
Central Zone
Edmonton Zone
North Zone
20-34
33.3 (24.1,42.4)
32.2 (26.3,38.2)
38.2 (30.8,45.6)
29.3 (22.6,36.0)
35.6 (29.0,42.0)
35-49
18.9 (10.0,27.8)
20.6 (15.0,26.2)
25.6 (17.2,34.0)
23.7 (16.0,31.4)
31.1 (24.1,38.0)
50-64
14.8 (6.8,22.8)
18.9 (12.8,25.0)
22.7 (15.0,30.4)
12.9 (7.8,18.0)
19.0 (13.4,24.6)
65
12.8 (7.0,18.6)
8.2 (3.9,12.5)
10.5 (5.8,15.2)
12.5 (6.5,18.4)
18.2 (11.9,24.4)
57
Table 1.2.3
Age at
Exposure
Proportions and cases of lung cancer attributable to passive tobacco smoke exposure in
Alberta never smokers (2012)
Age at
Outcome
Observed
Cases
30-44
45-59
60-74
75
Total
30-44
45-59
60-74
75
Total
Any Exposure
Exposure at Home
PAR (95% CI)
EAC (95% CI)
PAR (95% CI)
EAC (95% CI)
<5
14
47
33
< 99
11.7 (8.3,15.2)
7.9 (5.4,10.7)
6.6 (4.3,9.3)
3.6 (2.0,5.7)
1 (1,2)
3 (2,5)
1 (1,2)
5
1.5 (0.5,2.7)
0.7 (0.2,1.4)
1.1 (0.4,2.1)
0.6 (0.2,1.3)
1 (0,1)
1
<5
17
48
34
< 104
8.1 (5.7,10.8)
6.6 (4.3,9.2)
4.7 (3.0,6.7)
3.7 (2.4,5.4)
1 (1,2)
2 (1,3)
1 (1,2)
4
1.3 (0.5,2.3)
0.9 (0.3,1.8)
1.0 (0.3,1.8)
1.0 (0.3,1.9)
1 (0,1)
1
9.9 (7.1,12.9)
1.4 (0.5,2.4)
30-44
<5
7.3 (5.0,9.6)
2 (1,3)
0.8 (0.3,1.5)
35-49
45-59
31
5.5 (3.7,7.4)
5 (3,7)
1.0 (0.4,1.8)
50-64
60-74
95
3.7 (2.4,5.2)
2 (2,4)
0.9 (0.3,1.6)
65
75
67
9
Total
Total
< 198
CI, confidence intervals; EAC, excess attributable cases; PAR, population attributable risk
1 (0,2)
1 (0,1)
2
Men
20-34
35-49
50-64
65
Total
Women
20-34
35-49
50-64
65
Total
Total
20-34
Notes:

PAR represents the proportion (%) of lung cancer cases attributable to passive tobacco exposure
Excess attributable cases represent the number of lung cancer cases attributable to passive
smoking exposure in 2012
Results by zone are included in Table 1.2.4
58
Table 1.2.4
Proportions and cases of lung cancer in never smokers attributable to any source of passive
tobacco smoke exposure in Alberta Health Services regions (2012)
Age at Exposure
Age at Outcome
Observed Cases
PAR (95% CI)
EAC (95% CI)
South Zone
20-34
30-44
<5
6.0 (3.1,9.5)
35-49
45-59
8
4.8 (2.2,8.0)
1 (0,1)
50-64
60-74
7
4.2 (2.2,6.5)
65
75
< 20
1
Total
Total
Calgary Zone
<5
9.9 (6.8,13.3)
20-34
30-44
10
6.5 (4.3,9.2)
1 (0,1)
35-49
45-59
25
6.0 (3.7,8.8)
2 (1,3)
50-64
60-74
20
2.7
(1.3,4.5)
1 (0,1)
65
75
< 60
4
Total
Total
Central Zone
<5
11.5 (8.0,15.4)
20-34
30-44
<
5
8.0
(4.9,11.6)
35-49
45-59
15
7.2 (4.4,10.4)
1 (0,2)
50-64
60-74
8
3.4 (1.8,5.5)
65
75
28
1
Total
Total
Edmonton Zone
20-34
30-44
10
7.5 (4.6,10.8)
1 (0,1)
35-49
45-59
32
4.2 (2.4,6.4)
1 (1,2)
50-64
60-74
25
4.1 (2.0,6.6)
1 (0,2)
65
75
67
3
Total
Total
North Zone
20-34
30-44
<5
9.6 (6.4,13.0)
35-49
45-59
14
6.1 (3.8,8.7)
1 (0,1)
50-64
60-74
6
5.8 (3.5,8.6)
65
75
< 25
1
Total
Total
CI, confidence intervals; EAC, excess attributable cases; PAR, population attributable risk
59
Figure 1.2.1
Prevalence of passive tobacco smoke exposure in Alberta, Canadian Community Health

Survey, 2003
60
Figure 1.2.2
Prevalence of passive tobacco smoke exposure from any source location by Alberta
Health Services region, Canadian Community Health Survey, 2003
61
CHAPTER 2
Cancer Incidence Attributable to Overweight and Obesity

in Alberta, Canada in 2012
62
SUMMARY
Approximately 48 64% of men and 27 55% of women in Alberta were classified as either
overweight or obese, where these proportions increased with age in both sexes. We estimate that
approximately 17% of obesity-related cancers among men and 11% among women can be attributed to
excess body weight in Alberta in 2012. Site-specific results suggest that the heaviest absolute burden in
terms of number of cases is seen for breast cancer among women and for colorectal cancer among
men. Overall, approximately 5% of all cancers in Alberta in 2012 were attributable to excess body
weight among adult Albertans in 2000-2003 (Table 2.1).
METHODS OVERVIEW
Overweight and obesity were analyzed independently and as a combined variable to calculate
PARs of cancer in Alberta. Data from the Canadian Community Health Survey (CCHS) were obtained to
estimate the prevalence of overweight and obese adults in Alberta. The cycle of the CCHS used
corresponded to the midpoint of the latency period suggested by prospective cohort studies for each
cancer site of interest (Table 2.2). Alberta Health Services (AHS) Zone data were not available for Cycle
1.1 (2000/2001) of the CCHS. Therefore PAR calculations by Zone for cancer sites using exposure data
from Cycle 1.1 were performed using CCHS Cycle 2.1 (2003), as this was the earliest date for which such
data were available. In the CCHS, overweight and obesity are based on body mass index (BMI)
measurements. Persons defined as overweight are those with a BMI between 25.0 and 29.9 kg/m2.
Those with a BMI greater than 30.0kg/m2 were considered obese. The proportions of overweight and
obese Albertans in are shown in Table 2.4 (Figure 2.1) and by AHS zone in Table 2.5. The proportions of
overweight and obese Albertans by AHS zone are shown in Tables 2.2 (Figure 2.2) and 2.3 (Figure 2.3),
respectively.
Estimates of the risk association between overweight/obesity and the cancer sites of interest
were only available for men and women separately (Table 2.3). PARs associated with either overweight
or obesity were estimated using the equation below:
2.1: =
(1 1 ) + (2 2 )
1 + (1 1 ) + (2 2 )
Where 1 is the prevalence of overweight and 2 is the prevalence of obesity. 1 and
2 denote the excess relative risks associate with overweight and obesity, respectively. The PARs
were then multiplied by the incident cancer cases of interest in Alberta in 2012 from the Alberta Cancer
Registry.
63
For PAR estimates in the total population (men and women combined), the number of excess
attributable cases in men and women for each cancer site (by age group) were combined and then
divided by the total number of incident cancer cases for each cancer site. In situations where the total
number of cases in men and women combined was 0, it was not possible to calculate the PAR for the
total population using the method above.
Estimates of PAR as well as the number of site-specific cancer cases attributable to overweight
and obesity are presented in Table 2.6. PAR estimates by AHS Zone are shown in Tables 2.7 2.11. PAR
estimates for overweight and obesity separately are displayed in Tables 2.12 and 2.13, respectively.
Table 2.14 shows estimates of PAR for Alberta similar to Table 2.4 including 95% confidence intervals to
demonstrate the precision of our estimates. The total number of cancer cases at each site attributable
to insufficient fruit and vegetable consumption and other causes are shown in Figure 2.4.
64
Table 2.1
Summary of cases and proportions of cancer in Alberta adults in 2012 attributable to overweight/obesitya
Cancer Siteb
Observed
Casesc
Esophagusf
Pancreas
Colorectum
Kidney
Breastg
Endometrium
Gall Bladder
123
380
1955
482
1545
504
55
All Associated Cancersh
5044
Total
Men
Women
Excess
Excess
Excess
%
Observed
%
Observed
Attributable
Attributable
Attributable
% Attributablee
e
c
e
c
Attributable
Cases
Attributable
Cases
Casesd
Casesd
Casesd
38
30.9
110
35
31.4
13
3
26.8
25
6.7
172
9
5.5
208
16
7.7
239
12.2
1107
191
17.2
848
48
5.7
83
17.3
326
54
16.5
156
29
18.8
124
8.0
1545
124
8.0
153
30.3
504
153
30.3
11
20.3
24
2
6.5
31
10
30.9
673
13.3
1739
290
16.7
3305
383
All Cancersi
15836
673
4.3
8155
290
3.6
7681
383
a. Overweight and obesity measured using body mass index (BMI) measures from the Canadian Community Health Survey. Overweight
defined as BMI 25 and <30, Obese defined as BMI 30.
b. Cancer incidence data obtained from the Alberta Cancer Registry. Data from 2012 was used for observed cancer cases for all cancer
sites.
d. Number of cancer cases at individual cancer sites that can be attributed to overweight/obesity.
e. Proportion of cancers at individual cancer sites attributable to overweight/obesity. Calculated as excess attributable cases/observed
cases.
f. Adenocarcinomas only.
g. Postmenopausal breast cancer only. Defined as cancers diagnosed at age 55 or older.
h. Represents all cancers with a known association with overweight/obesity, as listed in table.
i. Represents all incident cancers in Alberta in 2012 in all age groups.
11.6
5.0
65
Table 2.2
Predetermined latency periods by cancer site and cycle of prevalence data used for population
attributable risk calculations
Exposure
Overweight and
Obesity
Cancer site
Esophagus
Pancreas
Colon-rectum
Kidney
Gallbladder
Breast
Endometrium
Corresponding Canadian Community Health

Survey cycle (year)
1.1 (2000/2001)
2.1 (2003)
2.1 (2003)
1.1 (2000/2001)
1.1 (2000/2001)
2.1 (2000/2001)
1.1 (2000/2001)
66
Table 2.3
Risk associations for risk associated with overweight/obesity by cancer sites of interest
Cancer site
Sex
Relative Risk
Source
Men
1.52
Renehan et al, 2008
Women
1.51
Renehan et al, 2008
Men
1.07
Renehan et al, 2008
Women
1.12
Renehan et al, 2008
Men
1.24
Renehan et al, 2008
Women
1.09
Renehan et al, 2008
Men
1.15
Renehan et al, 2008
Women
1.25
Renehan et al, 2008
Men
1.09
Renehan et al, 2008
Women
1.59
Renehan et al, 2008
Breast
Women
1.12
Renehan et al, 2008
Endometrium
Women
1.59
Renehan et al, 2008
Esophagus
Pancreas
Colon-rectum
Kidney
Gallbladder
67
Table 2.4
Prevalence of overweight and obesity in Alberta, 2000-2001 (Canadian Community Health Survey)
Age (years)
Men
Women
Total
Overweight
Prevalence (95% CI)
Obese
18-34
35-44
45-54
55-64
65-74
75
33.7 (30.8,36.7)
41.9 (38.2,45.7)
43.2 (39.1,47.3)
47.2 (41.9,52.6)
38.2 (32.4,44.0)
41.0 (33.8,48.2)
13.8 (11.8,15.8)
19.0 (15.9,22.2)
19.4 (16.1,22.7)
17.2 (13.5,20.9)
17.7 (13.9,21.5)
13.3 (8.6,18.1)
18-34
35-44
45-54
55-64
65-74
75
17.2 (14.8,19.6)
26.6 (23.4,29.8)
27.7 (23.9,31.4)
35.2 (29.8,40.6)
35.1 (29.8,40.3)
28.5 (23.8,33.2)
9.3 (7.7,10.9)
14.7 (12.1,17.2)
17.5 (14.3,20.8)
20.2 (15.8,24.6)
17.3 (13.6,21.0)
13.9 (10.6,17.3)
25.9 (24.0,27.7)
34.4 (31.9,36.8)
35.7 (32.9,38.5)
41.1 (37.3,44.9)
36.6 (32.5,40.7)
33.7 (29.4,37.9)
11.7 (10.4,12.9)
16.9 (14.9,18.9)
18.5 (16.1,20.9)
18.7 (15.9,21.5)
17.5 (14.7,20.3)
13.7 (10.9,16.5)
18-34
35-44
45-54
55-64
65-74
75
68
Table 2.5
Prevalence of overweight and obesity in Alberta by health region (zone), 2003 (Canadian Community Health Survey)
Prevalence (95% CI)
Age (years)
South Zone
Calgary Zone
Central Zone
Edmonton Zone
North Zone
Overweight
Obesity
Overweight
Obesity
Overweight
Obesity
Overweight
Obesity
Overweight
Obesity
29.4
(22.4,36.4)
49.9
(36.7,63.2)
44.2
(34.2,54.1)
51.5
(42.8,60.3)
19.2
(12.3,26.2)
16.2
(7.1,25.2)
20.2
(12.9,27.5)
16.7
(10.1,23.4)
37.5
(30.2,44.7)
48.5
(40.4,56.6)
41.0
(34.3,47.6)
43.1
(34.4,51.8)
11.7
(7.9,15.4)
11.6
(7.4,15.9)
20.6
(14.7,26.4)
12.7
(7.5,17.9)
38.1
(30.4,45.9)
48.0
(38.6,57.4)
46.7
(38.9,54.4)
48.9
(40.7,57.1)
16.2
(10.6,21.7)
21.7
(14.2,29.2)
28.1
(20.5,35.7)
16.8
(11.0,22.6)
33.0
(25.2,40.8)
43.2
(33.6,52.8)
51.7
(44.7,58.7)
47.5
(37.1,57.8)
12.8
(7.0,18.7)
19.0
(11.6,26.3)
14.4
(10.1,18.6)
17.7
(10.1,25.3)
44.4
(37.2,51.5)
46.9
(39.6,54.2)
48.5
(42.8,54.3)
46.1
(35.3,56.9)
21.5
(16.0,27.0)
25.0
(17.6,32.4)
25.9
(20.9,31.0)
18.6
(11.8,25.3)
16.7
(10.8,22.5)
17.5
(6.6,28.3)
35.6
(27.1,44.2)
31.8
(23.7,39.9)
13.4
(7.6,19.2)
23.1
(10.9,35.2)
27.0
(20.1,33.9)
19.1
(11.7,26.4)
17.5
(12.2,22.7)
19.7
(13.3,26.2)
29.0
(22.4,35.5)
37.6
(28.6,46.6)
8.3
(4.3,12.3)
14.3
(8.7,19.9)
18.3
(12.9,23.8)
12.1
(5.9,18.3)
29.1
(22.2,36.0)
24.1
(16.4,31.8)
31.1
(25.2,36.9)
37.3
(30.0,44.6)
15.9
(10.3,21.5)
9.7
(4.8,14.6)
22.7
(18.0,27.3)
15.5
(10.8,20.1)
25.8
(19.2,32.4)
34.6
(23.4,45.7)
33.2
(26.3,40.1)
33.0
(25.6,40.4)
7.6
(4.3,10.9)
12.2
(6.3,18.1)
18.7
(13.8,23.6)
17.8
(11.2,24.5)
23.4
(17.9,29.0)
22.9
(16.4,29.4)
34.7
(29.0,40.5)
41.0
(33.5,48.5)
18.6
(14.2,22.9)
18.2
(11.6,24.8)
27.2
(21.9,32.5)
18.2
(12.6,23.8)
24.1
(19.5,28.6)
35-44
33.5
(25.0,42.1)
45-64
40.0
(33.8,46.3)
65
40.9
(35.1,46.7)
16.8
(12.1,21.5)
19.7
(11.8,27.5)
23.5
(18.3,28.7)
18.0
(12.6,23.4)
28.0
(23.4,32.6)
35.1
(29.6,40.7)
35.2
(30.8,39.6)
40.0
(34.0,46.1)
10.1
(7.5,12.6)
12.9
(9.5,16.3)
19.5
(15.5,23.5)
12.4
(8.3,16.4)
33.8
(28.5,39.2)
36.8
(30.5,43.0)
39.1
(34.6,43.6)
42.8
(37.3,48.3)
16.0
(11.8,20.3)
16.1
(11.2,20.9)
25.5
(21.1,29.8)
16.1
(12.4,19.8)
29.6
(24.7,34.5)
39.4
(32.2,46.6)
42.8
(38.3,47.3)
39.4
(33.2,45.5)
10.4
(6.8,13.9)
16.0
(11.0,21.0)
16.5
(13.0,19.9)
17.8
(12.8,22.7)
35.1
(30.5,39.7)
35.3
(30.5,40.1)
42.1
(38.0,46.2)
43.5
(37.3,49.8)
20.2
(16.7,23.7)
21.7
(16.9,26.6)
26.5
(22.9,30.1)
18.4
(13.8,23.0)
Men
20-34
35-44
45-64
65
Women
20-34
35-44
45-64
65
Total
20-34
69
Table 2.6
Cancer cases and proportions attributable to overweight and obesity in Alberta (2012)
Age at
Exposure
(years)
Men
18-34
35-44
45-54
55-64
65-74
75
Total
Age at
Outcome
(years)
Women
18-34
35-44
45-54
55-64
65-74
75
Total
Esophagusa
Obs.
PAR
EAC
Cases
(%)
Obs.
Cases
Pancreas
PAR
(%)
EAC
Colorectum
Obs.
PAR
EAC
Cases
(%)
Obs.
Cases
Kidney
PAR
(%)
Gallbladder
EAC
Obs.
Cases
PAR (%)
EAC
28-44
45-54
55-64
65-74
75-84
85
<5
20
38
25
17
6
<111
26.3
31.8
32.4
32
30.1
27.9
<5
6
12
8
5
2
<38
5
19
33
50
48
17
172
4.2
5.4
5.8
5.6
5.6
4.6
0
1
2
3
3
1
9
39
125
301
304
264
74
1107
13.4
16.8
18.1
17.6
17.3
14.4
5
21
54
54
46
11
191
28
56
109
79
48
6
326
13.4
16.9
17.2
17.1
15.7
14.5
4
9
19
13
8
1
54
<5
<5
6
12
<5
24
6.8
7
7
6.3
5.8
<5
<5
<5
1
<5
2
28-44
45-54
55-64
65-74
75-84
85
<5
<5
6
<5
<15
17.1
24.5
26.8
30.5
-
<5
<5
2
<5
<5
<5
26
42
54
60
25
<212
4.5
5.8
7.1
9.1
8.4
6.2
0
1
3
5
5
2
16
37
108
179
198
214
112
848
3.4
4.4
5.4
6.9
6.4
4.7
1
5
10
14
14
5
48
14
28
41
40
22
11
156
11.7
17.2
18.9
21.9
20.4
17.2
2
5
8
9
4
2
29
<5
<5
7
9
8
<5
31
19.6
27.6
30.1
34.1
32
27.6
<5
<5
2
3
3
<5
10
12.8
17
17.7
18.7
17.2
16.2
5
14
27
22
12
3
83
<5
<10
<12
15
20
<5
55
19.6
20.7
25
23.2
16.6
16.7
<5
<5
2
3
3
<5
11
Total
18-34
28-44
5
24.4
1
<10
4.2
0
76
8.5
6
42
35-44
45-54
<25
30.6 <10
45
5.6
3
233
11.1
26
84
45-54
55-64
44
31.3
14
75
6.6
5
480
13.4
64
150
55-64
65-74
<30
31.8 <10
104
7.4
8
502
13.4
67
119
65-74
75-84
17
29.9
5
108
7.1
8
478
12.4
59
70
75
85
6
27
2
42
5.6
2
186
8.6
16
17
Total
123
38
<384
25
1955
239
482
EAC, excess attributable risk; Obs. Cases, Observed cases; PAR, population attributable risk
Notes:
PAR represents the proportion (%) of cancer cases attributable to overweight/obesity
Excess attributable cases represent the number of cases attributable to overweight/obesity in 2012
Results by zone are included in Tables 2.7-2.11
70
Table 2.6 continued

Age at Exposure
(years)
Men
18-34
35-44
45-54
55-64
65-74
75
Total
Women
18-34
35-44
45-54
55-64
65-74
75
Total
Cancer cases and proportions attributable to overweight and obesity in Alberta (2012)
Age at Outcome
(years)
Obs. Cases
Breast
PAR (%)
Endometrium
PAR (%)
EAC
Obs. Cases
EAC
41
49
27
7
124
26
83
195
127
55
18
504
19.6
27.6
30.1
34.1
32
27.6
5
23
59
43
18
5
153
41
49
27
7
124
26
83
195
127
55
18
504
19.6
27.6
30.1
34.1
32
27.6
5
23
59
43
18
5
153
28-44
45-54
55-64
65-74
75-84
85
28-44
45-54
55-64
65-74
75-84
85
577
541
321
106
1545
7.1
9.1
8.4
6.2
Total
18-34
35-44
45-54
55-64
65-74
75
Total
28-44
45-54
55-64
65-74
75-84
85
577
541
321
106
1545
7.1
9.1
8.4
6.2
PAR, population attributable risk (%)
71
Table 2.7
Age at
Exposure
(years)
Men
20-34
35-44
45-64
65
Total
Cancer cases in the South Zone health region (2012) and proportions attributable to overweight or obesity
Age at
Outcome
(years)
Esophagus
Obs.
PAR (%)
Cases
Pancreas
Obs.
Cases
PAR (%)
Colon-rectum
Obs.
PAR (%)
Cases
Obs.
Cases
Kidney
PAR (%)
Gallbladder
Obs.
PAR (%)
Cases
30-44
45-54
55-74
75
Total
7
<5
<12
33.1
32.7
<5
11
7
<23
5.5
5.7
5.7
5
11
56
27
99
14.8
17.1
17.7
17.6
<5
5
23
<5
31
14.8
17.1
17.7
17.6
<5
<5
7.2
Women
20-34
35-44
45-64
65
Total
30-44
45-54
55-74
75
Total
5
8
8
21
7.4
10
8
<5
13
45
20
82
3.9
5.6
7.6
6.1
<5
<5
7
<5
12
14
19.6
25.1
20.6
Total
20-34
35-44
45-64
65
Total
30-44
45-54
55-74
75
Total
7
<5
<12
33.2
32.7
<10
19
15
<44
6.9
7.5
6.9
<10
24
101
47
181
9.9
10.9
13.2
12.7
<5
<10
30
5
43
14.4
17.5
19.4
19.4
<5
<5
7.2
72
Table 2.7 continued Cancer cases in the South Zone health region (2012) and proportions attributable to overweight or obesity
Age at Exposure
(years)
Men
20-34
35-44
45-64
65
Total
Women
20-34
35-44
45-64
65
Total
Total
20-34
35-44
45-64
65
Total
Age at Outcome
(years)
Breast
Obs. Cases
PAR (%)
Endometrium
Obs. Cases
PAR (%)
30-44
45-54
55-74
75
Total
30-44
45-54
55-74
75
Total
30-44
45-54
55-74
75
Total
101
33
134
101
33
134
10
8
10
8
<5
5
30
10
<50
23.3
31.3
38.4
32.4
<5
5
30
10
<50
23.3
31.3
38.4
32.4
73
Table 2.8
Age at
Exposure
(years)
Men
20-34
35-44
45-64
65
Total
Observed cancer cases in the Calgary Zone health region (2012) and proportions attributable to overweight or obesity
Age at
Outcome
(years)
Esophagus
Pancreas
Obs.
PAR (%)
Cases
Colon-rectum
Obs.
PAR (%)
Cases
Obs.
Cases
Kidney
PAR (%)
Gallbladder
Obs.
PAR (%)
Cases
Obs. Cases
PAR (%)
30-44
45-54
55-74
75
Total
<5
18
8
<31
28.8
32.6
28.1
<5
5
32
27
<69
4.1
4.8
5.5
4.6
10
39
190
110
349
13.3
15.2
17.3
14.7
13
17
70
23
123
13.3
15.2
17.3
14.7
6
<5
<11
7
5.9
Women
20-34
35-44
45-64
65
Total
30-44
45-54
55-74
75
Total
<5
<5
<5
<5
16.4
22.1
27.6
-
7
37
24
68
5.7
7.5
7.1
17
46
116
99
278
3
4.3
5.7
5.4
<5
11
26
12
<54
11.2
15.3
19.6
18.3
<5
7
5
<17
25.1
31.1
28.9
Total
20-34
35-44
45-64
65
Total
30-44
45-54
55-74
75
Total
<5
5
<23
8
33
16.4
25.9
31.4
27.6
<5
12
69
51
<137
4.1
5.3
6.6
5.8
27
85
306
209
627
6.8
9.3
12.9
10.3
<18
28
96
35
<177
12.8
15.2
17.9
15.9
<5
13
<10
25
25.1
20
18.7
74
Table 2.8 continued

Age at Exposure
(years)
Men
20-34
35-44
45-64
65
Total
Women
20-34
35-44
45-64
65
Total
Observed cancer cases in the Calgary Zone health region (2012) and proportions attributable to overweight or obesity
Age at Outcome
(years)
Breast
Obs. Cases
PAR (%)
Endometrium
Obs. Cases
PAR (%)
30-44
45-54
55-74
75
Total
30-44
45-54
55-74
75
Total
385
148
533
7.5
7.1
Total
20-34
30-44
35-44
45-54
45-64
55-74
65
75
Total
Total
385
148
533
7.5
7.1
8
28
122
17
175
18.7
25.1
31.1
28.9
8
28
122
17
175
18.7
25.1
31.1
28.9
75
Table 2.9
Age at
Exposure
(years)
Men
20-34
35-44
45-64
65
Total
Observed cancer cases in the Central Zone health region (2012) and proportions attributable to overweight or obesity
Age at
Outcome
(years)
Esophagus
Pancreas
Obs.
PAR (%)
Cases
Colon-rectum
Obs.
PAR (%)
Cases
Obs.
Cases
Kidney
PAR (%)
Gallbladder
Obs.
PAR (%)
Cases
Obs. Cases
PAR (%)
30-44
45-54
55-74
75
Total
<5
<5
7
<5
<15
29.1
34.8
37.9
32.2
<5
7
11
<23
6.1
6.8
5.5
5
20
87
51
163
15.1
18.8
20.8
17.2
<5
10
21
11
<47
15.1
18.8
20.8
17.2
<5
<5
5
7.8
7
Women
20-34
35-44
45-64
65
Total
30-44
45-54
55-74
75
Total
<5
<5
31
-
<5
11
14
<30
5.1
8.7
7.8
5
54
56
115
3.8
6.6
5.9
<5
<5
13
5
24
18.4
13.7
22.3
20
<5
<5
<5
<5
22.5
34.7
31.4
Total
20-34
35-44
45-64
65
Total
30-44
45-54
55-74
75
Total
<5
<5
<12
<5
16
29.1
34.8
35.9
31
6
18
25
49
5.6
8
6.8
5
25
141
107
278
15.1
15.8
15.4
11.3
<10
<15
34
16
<75
16.2
17.4
21.4
18.1
<5
<5
<5
<10
15.1
34.7
11.9
76
Table 2.9 continued

Age at Exposure
(years)
Men
20-34
35-44
45-64
65
Total
Women
20-34
35-44
45-64
65
Total
Observed cancer cases in the Central Zone health region (2012) and proportions attributable to overweight or obesity
Age at Outcome
(years)
Breast
Obs. Cases
PAR (%)
Endometrium
Obs. Cases
PAR (%)
30-44
45-54
55-74
75
Total
30-44
45-54
55-74
75
Total
140
63
203
8.7
7.8
Total
20-34
30-44
35-44
45-54
45-64
55-74
65
75
Total
Total
140
63
203
8.7
7.8
<5
12
41
13
<71
29.3
22.5
34.7
31.4
<5
12
41
13
<71
29.3
22.5
34.7
31.4
77
Table 2.10
Age at
Exposure
(years)
Men
20-34
35-44
45-64
65
Total
Observed cancer cases in the Edmonton Zone health region (2012) and proportions attributable to overweight or obesity
Age at
Outcome
(years)
Esophagus
Obs.
PAR (%)
Cases
Pancreas
Obs.
PAR (%)
Cases
Colon-rectum
Obs.
PAR (%)
Cases
Obs.
Cases
Kidney
PAR (%)
Gallbladder
Obs.
PAR (%)
Cases
30-44
45-54
55-74
75
Total
<5
12
25
7
<49
25.3
32.1
31.4
32.4
8
21
15
44
5.5
5.4
5.6
10
35
206
109
360
12.9
17.1
16.8
17.3
6
16
52
13
87
12.9
17.1
16.8
17.3
<5
5
<10
6.9
7.1
Women
20-34
35-44
45-64
65
Total
30-44
45-54
55-74
75
Total
5
5
29
-
<5
9
31
31
<76
4.8
6.8
8
7.8
12
33
114
125
284
3.6
5.1
6.1
5.9
<5
6
24
9
<44
12.9
17.7
20.7
20.2
<5
5
<5
<15
21.2
32.5
31.8
Total
20-34
35-44
45-64
65
Total
30-44
45-54
55-74
75
Total
<5
12
30
7
<54
25.3
32.1
31.1
31.8
<5
17
52
46
<120
4.8
6.2
7
7.1
22
68
320
234
644
7.8
11.3
13
11.2
<11
22
76
22
<131
12.9
17.2
18
18.5
<5
7
9
<20
21.2
25.2
18.1
78
Table 2.10 continued Observed cancer cases in the Edmonton Zone health region (2012) and proportions attributable to overweight or obesity
Age at Exposure
(years)
Men
Age at Outcome
(years)
20-34
35-44
45-64
65
Total
30-44
45-54
55-74
75
Total
Women
20-34
35-44
45-64
65
Total
30-44
45-54
55-74
75
Total
Obs.
Cases
397
152
549
Breast
Endometrium
PAR (%)
8
7.8
Total
20-34
30-44
35-44
45-54
45-64
55-74
65
75
Total
Total
397
152
549
8
7.8
Obs. Cases
PAR (%)
8
26
98
28
160
21.2
28.1
32.5
31.8
8
26
98
28
160
21.2
28.1
32.5
31.8
79
Table 2.11 Observed cancer cases in the North Zone health region (2012) and proportions attributable to overweight or obesity
Age at
Exposure
(years)
Men
20-34
35-44
45-64
65
Total
Age at
Outcome
(years)
Esophagus
Obs.
PAR
Cases
(%)
Pancreas
Obs.
PAR
Cases
(%)
Colon-rectum
Obs.
PAR
Cases
(%)
Kidney
Gallbladder
Obs. Cases
PAR (%)
Obs. Cases
PAR (%)
30-44
45-54
55-74
75
Total
<5
6
<5
<15
36.4
37.2
32.6
<5
<5
12
5
<27
5.9
6.5
6.7
5.6
7
20
66
41
134
18.2
19.8
20.4
17.4
<5
8
22
5
<40
18.2
19.8
20.4
17.4
<5
<5
8.2
-
Women
20-34
35-44
45-64
65
Total
30-44
45-54
55-74
75
Total
<5
<5
<5
25.9
34.4
-
<5
9
8
<22
6.9
10
8.7
<5
11
48
26
<90
5.3
5.2
7.6
6.6
<5
6
11
<5
<25
18.5
18.2
25.1
22.1
<5
<5
38.3
-
Total
20-34
35-44
45-64
65
Total
30-44
45-54
55-74
75
Total
<5
<10
<5
14
33.8
36.8
32.6
<5
<5
21
13
38
5.9
6.7
8.1
7.5
<12
31
114
67
<224
15.3
14.6
15
13.2
<10
14
33
<10
63
18.3
19.1
21.9
19.5
<5
<5
<5
8.2
38.3
-
80
Table 2.11 continued Observed cancer cases in the North Zone health region (2012) and proportions attributable to overweight or obesity
Age at Exposure
(years)
Men
Age at Outcome
(years)
20-34
35-44
45-64
65
Total
30-44
45-54
55-74
75
Total
Women
20-34
35-44
45-64
65
Total
30-44
45-54
55-74
75
Total
Total
20-34
35-44
45-64
65
Total
30-44
45-54
55-74
75
Total
Obs.
Cases
95
31
126
95
31
126
Breast
Endometrium
PAR (%)
10
8.7
10
8.7
Obs. Cases
PAR (%)
<5
12
31
5
<53
29.7
29.2
38.3
34.2
<5
12
31
5
<53
29.7
29.2
38.3
34.2
81
Table 2.12 Observed cancer cases in Alberta (2012) and proportions attributable to overweight
Age at
Exposure
(years)
Men
18-34
35-44
45-54
55-64
65-74
75
Total
Women
18-34
35-44
45-54
55-64
65-74
75
Total
Age at
Outcome
(years)
Esophagus
Obs.
PAR (%)
Cases
Pancreas
Obs.
PAR (%)
Cases
Colon-rectum
Obs.
PAR (%)
Cases
Kidney
Obs.
Cases
Gallbladder
PAR (%)
Obs. Cases
PAR (%)
28-44
45-54
55-64
65-74
75-84
85
<5
20
38
25
17
6
<111
14.9
17.9
18.3
19.7
16.6
17.6
5
19
33
50
48
17
172
2.3
3.2
3.3
2.8
3.2
2.9
39
125
301
304
264
74
1107
7.5
10
10.4
9.1
10.2
9.4
28
56
109
79
48
6
326
7.5
9.1
9.4
10.2
8.4
9
<5
<5
6
12
<5
24
3.6
3.7
4.1
3.3
3.6
28-44
45-54
55-64
65-74
75-84
85
<5
<5
6
<5
<15
8.1
11.9
12.4
15.2
-
<5
26
42
54
60
25
<212
2.3
2.7
3.4
3.7
4.2
3.7
37
108
179
198
214
112
848
1.8
2
2.5
2.8
3.2
2.8
14
28
41
40
22
11
156
5.5
8.3
8.6
10.7
10.7
8.8
<5
<5
7
9
8
<5
31
9.2
13.6
14
17.2
17.2
14.4
13.5
16.9
17.2
19
16.4
16.3
<10
45
75
104
108
42
<384
2.3
2.9
3.3
3.3
3.8
3.4
76
233
480
502
478
186
1955
4.7
6.3
7.5
6.6
7
5.4
42
84
150
119
70
17
482
6.8
8.9
9.2
10.3
9.1
8.9
<5
<10
<12
15
20
<5
55
9.2
10.3
11.8
11.9
8.9
9
Total
18-34
28-44
5
35-44
45-54
<25
45-54
55-64
44
55-64
65-74
<30
65-74
75-84
17
75
85
6
Total
123
Notes:
PAR represents the proportion (%) of cancer cases attributable to overweight
Results based on overweight only
82
Table 2.12 continued Observed cancer cases in Alberta (2012) and proportions attributable to overweight
Age at Exposure
(years)
Men
18-34
35-44
45-54
55-64
65-74
75
Total
Women
18-34
35-44
45-54
55-64
65-74
75
Total
Age at Outcome
(years)
Breast
Obs. Cases
PAR (%)
Endometrium
Obs. Cases
PAR (%)
28-44
45-54
55-64
65-74
75-84
85
28-44
45-54
55-64
65-74
75-84
85
577
541
321
106
1545
3.4
3.7
4.2
3.7
Total
18-34
28-44
35-44
45-54
45-54
55-64
55-64
65-74
65-74
75-84
75
85
Total
577
541
321
106
1545
3.4
3.7
4.2
3.7
26
83
195
127
55
18
504
9.2
13.6
14
17.2
17.2
14.4
26
83
195
127
55
18
504
9.2
13.6
14
17.2
17.2
14.4
83
Table 2.13 Observed cancer cases in Alberta (2012) and proportions attributable to obesity
Age at
Exposure
(years)
Men
18-34
35-44
45-54
55-64
65-74
75
Total
Women
18-34
35-44
45-54
55-64
65-74
75
Total
Age at
Outcome
(years)
Esophagus
Pancreas
Colon-rectum
Kidney
Gallbladder
Obs. Cases
PAR (%)
Obs. Cases
PAR (%)
Obs. Cases
PAR (%)
Obs. Cases
PAR (%)
Obs. Cases
PAR (%)
28-44
45-54
55-64
65-74
75-84
85
<5
20
38
25
17
6
<111
15.3
19.9
20.3
18.4
18.8
14.8
5
19
33
50
48
17
172
1.9
2.4
2.7
3
2.5
1.7
39
125
301
304
264
74
1107
6.9
8.3
9.4
10.2
8.8
6.1
28
56
109
79
48
6
326
6.9
9.3
9.4
8.5
8.7
6.7
<5
<5
6
12
<5
24
3.5
3.5
3.1
3.2
2.4
28-44
45-54
55-64
65-74
75-84
85
<5
<5
6
<5
<15
10.6
15.8
18.3
20.5
18.1
15.1
<5
26
42
54
60
25
<212
2.3
3.2
4
5.8
4.5
2.7
37
108
179
198
214
112
848
1.7
2.4
3
4.4
3.4
2
14
28
41
40
22
11
156
6.9
10.5
12.2
13.8
12.1
10
<5
<5
7
9
8
<5
31
12.4
18.3
21.1
23.6
20.9
17.5
14.4
19.3
19.9
18.8
18.8
14.9
<10
45
75
104
108
42
<384
2
2.9
3.4
4.5
3.6
2.3
76
233
480
502
478
186
1955
4.3
5.6
7
7.9
6.4
3.6
42
84
150
119
70
17
482
6.9
9.7
10.2
10.3
9.8
8.8
<5
<10
<12
15
20
<5
55
12.4
13.4
17.2
15.4
10.3
10
Total
18-34
28-44
5
35-44
45-54
<25
45-54
55-64
44
55-64
65-74
<30
65-74
75-84
17
75
85
6
Total
123
Notes:
PAR represents the proportion (%) of cancer cases attributable to obesity
Results based on obesity only
84
Table 2.13 continued Observed cancer cases in Alberta (2012) and proportions attributable to obesity
Age at Exposure
(years)
Men
18-34
35-44
45-54
55-64
65-74
75
Total
Women
18-34
35-44
45-54
55-64
65-74
75
Total
Age at Outcome
(years)
Obs. Cases
Breast
PAR (%)
Endometrium
Obs. Cases
PAR (%)
28-44
45-54
55-64
65-74
75-84
85
28-44
45-54
55-64
65-74
75-84
85
577
541
321
106
1545
4
5.8
4.5
2.7
Total
18-34
28-44
35-44
45-54
45-54
55-64
55-64
65-74
65-74
75-84
75
85
Total
577
541
321
106
1545
4
5.8
4.5
2.7
26
83
195
127
55
18
504
12.4
18.3
21.1
23.6
20.9
17.5
26
83
195
127
55
18
504
12.4
18.3
21.1
23.6
20.9
17.5
85
Table 2.14 Cancer cases and proportions in 2012 attributable to overweight or obesity in Alberta by
age and sex
Age
Group at
Exposure
Age
Group at
Outcome
18-34
28 - 44
35-44
45 - 54
45-54
55-64
55 - 64
65 - 74
Total
Observed
Cases
Total PAR
(%)
Esophagus
Pancreas
Colon-rectum
Kidney
Gallbladder
Breast
Endometrium
5
<10
76
42
<5
24.4
4.2
8.5
12.8
19.6
26
19.6
Esophagus
Pancreas
Colon-rectum
Kidney
Gallbladder
Breast
<25
45
233
84
<5
31.2
5.6
11.1
17
20.7
Endometrium
Esophagus
Pancreas
Colon-rectum
Kidney
Gallbladder
Breast
Endometrium
83
44
75
480
150
<12
577
195
27.6
31.6
6.6
13.4
17.7
25
7.1
30.1
Esophagus
Pancreas
Colon-rectum
Kidney
Gallbladder
Breast
29
104
502
119
15
541
31.8
7.4
13.4
18.7
23.2
9.1
Endometrium
127
34.1
Cancer Site
Observed
Cases Men
Men PAR (%)

(95% CI)
Observed
Cases
Women
Women PAR (%)

(95% CI)
<5
5
39
28
-
26.3 (20.1,32.7)
4.2 (0,10.4)
13.4 (9.8,17.1)
13.4 (9.9,17.1)
-
<5
<5
37
14
<5
17.1 (12.4,22.6)
4.5 (1.9,7.4)
3.4 (2.3,4.6)
11.7 (9.3,14.3)
19.6 (5.8,37.9)
26
19.6 (17.0,22.4)
31.8 (24.9,39.1)
5.4 (0,13.5)
16.8 (12.5,21.3)
16.9 (12.5,21.3)
6.8 (1.2,12.5)
<5
26
108
28
<5
24.5 (18.1,31.4)
5.8 (2.5,9.5)
4.4 (2.9,5.9)
17.2 (13.9,20.7)
27.6 (9.7,48.6)
32.4 (25.3,39.7)
5.8 (0,14.4)
18.1 (13.6,22.7)
17.2 (12.8,21.7)
7.0 (1.3,12.9)
83
6
42
179
41
7
27.6 (24.3,31.1)
26.8 (19.8,34.3)
7.1 (3.1,11.5)
5.4 (3.6,7.3)
18.9 (15.3,22.8)
30.1 (9.7,52.7)
577
195
4
54
198
40
9
541
127
7.1 (5.3,9.0)
30.1 (26.4,34.0)
30.5 (22.7,38.6)
9.1 (3.9,14.5)
6.9 (4.7,9.4)
21.9 (17.7,26.4)
34.1 (11.5,56.8)
9.1 (6.9,11.5)
34.1 (29.7,38.4)
20
19
125
56
<5
38
33
301
109
<5
25
50
304
79
6
32.0 (24.9,39.1)
5.6 (0,13.9)
17.6 (13.1,22.4)
17.1 (12.7,21.6)
7.0 (1.3,12.7)
86
Table 2.14
Age
Age
Group at Group at
Exposure Outcome
65-74
75 84
75
85
Continued
Cancer Site
Esophagus
Pancreas
Colon-rectum
Kidney
Gallbladder
Breast
Endometrium
Esophagus
Pancreas
Colon-rectum
Kidney
Gallbladder
Breast
Endometrium
Total
Observed
Cases
17
108
478
70
20
321
55
6
42
186
17
<5
106
18
Total
PAR (%)
30.1
7.1
12.4
17.2
16.6
8.4
32.0
27.9
5.6
8.6
16.2
16.7
6.2
27.6
Observed
Cases
Men
17
48
264
48
12
30.1 (23.1,37.4)
5.6 (0,13.8)
17.3 (12.9,22.1)
15.7 (11.6,20.2)
6.3 (1.3,11.8)
6
17
74
6
<5
27.9 (21.1,35.3)
4.6 (0,11.5)
14.4 (10.3,18.7)
14.5 (10.4,18.9)
5.8 (1.0,11.1)
Men PAR (%)

(95% CI)
Observed
Cases
Women
60
214
22
8
321
55
25
112
11
<5
106
18
Women PAR
(%) (95% CI)
8.4 (3.7,13.3)
6.4 (4.3,8.5)
20.4 (16.6,24.5)
32.0 (11.8,53.9)
8.4 (6.3,10.6)
32.0 (28.0,36.2)
6.2 (2.6,10.1)
4.7 (3.2,6.4)
17.2 (13.8,21.0)
27.6 (9.5,48.4)
6.2 (4.5,8.1)
27.6 (23.7,31.6)
Notes:
This table duplicates Table 2.5, with the addition of 95% confidence intervals
87
Figure 2.1 Prevalence of overweight and obsess adults in Alberta by age group, 2000
(Canadian Community Health Survey)
88
Figure 2.2 Prevalence of overweight adults in Alberta by age group and Alberta Health
Services region, 2003 (Canadian Community Health Survey)
89
Figure 2.3 Prevalence of obese adults in Alberta by age group and Alberta Health
Services region, 2003 (Canadian Community Health Survey)
90
Figure 2.4 Cancer cases attributable to overweight or obesity and other known
and unknown cancer causes
91
CHAPTER 3
Cancer Incidence Attributable to Inadequate Physical in

92
SUMMARY
Approximately 60 75% of men and 69 78% of women in Alberta were classified as
moderately inactive or inactive. We estimate that approximately 10% and 18% of inactivity-related
cancers among men and women respectively could be attributed to sub-optimal physical activity levels
in Alberta in 2012. Site-specific results suggest that the heaviest absolute burden in terms of number of
cancer cases is seen for breast among women and for lung and colorectal among men. Approximately
14% of associated cancer could be attributed to inadequate physical activity. Overall, approximately 8%
of all cancers in Alberta in 2012 were attributable to physical inactivity in 2000-2003 (Table 3.1).
METHODS OVERVIEW
Moderate inactivity and inactivity were analyzed independently and as a combined variable
(referred to henceforth as inadequate physical activity) to calculate population attributable risks (PARs)
of cancer in Alberta. Data from the Canadian Community Health Survey (CCHS) were obtained for
prevalence estimates of physically inactive adults in Alberta. The cycle of the CCHS used corresponded
to the midpoint of the latency period suggested by cohort studies for each cancer site of interest (Table
3.2). CCHS Cycle 2.1 (2003) was used for all PAR calculations. The relative risks for the associations
between inadequate physical activity and lung, colorectal, prostate, ovarian, endometrial and postmenopausal breast cancers are shown in table 3.3.
In the CCHS, physical activity level was based on leisure time physical activity only. To estimate
average daily energy expenditure for each leisure time physical activity, the number of times a
respondent engaged in the activity each day was multiplied by the average duration of the activity. This
product was then multiplied by the energy cost (kilocalories [kcal] per kilogram [kg] of body weight per
hour) of the activity. Respondents were classified as physically active (> 3.0 kcal/kg/day), moderately
active (1.5 2.9 kcal/kg/day) or inactive (< 1.5 kcal/kg/day). In terms of cancer prevention, being in the
moderately active group is sub-optimal. Therefore, this group is referred to as moderately inactive in the
following tables and figures. The proportions of moderately inactive and inactive Albertans are shown in
Table 3.4 (Figure 3.1) and by AHS zone in Table 3.5. The prevalence of moderately inactive and inactive
Albertans by AHS zone are shown in Tables 2.2 (Figure 3.2) and 2.3 (Figure 3.3), respectively.
93
PARs associated with being either moderately inactive or inactive were calculated using the
equation below:
2.1: =
(1 1 ) + (2 2 )
1 + (1 1 ) + (2 2 )
Where 1 is the prevalence of moderate inactivity and 2 is the prevalence of inactivity. 1 and
2 denote the excess relative risks associate with moderate inactivity and inactivity, respectively. The
PARs were then multiplied by the incident cancer cases of interest in Alberta in 2012 from the Alberta
Cancer Registry. Estimates of PAR as well as the number of site-specific cancer cases attributable to
inadequate physical activity are presented in Table 3.6. PAR estimates by AHS Zone are shown in Tables
3.7 3.11. PAR estimates for moderate inactivity and inactivity separately are displayed in Tables 3.12
and 3.13, respectively. The total number of cancer cases at each site attributable to inadequate physical
activity and other causes are shown in Figure 3.4.
94
Table 3.1
Summary of cases and proportions of cancer in Alberta in 2012 attributable to inadequate physical activitya
Cancer Siteb
Prostate
Breastf
Lung
Colorectum
Endometrium
Ovary
All Associated Cancersg
All Cancersh
Total
Men
Women
Excess
Excess
Excess
Observed
%
Observed
%
Observed
%
Attributable
Attributable
Attributable
e
Casesc
Attributable
Cases
Attributable
Cases
Attributable
Casesd
Cases
Cases
2353
69
2.9
2353
69
2.9
1267
1267
221
17.4
221
17.4
1952
403
20.7
953
192
20.2
999
210
21.0
1951
315
16.1
1105
175
15.8
846
139
16.4
503
103
20.4
503
103
20.4
189
24
12.5
189
24
12.5
8215
1298
13.8
4411
437
9.9
3804
696
18.3
15836
1298
8.2
8155
437
5.4
7681
696
9.1
a. Data on prevalence of physical activity from the Canadian Community Health Survey. Respondents were classified as physically active (>
3.0 kcal/kg/day), moderately active (1.5 2.9 kcal/kg/day) or inactive (< 1.5 kcal/kg/day).
sites.
d. Number of cancer cases at individual cancer sites that can be attributed to inadequate physical activity.
e. Proportion of cancers at individual cancer sites attributable to inadequate physical activity. Calculated as excess attributable
cases/observed cases.
f. Postmenopausal breast cancer only. Defined as cancers diagnosed at age 55 or older.
g. Represents all cancers with a known association with inadequate physical activity, as listed in table.
h. Represents all incident cancers in Alberta in 2012 in all age groups.
95
Table 3.2
Exposure
Inadequate physical
activity
Cancer site
Lung
Colorectum
Prostate
Breast
Ovary
Endometrium

2.1 (2003)
2.1 (2003)
2.1 (2003)
2.1 (2003)
2.1 (2003)
2.1 (2003)
96
Table 3.3
Risk associations for risk associated with overweight/obesity by cancer sites of interest
Cancer site
Sex
Lung
All
Colorectum
All
Prostate
Men
Breast
Women
Ovary
Women
Endometrium
Women
Moderately Active
Relative
Riska
0.84
Active
0.74
Moderately Active
0.87
Active
0.76
Moderately Active
0.98
Active
0.95
Moderately Active
0.87
Active
0.75
Moderately Active
0.90
Active
0.81
Moderately Active
0.84
Active
0.70
Exposure
Source
Tardon, 2005
Wolin, 2009 and Wolin, 2011
Leitzmann, 2011 and Liu, 2011
Friedenreich, 2008 and Lynch, 2011
Olsen 2007 and Cust, 2011
Cust, 2011
Protective effects associated with engaging in 1.5-2.9 kcal/kg/day (moderately active) or 3.0 kcal/kg/day (active
of physical activity during leisure time
b
Post-menopausal only
97
Table 3.4
Prevalence of inadequate physical activity in Alberta, 2003 (Canadian Community Health Survey)
Age (years)
Men
Women
Total
Prevalence (95% CI)

Moderately Inactive
Inactive
20-34
35-49
50-64
65
21.6 (18.3,24.9)
24.4 (21.1,27.7)
28.7 (24.5,33.0)
21.0 (17.3,24.8)
37.8 (34.1,41.6)
48.8 (44.9,52.6)
46.6 (42.2,51.1)
49.4 (44.9,53.9)
20-34
35-49
50-64
65
24.6 (21.7,27.5)
24.6 (21.0,28.0)
28.5 (24.8,32.2)
22.4 (19.0,25.7)
44.7 (41.2,48.3)
44.0 (39.9,48.0)
49.3 (45.1,53.4)
56.0 (51.9,60.0)
23.1 (20.9,25.3)
24.5 (22.1,36.9)
28.6 (25.8,31.4)
21.8 (19.3,24.2)
41.2 (38.6,43.8)
46.4 (43.6,49.2)
48.0 (44.9,51.0)
53.0 (50.0,56.0)
20-34
35-49
50-64
65
98
Table 3.5
Prevalence of inadequate physical activity in Alberta by health region (zone), 2003 (Canadian Community Health Survey)
Prevalence (95% CI)
South Zone
Moderately
Inactive
Inactive
Calgary Zone
Moderately
Inactive
Inactive
Central Zone
Moderately
Inactive
Inactive
Edmonton Zone
Moderately
Inactive
Inactive
North Zone
Moderately
Inactive
Inactive
20-34
18.8
(12.6,25.1)
45.1
(35.5,54.7)
20.9
(15.4,26.3)
36.7
(30.0,43.4)
22.1
(15.3,28.9)
46.6
(38.4,54.8)
23.0
(15.6,30.3)
32.7
(25.2,40.2)
21.9
(16.1,27.8)
41.2
(34.4,48.0)
35-49
25.1
(16.5,33.7)
55.0
(44.6,65.3)
26.0
(19.9,32.0)
44.5
(37.5,51.4)
21.5
(15.2,27.8)
53.7
(45.9,61.5)
22.7
(16.2,29.3)
50.5
(42.6,58.2)
26.4
(20.3,32.5)
50.4
(43.9,56.8)
50-64
22.4
(14.0,30.9)
44.6
(33.5,55.8)
33.2
(24.3,42.1)
47.2
(38.2,56.3)
20.5
(14.2,26.9)
52.8
(44.5,61.2)
30.2
(22.5,37.8)
42.5
(34.4,50.6)
23.9
(17.8,30.1)
52.4
(45.4,59.3)
65
25.6
(16.3,34.9)
47.3
(37.6,57.0)
21.9
(14.9,29.0)
48.8
(39.8,57.8)
14.6
(10.0,19.3)
53.2
(45.7,60.8)
23.4
(15.1,31.7)
46.7
(37.3,56.2)
16.6
(10.5,22.6)
55.8
(46.4,65.2)
20-34
28.3
(20.2,36.4)
43.3
(34.1,52.5)
27.1
(21.5,32.7)
41.2
(34.7,47.7)
29.4
(22.6,36.1)
40.8
(33.9,47.7)
17.9
(13.2,22.6)
52.4
(45.4,59.4)
28.4
(22.4,34.3)
39.7
(33.5,45.8)
35-49
27.8
(16.4,39.2)
39.4
(28.6,50.1)
24.4
(18.7,30.1)
39.7
(32.7,46.6)
28.8
(21.1,36.4)
46.5
(38.9,54.2)
23.5
(15.9,31.2)
47.5
(38.8,56.1)
21.5
(16.2,26.8)
48.8
(42.1,55.5)
50-64
27.7
(18.7,36.7)
49.1
(39.0,59.2)
31.0
(23.9,38.0)
43.0
(35.2,50.9)
24.7
(19.2,30.3)
51.9
(45.3,58.4)
28.5
(21.0,36.0)
53.7
(45.4,61.9)
24.8
(19.1,30.5)
53.2
(46.4,60.1)
65
22.0
(5.6,28.4)
59.3
(51.7,66.9)
24.2
(17.1,31.4)
50.8
(42.5,59.0)
24.0
(18.3,30.0)
58.1
(51.6,64.6)
21.2
(15.1,27.3)
58.3
(50.2,66.4)
17.1
(11.1,23.2)
58.7
(50.6,66.8)
20-34
23.1
(18.0,28.2)
44.3
(37.6,51.0)
23.9
(20.0,27.8)
38.9
(34.2,43.6)
25.7
(20.9,30.5)
43.7
(38.4,49.1)
20.4
(16.0,24.8)
42.5
(37.2,47.9)
25.0
(20.9,29.2)
40.5
(35.9,45.0)
35-49
26.4
(19.3,33.6)
47.3
(39.6,54.9)
25.2
(21.0,29.4)
42.2
(37.2,47.1)
25.0
(20.0,30.0)
50.2
(44.7,55.7)
23.1
(18.1,28.1)
49.0
(43.2,54.8)
24.0
(20.0,28.1)
49.6
(45.0,54.2)
50-64
25.2
(19.0,31.5)
47.0
(39.5,54.5)
32.1
(26.4,37.8)
45.1
(39.1,51.1)
22.6
(18.4,26.8)
52.4
(47.1,57.6)
29.4
(24.0,34.7)
48.0
(42.2,53.8)
24.3
(20.2,28.5)
52.8
(47.9,57.7)
65
23.6
(18.2,29.1)
53.9
(47.8,60.0)
23.2
(18.2,28.3)
49.9
(43.8,56.0)
19.6
(15.9,23.4)
55.8
(50.9,60.8)
22.2
(17.2,27.2)
53.2
(47.0,59.3)
16.8
(12.6,21.1)
57.2
(51.1,63.4)
Age (years)
Men
Women
Total

99
Table 3.6
Observed cancer cases in Alberta (2012) and proportions attributable to inadequate physical activity
Age at
Exposure
Age at
Outcome
Men
20-34
35-49
50-64
65
Total
30-44
45-59
60-74
75
Total
13
141
468
331
953
16.9
20.4
20.3
20.1
Women
20-34
35-49
50-64
65
Total
30-44
45-59
60-74
75
Total
8
171
479
341
999
Total
20-34
35-49
50-64
65
Total
30-44
45-59
60-74
75
Total
21
312
947
672
1952
Obs.
Cases
Lung
PAR
(%)
Colorectum
Obs.
PAR
EAC
Cases
(%)
Obs.
Cases
2
29
95
67
192
37
276
454
338
1105
13.2
16.0
16.0
15.8
5
44
73
53
175
18
591
1240
504
2353
19.3
19.1
21.0
22.0
2
33
101
75
210
35
193
292
326
846
15.1
14.9
16.5
17.4
5
29
48
57
139
18.1
19.7
20.6
21.2
4
62
196
142
403
72
469
746
664
1951
14.1
15.5
16.3
16.7
10
73
121
111
315
EAC
18
591
1240
504
2353
Prostate
PAR
EAC
(%)
2.4
3.0
2.9
2.9
2.4
3.0
2.9
2.9
Obs.
Cases
Breast
PAR
(%)
EAC
Obs.
Cases
Ovary
PAR
(%)
EAC
Endometrium
Obs.
PAR
EAC
Cases
(%)
18
37
15
69
18
37
15
69
840
427
1267
17.1
18
144
77
221
15
62
64
48
189
11.7
11.5
12.8
13.5
2
7
8
6
24
25
175
230
73
503
19.3
19.1
21.0
22.0
5
33
48
16
103
840
427
1267
17.1
18
144
77
221
15
62
64
48
189
11.7
11.5
12.8
13.5
2
7
8
6
24
25
175
230
73
503
19.3
19.1
21.0
22.0
5
33
48
16
103
EAC, excess attributable risk; PAR, population attributable risk

Notes:
PAR represents the proportion (%) of cancer cases attributable to inadequate physical activity (moderately inactive and inactive)
Excess attributable cases represent the number of cases attributable to inadequate physical activity (moderately inactive and inactive)
100
Table 3.7
Age at
Exposure
Observed cancer cases in the South Zone health region (2012) and proportions attributable to inadequate physical activity
Age at
Outcome
Lung
Obs.
Cases
PAR (%)
Colorectum
Obs.
PAR (%)
Cases
Prostate
Obs.
PAR (%)
Cases
Breast
Ovary
Obs.
Cases
PAR (%)
Obs.
Cases
PAR (%)
Endometrium
Obs.
PAR (%)
Cases
Men
20-34
30-44
14.6
35-49
45-59
18
22.1
26
17.4
48
3.3
50-64
60-74
46
19
41
14.8
93
2.7
65
75
35
20.1
27
15.8
35
2.9
Total
Total
99
20-34
30-44
<5
15.2
<5
19.3
35-49
45-59
13
18.2
23
14.2
<5
11
15
18.2
50-64
60-74
38
20.8
35
16.4
82
17
12.7
20
20.8
65
75
37
22.8
20
18
33
18.7
14.1
10
22.8
Total
88
20-34
30-44
< 10
14.9
<5
19.3
35-49
45-59
31
20.2
49
15.9
48
3.3
<5
11
15
18.2
50-64
60-74
84
20
76
15.7
93
2.7
82
17
12.7
20
20.8
65
75
72
21.6
47
17
35
2.9
33
18.7
14.1
10
22.8
Total
187
99
176
Women
Total
< 83
115
< 20
< 50
Total
Total
< 182
176
115
< 20
< 50
101
Table 3.8
Age at
Exposure
Observed cancer cases in the Calgary Zone health region (2012) and proportions attributable to inadequate physical activity
Age at
Outcome
Lung
Obs.
Cases
PAR (%)
Colorectum
Obs.
PAR (%)
Cases
Prostate
Obs.
PAR (%)
Cases
Breast
Obs.
Cases
Ovary
PAR (%)
Obs.
Cases
PAR (%)
Endometrium
Obs.
PAR (%)
Cases
Men
20-34
30-44
<5
16.5
10
12.8
12
2.3
35-49
45-59
40
19.4
81
15.2
231
2.8
50-64
60-74
122
21
148
16.6
455
3.1
65
75
108
20.1
110
15.7
152
2.9
Total
Total
< 275
20-34
30-44
<5
18.6
17
14.6
11.2
18.6
35-49
45-59
60
17.8
77
13.9
23
10.7
67
17.8
50-64
60-74
127
19.6
85
15.4
295
15.9
25
11.9
83
19.6
65
75
96
20.9
99
16.4
148
17
15
12.7
17
20.9
Total
< 288
20-34
30-44
17.5
27
13.7
12
2.3
11.2
18.6
35-49
45-59
100
18.6
158
14.6
231
2.8
23
10.7
67
17.8
50-64
60-74
249
20.3
233
16
455
3.1
295
15.9
25
11.9
83
19.6
65
75
204
20.5
209
16.1
152
2.9
148
17
15
12.7
17
20.9
Total
559
349
850
Women
Total
278
443
69
175
Total
Total
627
850
443
69
175
102
Table 3.9 Observed cancer cases in the Central Zone health region (2012) and proportions attributable to inadequate physical activity
Age at
Exposure
Age at
Outcome
Lung
Obs.
Cases
PAR (%)
Colorectum
Obs.
PAR (%)
Cases
Prostate
Obs.
PAR (%)
Cases
Breast
Ovary
Obs.
Cases
PAR (%)
Obs.
Cases
PAR (%)
Endometrium
Obs.
PAR (%)
Cases
Men
20-34
30-44
19.5
15.3
<5
2.8
35-49
45-59
22
21.3
42
16.8
57
3.2
50-64
60-74
67
21
65
16.5
179
3.1
65
75
32
20.4
51
16
115
Total
Total
126
20-34
30-44
<5
18.8
<5
18.8
35-49
45-59
21
20.3
16
16
12.4
25
20.3
50-64
60-74
85
21.2
43
16.7
106
17.3
13
28
21.2
65
75
45
22.8
56
18
63
18.7
14
13
22.8
Total
< 156
20-34
30-44
< 10
19.1
15
<5
2.8
<5
18.8
35-49
45-59
43
20.8
58
16.4
57
3.2
12.4
25
20.3
50-64
60-74
152
21.1
108
16.6
179
3.1
106
17.3
13
28
21.2
65
75
77
21.7
107
17
115
63
18.7
14
13
22.8
Total
< 282
163
< 356
Women
Total
115
169
24
< 71
Total
Total
278
< 356
169
24
< 71
103
Table 3.10
Age at
Exposure
Observed cancer cases in the Edmonton Zone health region (2012) and proportions attributable to inadequate physical activity
Age at
Outcome
Lung
Obs.
Cases
PAR (%)
Colorectum
Obs.
PAR (%)
Cases
Prostate
Obs.
PAR (%)
Cases
Breast
Ovary
Obs.
Cases
PAR (%)
Obs.
Cases
PAR (%)
Endometrium
Obs.
PAR (%)
Cases
Men
20-34
30-44
<5
15.5
10
12.1
2.1
35-49
45-59
40
20.6
80
16.2
185
50-64
60-74
165
19.3
161
15.2
393
2.8
65
75
120
19.7
109
15.4
148
2.9
Total
Total
< 330
20-34
30-44
<5
20.6
12
16.1
12.5
20.6
35-49
45-59
59
19.9
59
15.6
16
12.1
46
19.9
50-64
60-74
157
22.1
88
17.5
285
18.1
21
13.6
78
22.1
65
75
134
22.5
125
17.7
152
18.4
14
13.8
28
22.5
Total
< 355
20-34
30-44
18.1
22
14.1
2.1
12.5
20.6
35-49
45-59
99
20.3
139
15.9
185
16
12.1
46
19.9
50-64
60-74
322
20.7
249
16.4
393
2.8
285
18.1
21
13.6
78
22.1
65
75
254
21.3
234
16.7
148
2.9
152
18.4
14
13.8
28
22.5
Total
680
360
731
Women
Total
284
437
56
160
Total
Total
644
731
437
56
160
104
Table 3.11 Observed cancer cases in the North Zone health region (2012) and proportions attributable to inadequate physical activity
Age at
Exposure
Age at
Outcome
Lung
Obs.
Cases
PAR (%)
Colorectum
Obs.
PAR (%)
Cases
Prostate
Obs.
PAR (%)
Cases
Breast
Obs.
Cases
Ovary
PAR (%)
Obs.
Cases
PAR (%)
Endometrium
Obs.
PAR (%)
Cases
Men
20-34
30-44
<5
17.9
14
35-49
45-59
21
21
47
16.6
70
3.1
50-64
60-74
68
21.3
39
16.7
120
3.1
65
75
36
21.3
41
16.7
54
3.2
Total
Total
< 130
20-34
30-44
<5
18.3
<5
14.4
<5
11.1
<5
18.3
35-49
45-59
18
20
18
15.7
12
12.2
22
20
50-64
60-74
72
21.6
41
17
72
17.7
13.2
21
21.6
65
75
29
22.1
26
17.4
31
18.1
13.5
22.1
Total
< 124
20-34
30-44
18.1
< 12
14.2
<5
11.1
<5
18.3
35-49
45-59
39
20.5
65
16.1
70
3.1
12
12.2
22
20
50-64
60-74
140
21.4
80
16.9
120
3.1
72
17.7
13.2
21
21.6
65
75
65
21.7
67
17.1
54
3.2
31
18.1
13.5
22.1
Total
248
134
244
Women
Total
< 90
103
< 23
< 53
Total
Total
< 224
244
103
< 23
< 53
105
Table 3.12 Observed cancer cases in Alberta (2012) and proportions attributable to moderate physical inactivity
Age at
Exposure
Age at
Outcome
Lung
Obs.
Cases
PAR (%)
Colorectum
Obs.
PAR (%)
Cases
Prostate
Obs.
PAR (%)
Cases
Breast
Ovary
Obs.
Cases
PAR (%)
Obs.
Cases
PAR (%)
Endometrium
Obs.
PAR (%)
Cases
Men
20-34
30-44
13
37
3.1
18
0.4
35-49
45-59
141
4.4
276
3.5
591
0.5
50-64
60-74
468
5.2
454
4.1
1240
0.6
65
75
331
3.8
338
504
0.4
Total
Total
953
20-34
30-44
4.5
35
3.5
15
2.7
25
4.5
35-49
45-59
171
4.5
193
3.5
62
2.7
175
4.5
50-64
60-74
479
5.1
292
4.1
840
4.1
64
3.1
230
5.1
65
75
341
4.1
326
3.2
427
3.2
48
2.4
73
4.1
Total
999
20-34
30-44
21
4.2
72
3.3
18
0.4
15
2.7
25
4.5
35-49
45-59
312
4.5
469
3.5
591
0.5
62
2.7
175
4.5
50-64
60-74
947
5.2
746
4.1
1240
0.6
840
4.1
64
3.1
230
5.1
65
75
672
664
3.2
504
0.4
427
3.2
48
2.4
73
4.1
Total
1952
1105
2353
Women
Total
846
1267
189
503
Total
Total
1951
2353
1267
189
503

Notes:
PAR represents the proportion (%) of cancer cases attributable to moderate physical inactivity
Results based on moderate inactivity only
106
Table 3.13 Cancer cases in Alberta (2012) and proportions attributable to physical inactivity
Age at
Exposure
Age at
Outcome
Lung
Obs.
Cases
PAR (%)
Colorectum
Obs.
PAR (%)
Cases
Prostate
Obs.
PAR (%)
Cases
Breast
Ovary
Obs.
Cases
PAR (%)
Obs.
Cases
PAR (%)
Endometrium
Obs.
PAR (%)
Cases
Men
20-34
30-44
13
13.9
37
10.7
18
35-49
45-59
141
17.3
276
13.4
591
2.5
50-64
60-74
468
16.6
454
12.8
1240
2.4
65
75
331
17.5
338
13.5
504
2.5
Total
Total
953
20-34
30-44
16.1
35
12.4
15
9.5
25
16.1
35-49
45-59
171
15.9
193
12.2
62
9.4
175
15.9
50-64
60-74
479
17.4
292
13.5
840
14.1
64
10.4
230
17.4
65
75
341
19.4
326
15
427
15.7
48
11.6
73
19.4
Total
999
20-34
30-44
21
15
72
11.5
18
15
9.5
25
16.1
35-49
45-59
312
16.6
469
12.8
591
2.5
62
9.4
175
15.9
50-64
60-74
947
17.1
746
13.2
1240
2.4
840
14.1
64
10.4
230
17.4
65
75
672
18.5
664
14.3
504
2.5
427
15.7
48
11.6
73
19.4
Total
1952
1105
2353
Women
Total
846
1267
189
503
Total
Total
1951
2353
1267
189
503

Notes:
PAR represents the proportion (%) of cancer cases attributable to physical inactivity
Results based on inactivity only
107
Figure 3.1 Prevalence of moderately inactive and inactive adults in Alberta by age group, 2003
108
Figure 3.2 Prevalence of moderately inactive adults in Alberta by age group and Alberta
Health Services region, 2003 (Canadian Community Health Survey)
109
Figure 3.3 Prevalence of inactive adults in Alberta by age group and Alberta Health Services
region, 2003 (Canadian Community Health Survey)
110
Figure 3.4 Cancer cases attributable to physical inactivity and other known and unknown
cancer causes
111
CHAPTER 4
Cancer Incidence Attributable to Alcohol Consumption in

112
SUMMARY
Population attributable risks for alcohol-related cancers ranged from 5% (liver) to 20% (oral
cavity/pharynx) among men and 1% (liver) to 8% (oral cavity/pharynx and larynx) among women in
Alberta. While the total number of attributable cancer cases was highest among common cancers
(colorectal, female breast), at individual cancer sites PARs were highest for upper aerodigestive tract
(oral cavity/pharynx, larynx, esophagus) cancers. Approximately 5% of alcohol-associated cancers and
2% of cancers overall in Alberta were attributable to alcohol consumption in 2012 (Table 4.1). When
results were adjusted for potential undercoverage in survey data using recorded alcohol consumption
based on Statistics Canada sales data, these proportions rose to 12% for alcohol-associated cancers and
4% of cancers in Alberta overall (Table 4.2). Estimates accounting for recorded and unrecorded
consumption are shown in Table 4.3.
METHODS OVERVIEW
Estimates of the prevalence of alcohol consumption in Alberta and within individual AHS Zones
were obtained using data from the CCHS, applying the methods described by Cancer Care Ontario.
Briefly, based on responses to three specific alcohol-related questions, individuals were categorized into
one of fifteen individual alcohol consumption categories, primarily focused on frequency of
consumption. A number of drinks per day was then assigned to each category and used to estimate
exposure in grams per day based on the standard 13.6 grams per drink in Canada. The cycle of the CCHS
used corresponded to the midpoint of the latency period suggested by prospective cohort studies for
each cancer site of interest (Table 4.4). The proportions of Albertans in each of the CCHSs 15 alcohol
consumption categories are shown in Table 4.6 and by AHS zone in Table 4.7.
The risk of cancers at individual sites associated with alcohol consumption was conceptualized
as the increase in risk per gram of alcohol consumption. Estimates of the risk association between
113
alcohol consumption and the cancer sites of interest are presented in Table 4.5. The excess relative risk
(ERR) of alcohol consumption was estimated using equation 4.1:
4.1: ( ) = exp 1
Rg = increase in risk per gram of alcohol intake

Gx = quantity of alcohol consumed (g/day) in consumption category x
Population attributable risks for alcohol consumption were estimated using equation 3.1.
3.1: =
(1 1 ) + (2 2 ) + + ( )
1 + (1 1 ) + (2 2 ) + + ( )
Where pex represents the proportion of the population in alcohol consumption category . To estimate
the total number of cancers at each site overall and by age-group and gender attributable to alcohol
consumption, PARs were applied to cancer incidence data from the Alberta Cancer Registry for 2012.
Estimates of PAR as well as the number of site-specific cancer cases attributable to alcohol consumption
are presented in Table 4.8. PAR estimates by AHS Zone are shown in Table 4.9. The total number of
cancer cases at each site attributable to alcohol consumption compared to other known and unknown
cancer causes is shown in Figure 4.1.
Previous work has demonstrated that alcohol consumption measures in population surveys can
underestimate alcohol consumption as measured by per capita consumption levels by as much as 30
70%. To examine the impact of potential underestimation of alcohol consumption in Alberta as
measured by CCHS data, two separate sensitivity analyses were performed. In the first, the coverage
rate of CCHS survey data was estimated using the method employed by Cancer Care Ontario, where
total per capita consumption based on Statistics Canada data on volume of sales of alcoholic beverages
were characterized as total recorded consumption in Alberta, as to our knowledge the proportion of
unrecorded alcohol consumption in Alberta has not been estimated. Subsequently, a second sensitivity
analysis applying the proportion of unrecorded alcohol consumption in Ontario to Alberta data was
performed, again estimating the coverage rate of CCHS data using the formula described by Cancer Care
114
Ontario. The estimated coverage rates were then used to adjust estimates of the prevalence of alcohol
consumption used in the estimation of PARs (see Appendix A).
115
Table 4.1
Summary of cases and proportions of cancer in Alberta adults in 2012 attributable to alcohol consumptiona
Cancer Siteb
Observed
Casesc
Breast
Larynx
Colorectum
Liver
Esophagus
Oral Cavity/Pharynx
2322
76
1951
217
183
373
All Associated Cancersf
5122
Total
Men
Women
Excess
Excess
Excess
%
Observed
%
Observed
%
Attributable
Attributable
Attributable
Attributablee Casesc
Attributablee Casesc
Attributablee
d
d
d
Cases
Cases
Cases
69
3
2322
69
3
9
11.4
64
8
12.8
12
1
4.4
108
5.5
1105
83
7.5
846
25
2.9
9
4.1
148
8
5.1
69
1
2
21
11.3
151
19
12.6
32
2
5.3
62
16.6
273
54
9.9
100
8
7.6
278
5.4
1780
172
9.7
3381
106
3.1
All Cancersg
15836
278
1.7
8155
172
2.1
7681
106
1.4
a. Alcohol consumption in Alberta by age-sex group assessed using data from the Canadian Community Health Survey.
sites.
d. Number of cancer cases at individual cancer sites that can be attributed to alcohol consumption.
e. Proportion of cancers at individual cancer sites attributable to alcohol consumption. Calculated as excess attributable cases/observed
cases.
f. Represents all cancers with a known association with alcohol consumption, as listed in table.
g. Represents all incident cancers in Alberta in 2012 in all age groups.
116
Table 4.2
Summary of cases and proportions of cancer in Alberta adults in 2012 attributable to recorded alcohol consumptiona
Cancer Site
Observed
Casesc
Breast
Larynx
Colorectum
Liver
Esophagus
Oral Cavity/Pharynx
2322
76
1951
217
183
373
5122
Total
Excess
%
Attributable
e
Attributable
Casesd
150
6.5
19
25.2
236
12.1
19
8.8
47
25.6
146
39
617
12
Men
Women
Excess
Excess
Observed
%
Observed
%
Attributable
Attributable
e
c
e
Casesc
Attributable
Cases
Attributable
Casesd
Casesd
2322
150
6.5
64
18
28
12
1
10
1105
182
16.5
846
54
6.4
148
16
10.9
69
3
4.3
151
43
28.5
32
4
12
273
127
46.6
100
18
18.4
1780
386
21.7
3381
230
6.8
All Cancersg
15836
617
3.9
8155
386
4.7
7681
230
3.0
a. Alcohol consumption in Alberta by age-sex group assessed using data from the Canadian Community Health Survey, adjusted for survey
undercoverage using Statistics Canada alcohol sales data.
sites.
cases.
117
Table 4.3
Summary of cases and proportions of cancer in Alberta adults in 2012 attributable to recorded and unrecorded alcohol
consumptiona
Cancer Siteb
Observed
Casesc
Breast
Larynx
Colorectum
Liver
Esophagus
Oral Cavity/Pharynx
2322
76
1951
217
183
373
5122
Total
Excess
%
Attributable
Attributablee
Casesd
183
7.9
23
30.6
288
14.7
23
10.6
58
31.8
181
48.5
756
14.8
Men
Women
Excess
Excess
Observed
%
Observed
%
Attributable
Attributable
c
e
c
Cases
Attributable
Cases
Attributablee
Casesd
Casesd
2322
183
7.9
64
22
34.1
12
1
12.4
1105
222
20.1
846
66
7.8
148
19
13.2
69
4
5.2
151
53
35.3
32
5
15
273
157
57.6
100
24
23.6
1780
474
26.6
3381
283
8.4
All Cancersg
15836
756
4.8
8155
474
5.8
7681
283
3.7
a. Alcohol consumption in Alberta by age-sex group assessed using data from the Canadian Community Health Survey, adjusted for survey
undercoverage using Statistics Canada alcohol sales data and unrecorded alcohol consumption as an additional 19.5% of recorded
consumption, as estimated in Ontario by Macdonald et. al., 1999 .
sites.
cases.
118
Table 4.4
Exposure
Alcohol consumption
Cancer site
Oral cavity/pharynx
Larynx
Esophagus
Liver
Colon-rectum
Breast

1.1 (2000/2001)
2.1 (2003)
1.1 (2000/2001)
2.1 (2003)
1.1 (2000/2001)
1.1 (2000/2001)
119
Table 4.5
Risk associations for risk associated alcohol consumption
Cancer site
Sex
Exposure
Relative Riska
Source
Oral cavity/pharynx
All
1 gram/day consumption
0.018
Corrao, 2004
Larynx
All
0.014
Corrao, 2004
Esophagus
All
0.013
Corrao, 2004
Liver
All
0.006
Corrao, 2004
Colon-rectum
All
0.008
Breast
Women
0.007
Cho et al., 2004

Moskal et al., 2007
Ferrari et al., 2007
WCRF, 2007
CGHFBC, Collaborative Group on Hormonal Factors in Breast Cancer

a
The increase in risk per gram of alcohol consumption
120
Table 4.6
Proportion of Alberta Adults (%) in each alcohol consumption category by sex, 2000/2001(Canadian Community Health Survey)
Consumption Category
Prevalence (95% CI)
Men
35.5 (33.7,37.2)
Women
30.7 (29.1,32.3)
2. Drank during past week: average 1 - 2 drinks/day
1.8 (1.3,2.3)
1.1 (0.7,1.5)
0.2 (0,0.3)
0 (0,0.1)
0.3 (0.1,0.5)
0.2 (0,0.4)
5. Drank during past week: average 4 drinks/day

6. No drinking past week but drank during past year 1 time/month
4.1 (3.4,4.7)
5.5 (4.7,6.2)
4.4 (3.4,5.3)
1.4 (1.0,1.8)
14.0 (12.8,15.1)
9.4 (8.1,10.7)
8. No drinking past week but drank during past year 2 - 3 times/month

9. No drinking past week but drank during past year 1 time/week
10. No drinking past week but drank during past year 2 - 3 times/week
12.3 (11.0,13.5)
4.0 (3.3,4.7)
1.9 (1.4,2.5)
4.7 (4.0,5.5)
1.0 (0.6,1.3)
0.5 (0.2,0.7)
2.1 (1.6,2.6)
0.3 (0.1,0.5)
12.2 (11.0,13.5)
21.5 (20,23.0)
13. Has had 1 drink in lifetime: used to regularly drink >12 drinks/week
14. Has had 1 drink in lifetime: did not regularly drink 12 drinks/week
5.1 (4.4,5.9)
4.9 (4.1,5.6)
6.2 (5.4,7.1)
4.8 (4.1,5.6)
15. Lifetime abstainers
3.0 (2.4,3.5)
2.5 (1.9,3.0)
1. Drank during past week: average 1 drink/day
12. No drinking past week but drank during past year everyday
121
Table 4.7
Proportion of Alberta Adults (%) in each alcohol consumption category by health region, 2000/2001(Canadian Community Health Survey)
Men
Women
South
Calgary
Prevalence (95% CI)

Central
29.8 (24.9,34.8)
9.5 (6.6,12.3)
5.0 (2.9,7.1)
2.2 (0.8,3.6)
3.4 (0.8,5.9)
10.6 (7.5,13.7)
4.8 (2.9,6.7)
5.5 (3.2,7.9)
2.4 (1.3,3.5)
1.5 (0.6,2.5)
0.6 (0,1.5)
0 (0,0)
5.1 (2.6,7.6)
9.2 (5.8,12.6)
4.6 (2.3,7.0)
37.2 (33.4,41.1)
13.9 (11.1,16.8)
5.2 (3.6,6.7)
1.5 (0.6,2.4)
2.3 (1.1,3.5)
7.2 (5.5,9.0)
5.1 (3.4,6.7)
5.5 (3.5,7.6)
2.7 (1.3,4.2)
2.6 (1.0,4.1)
0.2 (0,0.4)
0.1 (0,0.4)
3.0 (1.8,4.1)
5.7 (3.6,7.8)
3.1 (1.9,4.3)
37.2 (33.1,41.3)
9.8 (7.3,12.5)
5.6 (3.8,7.4)
0.9 (0.3,1.6)
1.6 (0.7,2.5)
8.6 (6.4,10.7)
6.8 (4.5,9.1)
4.3 (2.7,5.8)
4.1 (2.2,5.9)
1.1 (0.5,1.7)
0.2 (0,0.5)
0.5 (0,1.0)
5.2 (3.2,7.3)
7.3 (5.5,9.2)
2.1 (1.1,3.0)
36.1 (31.9,40.3)
10.3 (8.0,12.6)
3.4 (2.1,4.7)
2.2 (1.0,3.5)
2.5 (0.6,4.4)
9.0 (6.9,11.2)
5.7 (3.4,8.0)
4.1 (2.8,5.4)
3.9 (2.2,5.7)
3.7 (1.7,5.8)
0.3 (0,0.7)
0.5 (0,1.2)
3.4 (1.6,5.2)
8.0 (5.5,10.4)
3.3 (1.8,4.9)
33.2 (29.7,36.7)
12.6 (9.9,15.1)
3.9 (2.4,5.3)
1.4 (0.7,2.1)
1.9 (1.0,2.8)
9.9 (8.0,11.8)
6.4 (4.4,8.4)
3.2 (2.1,4.2)
3.8 (2.5,5.2)
3.1 (1.7,4.5)
0.4 (0,0.9)
0.8 (0.1,1.4)
3.4 (2.4,4.5)
7.4 (5.5,9.3)
2.7 (1.5,3.9)
22.2 (18.5,25.9)
5.4 (3.4,7.4)
0.7 (0,1.5)
0.1 (0,0.3)
0.3 (0,0.8)
1.7 (12.8,19.4)
9.5 (5.9,13.1)
6.5 (3.6,9.5)
2.9 (1.5,4.3)
1.2 (0.3,2.2)
0 (0,0.1)
0.1 (0,0.4)
0.7 (0.2,1.2)
14.6 (11.4,17.9)
13.6 (9.4,17.8)
36.0 (32.5,39.6)
6.6 (4.8,8.3)
1.5 (0.5,2.4)
0.4 (0.1,0.7)
0 (0,0)
15.5 (13.0,18.1)
6.7 (4.8,8.6)
4.9 (3.0,6.7)
2.2 (1.3,3.1)
1.4 (0.6,2.2)
0.1 (0,0.3)
0.3 (0,0.6)
1.3 (0.5,2.0)
11.8 (9.3,14.3)
8.1 (6.0,10.2)
30.4 (27.0,33.9)
4.3 (2.7,5.9)
0.9 (0.4,1.5)
0 (0,0)
0.3 (0,0.6)
22.1 (18.9,25.2)
6.3 (4.7,8.0)
4.6 (3.1,6.2)
2.6 (1.5,3.6)
0.6 (0.1,1.2)
0.1 (0,0.3)
0.1 (0,0.2)
2.0 (1.2,2.9)
16.4 (13.7,19.2)
6.0 (4.3,7.7)
31.2 (27.4,35.0)
3.7 (2.2,5.2)
0.9 (0.3,1.4)
0.5 (0,1.5)
0.1 (0,0.2)
16.2 (13.2,19.3)
8.1 (5.8,10.3)
5.3 (3.6,7.0)
2.1 (1.1,3.1)
1.7 (0.7,2.6)
0.1 (0,0.3)
0.5 (0,1.2)
1.6 (0.7,2.6)
13.3 (10.9,15.8)
9.8 (6.8,12.7)
29.6 (26.3,32.9)
2.4 (1.7,3.1)
1.0 (0,2.1)
0.2 (0,0.4)
0.2 (0,0.4)
21.7 (18.8,24.7)
6.7 (4.8,8.6)
4.6 (3.2,5.9)
4.6 (2.8,6.4)
1.2 (0.3,2.0)
0 (0,0.1)
0.2 (0,0.4)
2.6 (1.4,3.9)
17.5 (14.9,20.1)
5.5 (3.8,7.3)
Edmonton
North
122
Table 4.8
Age at
Exposure
(years)
Observed cancer cases in Alberta (2012) and proportions attributable to alcohol consumption
Age at
Outcome
(years)
Larynx
<5
41
69
37
<152
18.4
14.2
12.4
10.5
<5
6
9
4
<24
24
119
96
34
273
27.5
20.9
18.3
15.8
7
25
18
5
54
35
4.2
1
<5
2.5
0
<5
<5
5.3
0
193
4.1
8
17
2.2
0
9
6
5.2
0
292
3.2
9
32
2.2
1
15
5
3.3
0
326
1.9
6
18
1.4
0
7
<16
0
846
25
<72
1
<36
EAC, excess attributable risk; PAR, population attributable risk; Total Obs. Cases, total observed cases
6.9
6.9
5.2
3.1
0
1
1
0
2
12
22
34
32
100
10.3
10.3
7.6
4.6
1
2
3
1
8
Women
20-34
35-49
50-64
65
Total
30-44
45-59
60-74
75
Total
Notes:
<5
18
37
7
<67
19.4
13.2
13
8.6
0
2
5
1
8
37
276
454
338
1105
11
8.6
7.5
6.3
EAC
4
24
34
21
83
<5
58
54
34
<151
Oral Cavity and

Pharynx
Total
PAR
Obs.
EAC
(%)
Cases
0
3
3
1
8
30-44
45-59
60-74
75
Total
EAC
PAR
(%)
Total
Obs.
Cases
Esophagus
EAC
PAR
(%)
Total
Obs.
Cases
Liver
Total
Obs.
Cases
Men
20-34
35-49
50-64
65
Total
Total
Obs.
Cases
Colon-rectum
PAR
(%)
7.9
5.5
5.5
3.6
PAR
(%)
EAC
Breast
Total
Obs.
Cases
257
798
840
427
2322
PAR represents the proportion (%) of cancer cases attributable to alcohol consumption
Excess attributable cases represent the number of cases attributable to alcohol consumption
Results adjusted for recorded and unrecorded alcohol consumption are presented in Appendix A (Tables A7 and A8)
Results by zone are included in Table 4.6
123
PAR
(%)
3.7
3.6
2.8
1.7
EAC
9
29
23
7
69
Table 4.9
Observed cancer cases in Alberta (2012) and proportions attributable to alcohol consumption by health region
Health Region
South
Age at Exposure
(years)
Larynx
Age at Outcome
(years)
20-34
30-44
35-49
45-59
50-64
60-74
65
75
Total
Total
Calgary
20-34
30-44
35-49
45-59
50-64
60-74
65
75
Total
Total
Central
20-34
30-44
35-49
45-59
50-64
60-74
65
75
Total
Total
Edmonton
20-34
30-44
35-49
45-59
50-64
60-74
65
75
Total
Total
North
20-34
30-44
35-49
45-59
50-64
60-74
65
75
Total
Total
Liver
Total Observed Cases
PAR (%)
PAR (%)
<5
<5
0
<5
6
17
<5
<28
<5
<5
<5
<5
<10
7
14
5
26
<5
<5
7
<5
<15
11.8
8
5.2
5
5
<5
<15
<5
25
39
19
<88
<5
7
8
5
<25
<5
27
26
14
<72
11
8
10
29
4.8
3.3
2.1
10.5
9.9
6.8
10.7
9
9.5
5
7.9
8.4
6.4
12.4
11.1
7.2
3.4
5.2
4.3
4.2
2.8
4.3
3.8
4
2.1
6.2
3.2
3.5
2.7
4.7
3
1.4
Note: Data by Zone only available for larynx and liver, as CCHS data prior to 2003 did not include data on the current AHS Zones
124
Figure 4.1
Cancer cases attributable to alcohol consumption and other known and unknown cancer causes
125
CHAPTER 5
Cancer Incidence Attributable to Insufficient Fruit and

Vegetable Consumption in Alberta, Canada in 2012
126
SUMMARY
Approximately 70 75% of men and 48 53% of women in Alberta do not consume the 5
servings per day of fruit and vegetables recommended by the World Cancer Research Fund for cancer
prevention. In Alberta, PARs for cancer related to insufficient fruit and vegetable consumption ranged
from 4.1% (lung) to 41.9% (esophagus) for men and from 2.5% (lung) to 30.9% (esophagus) for women.
Overall, approximately 10.2% of fruit and vegetable-associated cancers and 1.8% of cancers overall in
Alberta in 2012 could be attributed to insufficient fruit and vegetable consumption (Table 5.1).
METHODS OVERVIEW
Population attributable risks (PARs) of cancer associated with low fruit and vegetable intake in
Alberta were calculated by assessing fruit and vegetable intake separately and then combining these
into one overall estimate of PAR. Data from the Canadian Community Health Survey (CCHS) were used
to characterize fruit and vegetable consumption patterns among Albertans. Latency periods were
selected for each individual cancer site on the basis of follow-up periods from published cohort studies
deemed to be of high quality and the midpoint of the latency period suggested by these cohort studies
was chosen. The selected cycle of CCHS data for each cancer site of interest is shown in Table 5.2. As
increased fruit and vegetable consumption is protective with respect to cancer risk, the relative risks
shown in Table 5.3 were converted to measures of increased risk per 1 gram deficit per day in fruit and
vegetable consumption using to equation 5.1, where these excess risks are also shown in Table 5.3.
5.1: =
1
ln
x = exposure level (grams per day)
RRx = relative risk for x grams per day
Using data from the CCHS, total vegetable consumption was estimated by combining the
number of times individuals reported consuming green salad, carrots and other vegetables not including
salad, carrots or potatoes. Total fruit consumption was also estimated from CCHS data as the number of
times individuals reported consuming fruit and fruit juice. For fruit juice specifically, any reported
frequency of consumption of fruit juice was equivalent to one serving of fruit, as suggested by previous
literature. As the CCHS asks participants how many times per day they consume each type of
fruit/vegetable product, for the purposes of our analysis each reported instance of consumption was
approximated as one serving. The deficit in fruit and vegetable consumption relative to the 5 servings
(400g) recommended by the World Cancer Research Fund (WCRF) was then calculated. First, the mean
127
number of servings of each of fruits and vegetables consumed by men and women in each of four age
groups (20 34, 35 49, 50 64, 65+) was calculated for each year of survey data used in this analysis.
The ratio between fruit and vegetable consumption in these groups was then used to partition the 5
servings indicated necessary for cancer prevention by the WCRF guideline to preserve the ratios
observed in the CCHS prevalence data. To accomplish this, the ratio between the guideline of 5 servings
of fruits and vegetables and the total number of servings of fruit and vegetables consumed within each
age/sex group (calculated by summing the mean totals for fruits and vegetables) in the CCHS data was
estimated. The CCHS mean consumption level for each of fruit and vegetables in each age/sex group
was then multiplied by this ratio to estimate the level of consumption of each that would be consistent
with the guideline level. These values were converted into grams by multiplying the number of servings
by 80g per serving, corresponding to the WCRF guideline where 5 servings is equivalent to 400g.
Combined fruit and vegetable consumption was then classified into seven categories based on the total
number of servings of fruits and vegetables reported to be consumed per day (0,<1, <2, <3, <4, <5, 5).
The proportion of the population in each category within each age/sex group was then estimated and
the deficit in grams from the guideline level of consumption for each of fruit and vegetables was
estimated by subtracting the CCHS mean level of consumption in grams within each consumption
category from the guideline amount.
The proportion of Albertans in each of the seven consumption categories for 2007 CCHS data is
shown in Table 4.4. Additional data tables for other CCHS survey years are available in Appendix B.
Figure 5.1 shows the prevalence of Albertans who do and do not meet the recommended 5 servings of
fruit and vegetables each day in 2007, the most frequently used year of CCHS data. Figures 5.2 5.5
show the same information by Alberta Health Services zone for the years 2007 and 2003, the two most
commonly used years of CCHS data to allow comparison across two time points.
Population attributable risks (PARs) associated with fruit and vegetable consumption were
estimated individually for each of oral cavity and pharynx, oesophagus, stomach, larynx and lung (fruit
only) cancers. Excess relative risks were estimated for fruit and vegetable consumption separately,
incorporating both the relative risk for a deficit of 1g per day of fruit and vegetable consumption in
Table 5.3 and deficit in consumption relative to the WCRF guideline within each of the consumption
categories shown in Tables 5.4 and 5.5. The benefits of fruit and vegetable consumption were
considered multiplicative and thus a combined estimate of excess relative risk was estimated by
multiplying the individual excess relative risk values for fruit and vegetables within each consumption
category together.
128
These combined RR estimates were then used to estimate PARs within each age/sex group
according to equation 5.2, where represents the proportion of individuals in each consumption
category as shown in Tables 5.3 and 5.4, while represents the estimated values of excess relative
risk for each consumption category.

5.2: =
(1 1 ) + (2 2 ) + + ( )
1 + (1 1 ) + (2 2 ) + + ( )
To estimate the total number of cancers at each site overall and by age-group and gender
attributable to insufficient fruit and vegetable consumption, PARs were applied to cancer incidence data
obtained from the Alberta Cancer Registry for 2012. Estimates of PAR and excess attributable cancer
cases for Alberta and for individual AHS Zones are shown in Tables 5.6 5.11. Table 5.12 shows
estimates of PAR for Alberta similar to Table 5.6 including 95% confidence intervals to demonstrate the
precision of our estimates. The total number of cancer cases at each site attributable to insufficient fruit
and vegetable consumption and other known and unknown cancer causes are shown in Figure 5.6.
129
Table 5.1
Summary of cases and proportions of cancer in Alberta adults in 2012 attributable to insufficient fruit and vegetable consumptiona
Cancer Siteb
Observed
Casesc
Lung
Esophagus
Oral Cavity/Pharynx
Stomach
Larynx
1952
183
373
254
76
2838
Total
Men
Women
Excess
Excess
Excess
%
Observed
%
Observed
%
Attributable
Attributable
Attributable
e
c
e
c
e
Attributable
Cases
Attributable
Cases
Attributable
Casesd
Casesd
Casesd
64
3.3
953
39
4.1
999
25
2.5
73
40
151
63
41.9
32
10
30.9
92
24.7
273
83
30.4
100
9
8.9
47
18.6
158
36
22.5
96
12
12.1
14
18.2
64
12
19.2
12
2
12.8
290
10.2
1599
233
14.6
1239
57
4.6
All Cancersg
15836
290
1.8
8155
233
2.9
7681
57
0.7
a. Fruit and vegetable consumption estimated using data from the Canadian Community Health Survey (CCHS). Vegetable consumption
was calculated as the number of times per day individuals reported consuming each of green salad, carrots and other vegetables not
including salad, carrots or potatoes. Fruit consumption was characterized as the number of times individuals reported consuming fruit
and fruit juice (maximum on serving for fruit juice consumption). Each reported time of consumption in the CCHS data was
approximated as one serving, where insufficient fruit and vegetable consumption was defined as consuming less than 5 servings per day
of fruit and vegetables combined.
sites.
d. Number of cancer cases at individual cancer sites that can be attributed to overweight/obesity.
e. Proportion of cancers at individual cancer sites attributable to overweight/obesity. Calculated as excess attributable cases/observed
cases.
f. Represents all cancers with a known association with overweight/obesity, as listed in table.
130
Table 5.2
Predetermined latency periods by cancer site and cycle of prevalence data used for
population attributable risk calculations
Exposure
Vegetables
Cancer site

Larynx
Esophagus
Stomach
Fruit
Larynx
Esophagus
Stomach
Lung

2007/2008
2007/2008
3.1 (2005)
2.2 (2004)/3.1 (2005) for zone specific data
2007/2008
2007/2008
2.1 (2003)
2.1 (2003)
2.1 (2003)
131
Table 5.3
Risk associations for risk associated with fruit and vegetables consumption by cancer
sites of interest
Sex
RR Estimate
Units
Risk per gram

per day
Source
Oral cavity and

pharynx
All
0.89
40 g/day
0.00291
Boeing, 2006
Oral cavity and

pharynx
Men
0.83
40 g/day
0.00466
Boeing, 2006
Oral cavity and

pharynx
Women
0.93
40 g/day
0.00181
Boeing, 2006
Larynx
All
0.92
100 g/day
0.000834
Riboli, 2003
Esophagus
All
0.87
50 g/day
0.00279
WCRF, 2007
Stomach
All
0.70
100 g/day
0.00357
WCRF, 2007
Stomach
Men
0.70
100 g/day
0.00357
WCRF, 2007
Stomach
Women
0.77
100 g/day
0.00261
WCRF, 2007
Oral cavity and

pharynx
All
0.97
40 g/day
0.000761
Boeing, 2006
Oral cavity and

pharynx
Men
0.96
40 g/day
0.00102
Boeing, 2006
Oral cavity and

pharynx
Women
0.98
40 g/day
0.00051
Boeing, 2006
Larynx
All
0.73
100 g/day
0.00315
Riboli, 2003
Esophagus
All
0.56
100 g/day
0.00580
WCRF, 2007
Stomach
All
0.95
100 g/day
0.000513
WCRF, 2007
Lung
All
0.94
80 g/day
0.00084
WCRF, 2007
Cancer Site
Vegetables
Fruit
132
Table 5.4
Prevalence (%) of Albertans and 95% confidence intervals in each category of fruit and vegetable consumption for CCHS data
collected in 2007*
20 - 34
35 49
50 64
65
0 servings
0.3 (0.0, 0.8)
0.2 (0.0, 0.4)
0.4 (0.1, 0.7)
0 (0, 0)
<1 serving
0.9 (0.4, 1.4)
1.9 (1.0, 2.7)
1.9 (0.9, 3.0)
0.4 (0.1, 0.7)
Prevalence (95% Confidence Intervals)

<2 servings
<3 servings
<4 servings
9.9 (7.6, 12.3)
22.6 (18.7, 26.6)
21.6 (18.3, 24.8)
9.9 (6.9, 12.8)
18.6 (15.7, 21.5)
26.0 (22.1, 29.9)
7.7 (5.7,9.8)
19.4 (15.6, 23.2)
22.7 (19.0, 26.3)
7.4 (5.2, 9.7)
17.4 (13.9, 20.9)
23.9 (19.5, 28.4)
<5 servings
15.9 (12.7, 19.0)
17.5 (14.6, 20.5)
17.5 (13.2, 21.8)
22.4 (17.6, 27.2)
5 servings
28.8 (25.2, 32.5)
25.9 (22.2, 29.7)
30.4 (26.1, 34.8)
28.4 (23.7, 33.1)
20 - 34
35 49
50 64
65
0.1 (0.0,0.4)
0.02 (0.0,0.0)
0.04 (0.0, 0.1)
0 (0.0,0.0)
1.2 (0.2, 2.2)

0.6 (0.2, 1.1)
1.7 (0.8, 2.7)
1.2 (0.3, 2.0)
5.8 (4.1, 7.5)

4.5 (2.9, 6.1)
3.8 (2.3, 5.3)
3.2 (2.1 ,4.4)
15.3 (12.2, 18.5)

17.1 (14.1, 20.2)
16.3 (13.4, 19.2)
16.1 (13.3, 18.9)
50.6 (46.6, 54.6)

47.4 (43.4, 51.4)
51.5 (47.3, 55.8)
46.8 (42.6, 51.0)
Sex
Age
Men
Women
11.1 (8.8, 13.3)

12.1 (9.7, 14.6)
9.9 (7.1, 12.8)
10 (7.3, 12.7)
15.9 (13.4, 18.5)

18.2 (14.6, 21.8)
16.7 (13.8, 19.6)
22.7 (18.9, 26.4)

*Similar tables for other CCHS Survey Years shown in Appendix B
133
Table 5.5
Sex
Prevalence (%) of Albertans and 95% confidence intervals in each category of fruit and vegetable consumption for CCHS data
collected in 2007 by AHS Zone
Age
Prevalence (95% Confidence Intervals)

<2 servings
<3 servings
<4 servings
0 servings
<1 serving
0.0 (0.0,0.0)
0.2 (0.0,0.6)
1.2 (0.0,3.4)
0.0 (0.0,0.0)
3.5 (0.3,6.7)
3.7 (0.0,8.7)
2.1 (0.0,4.3)
1.1 (0.0,3.0)
13.3 (8.2,18.4)
6.9 (1.9,11.9)
11.9 (5.8,17.9)
10.5 (5.3,15.7)
25.6 (17.2,34.0)
20.5 (12.1,28.9)
19.7 (11.6,27.8)
14.6 (8.2,21.1)
20 - 34
35 49
50 64
65
0.0 (0.0,0.0)
0.0 (0.0,0.0)
0.0 (0.0,0.0)
0.0 (0.0,0.0)
0.2 (0.0,0.6)
2.6 (0.0,5.4)
4.2 (0.0,10.2)
0.1 (0.0,0.3)
6.2 (0.0,12.6)
5.2 (1.9,8.5)
4.6 (1.2,8.0)
5.5 (2.3,8.7)
Calgary Zone
Men
20 - 34
35 49
50 64
65
0.6 (0.0,1.8)
0.2 (0.0,0.5)
0.6 (0.0,1.8)
0.0 (0.0,0.0)
0.4 (0.0,0.9)
1.4 (0.3,2.4)
0.5 (0.0,1.4)
0.0 (0.0,0.0)
20 - 34
35 49
50 64
65
0.0 (0.0,0.0)
0.0 (0.0,0.0)
0.0 (0.0,0.0)
0.0 (0.0,0.0)
Central Zone
Men
20 - 34
35 49
50 64
65
South Zone
Men
20 - 34
35 49
50 64
65
Women
Women
Women
20 - 34
35 49
50 64
65
<5 servings
5 servings
19.9 (12.5,27.3)
27.8 (16.8,38.9)
34.5 (24.1,44.8)
25.5 (17.8,33.2)
15.5 (8.6,22.4)
15.7 (7.9,23.6)
10.5 (5.5,15.6)
24.2 (15.9,32.5)
22.2 (15.2,29.2)
25.2 (16.7,33.7)
20.1 (11.9,28.3)
24.1 (16.5,31.6)
12.8 (6.5,19.1)
9.6 (4.7,14.5)
11.2 (6.2,16.2)
9.6 (5.6,13.5)
18.4 (11.5,25.2)
20.8 (12.0,29.5)
9.6 (5.7,13.6)
19.2 (12.9,25.5)
11.6 (6.4,16.8)
14.3 (6.8,21.8)
20.4 (13.9,26.8)
20.1 (14.5,25.8)
50.8 (41.4,60.2)
47.5 (37.9,57.2)
49.9 (41.1,58.6)
45.5 (38.2,52.8)
8.0 (3.9,12.2)
11.4 (5.9,17.0)
6.5 (2.6,10.5)
6.4 (2.3,10.5)
22.1 (14.7,29.5)
16.1 (11.5,20.6)
16.2 (10.2,22.2)
14.6 (8.2,20.9)
25.9 (19.4,32.4)
27.5 (21.0,34.0)
21.7 (15.0,28.3)
29.2 (18.8,39.5)
16.4 (10.8,22.1)
18.7 (13.4,24.0)
19.4 (10.1,28.8)
23.8 (13.4,34.1)
26.5 (20.4,32.5)
24.8 (18.1,31.5)
35.0 (26.2,43.8)
26.1 (17.3,34.9)
1.3 (0.0,3.6)
0.0 (0.0,0.1)
1.2 (0.0,2.3)
1.0 (0.0,2.3)
4.6 (1.9,7.3)
2.2 (0.0,4.4)
2.0 (0.2,3.7)
2.4 (0.4,4.5)
8.7 (4.8,12.5)
11.0 (7.0,14.9)
10.7 (4.5,16.9)
12.5 (6.0,19.1)
16.1 (11.5,20.7)
21.6 (14.3,29.9)
18.5 (12.5,24.4)
27.6 (19.4,35.8)
16.7 (10.4,23.1)
17.7 (11.9,23.4)
14.2 (9.6,19.0)
13.2 (8.3,18.2)
52.8 (45.0,60.1)
47.6 (40.2,54.9)
53.5 (45.1,62.0)
43.2 (35.0,51.5)
0.0 (0.0,0.0)
0.1 (0.0,0.4)
0.4 (0.0,0.8)
0.0 (0.0,0.0)
0.8 (0.0,1.9)
0.6 (0.0,1.7)
2.3 (0.3,4.4)
1.0 (0.0,2.2)
10.7 (6.1,15.2)
5.7 (2.8,8.7)
6.1 (1.9,10.2)
8.7 (3.8,13.6)
17.9 (11.0,24.9)
21.3 (13.3,29.3)
14.7 (8.9,20.5)
19.0 (13.0,24.9)
25.7 (17.7,33.7)
17.9 (10.2,25.7)
28.0 (17.9,38.1)
24.5 (17.6,31.4)
13.3 (6.8,19.8)
22.7 (15.1,30.4)
16.6 (10.6,22.5)
21.8 (15.1,28.6)
31.6 (22.8,40.3)
31.6 (21.4,41.7)
32.0 (23.5,40.5)
25.0 (17.3,32.8)
0.0 (0.0,0.0)
0.0 (0.0,0.0)
0.0 (0.0,0.0)
0.0 (0.0,0.0)
1.2 (0.0,3.1)
0.9 (0.0,2.4)
2.7 (0.0,6.2)
0.3 (0.0,0.9)
6.3 (2.3,10.3)
8.2 (2.5,14.0)
4.3 (1.6,7.0)
3.2 (0.3,6.2)
11.0 (6.3,15.6)
10.4 (5.3,15.3)
9.2 (5.3,13.0)
7.7 (3.7,11.7)
17.1 (10.5,23.6)
15.0 (9.2,20.8)
16.4 (10.0,21.1)
23.9 (17.1,30.6)
15.1 (9.5,20.6)
16.5 (10.2,22.9)
15.7 (10.3,21.1)
17.8 (11.9,23.6)
49.4 (40.8,58.0)
48.9 (40.3,57.5)
51.7 (44.2,59.2)
47.1 (39.7,54.5)
134
Edmonton Zone
Men
20 - 34
35 49
50 64
65
0.3 (0.0,0.7)
0.1 (0.0,0.4)
0.0 (0.0,0.0)
0.0 (0.0,0.0)
0.6 (0.0,1.6)
2.7 (0.6,4.8)
3.5 (0.6,6.3)
0.4 (0.0,0.9)
9.1 (4.6,13.7)
9.0 (2.9,15.1)
8.4 (4.6,12.2)
7.7 (3.1,12.3)
20.3 (12.6,28.0)
19.2 (13.0,25.5)
25.0 (16.2,33.9)
18.6 (11.3,25.8)
17.4 (11.9,22.9)
29.1 (20.4,37.8)
18.1 (11.7,24.4)
16.1 (10.0,22.2)
17.3 (10.7,23.9)
13.8 (8.4,19.1)
16.7 (9.5,23.9)
21.8 (12.8,30.8)
35.1 (27.3,42.8)
26.1 (19.2,33.0)
28.3 (20.5,36.2)
35.5 (25.6,45.5)
20 - 34
35 49
50 64
65
0.4 (0.0,1.1)
0.0 (0.0,0.0)
0.1 (0.0,0.3)
0.0 (0.0,0.0)
1.4 (0.2,2.5)
0.8 (0.0,1.8)
1.6 (0.0,3.2)
2.0 (0.0,4.0)
4.9 (1.7,8.2)
5.5 (2.1,8.9)
5.4 (1.7,9.2)
3.7 (1.4,5.9)
13.6 (8.9,18.4)
13.3 (7.9,18.6)
9.1 (4.5,13.7)
8.8 (4.9,12.8)
14.0 (9.1,19.0)
16.4 (10.3,22.6)
14.2 (9.8,18.6)
19.0 (12.6,25.4)
13.6 (7.9,19.2)
18.0 (12.3,23.7)
17.9 (11.9,23.9)
16.4 (10.9,22.0)
52.1 (44.6,59.5)
46.0 (38.1,53.7)
51.6 (44.0,59.1)
50.1 (42.0,58.1)
North Zone
Men
20 - 34
35 49
50 64
65
0.0 (0.0,0.0)
0.7 (0.0,1.6)
0.1 (0.0,0.4)
0.0 (0.0,0.0)
1.7 (0.0,3.7)
1.6 (0.5,2.8)
1.5 (0.0,3.8)
0.3 (0.0,0.8)
15.4 (9.3,21.4)
12.5 (7.2,17.9)
8.9 (4.6,13.2)
5.7 (0.6,10.8)
33.5 (25.5,41.5)
22.0 (15.7,28.2)
19.0 (13.7,24.4)
24.0 (14.4,33.8)
16.2 (10.8,21.6)
20.5 (14.2,26.8)
24.5 (17.8,31.2)
28.1 (18.9,37.4)
12.8 (8.0,17.5)
18.5 (11.9,25.1)
19.3 (11.9,26.8)
18.8 (8.9,28.7)
20.5 (14.7,26.2)
24.1 (16.3,31.9)
26.6 (18.3,34.9)
23.1 (15.2,31.1)
0.2 (0.0,0.5)
0.1 (0.0,0.4)
0.0 (0.0,0.0)
0.0 (0.0,0.0)
0.8 (0.0,1.7)
0.7 (0.0,1.4)
1.0 (0.0,2.1)
1.5 (0.0,3.3)
11.7 (6.7,16.6)
5.1 (2.3,8.0)
3.8 (1.4,6.2)
1.9 (0.0,4.2)
12.3 (8.0,16.6)
15.9 (10.5,21.2)
9.6 (5.1,14.2)
9.1 (4.2,14.1)
17.6 (12.4,22.8)
14.1 (8.8,19.4)
24.2 (16.0,32.4)
19.4 (12.5,26.3)
17.8 (12.8,22.8)
15.1 (9.6,20.6)
16.0 (10.2,21.9)
19.2 (11.0,27.3)
39.7 (32.9,46.5)
49.0 (40.8,57.2)
45.3 (36.6,53.9)
48.8 (39.5,58.2)
Women
Women
20 - 34
35 49
50 64
65
135
Table 5.6
Cancer cases and proportions attributable to insufficient fruit and vegetable consumption in Alberta (2012)
Age at Exposure
(years)
Age at Outcome
(years)
Esophagus
Total Observed
PAR (%)
Cases
EAC*
Stomach
Total Observed
PAR (%)
Cases
Lung
EAC*
Total Observed
Cases
PAR (%)
EAC*
Men
20 - 34
35 - 49
50 - 64
65
Total
30 - 44
45 - 59
60 - 74
75
Total
<5
41
69
37
<152
48.2
42.8
42.4
39.4
<5
18
29
15
<67
6
30
65
57
158
26.4
23.7
22.1
21.9
2
7
14
12
36
13
141
468
331
953
5.6
5
4.4
3.1
1
7
21
10
39
Women
20 - 34
35 - 49
50 - 64
65
Total
30 - 44
45 - 59
60 - 74
75
Total
<5
9
15
7
<36
33.9
32.3
30.7
29
<5
3
5
2
<15
10
23
30
33
96
14.3
13.2
11.1
11.5
1
3
3
4
12
8
171
479
341
999
3.1
2.5
2.5
2.5
0
4
12
9
25
5
45.3
2
16
50
40.9
20
53
84
40.3
34
95
44
37.7
17
90
183
73
254
EAC, excess attributable risk; NA, not available; PAR, population attributable risk
18.8
19.1
18.6
18.1
3
10
18
16
47
21
312
947
672
1952
4.7
3.6
3.5
2.8
1
11
33
19
64
Total
20 - 34
35 - 49
50 - 64
65
Total
30 - 44
45 - 59
60 - 74
75
Total
*Numbers rounded to nearest case. Values for Total (Men and Women combined) may not match individual totals for Men and Women.
136
Table 5.6 continued
Cancer cases and proportions attributable to insufficient fruit and vegetable consumption in Alberta (2012)
Age at Exposure
(years)
Men
20 - 34
35 - 49
50 - 64
65
Total
Age at Outcome
(years)
Women
20 - 34
35 - 49
50 - 64
65
Total
Total

PAR (%)
EAC*
Larynx
Total Observed Cases PAR (%)
EAC*
25 - 39
40 - 54
55 - 69
70
Total
12
74
127
60
273
34
32
30.1
28.4
4
24
38
17
83
10
33
21
64
21.5
19.4
17.8
2
6
4
12
25 - 39
40 - 54
55 - 69
70
Total
9
17
32
42
100
9.6
9.2
8.9
8.7
1
2
3
4
9
<5
<5
7
12
12.5
11.8
13.5
<5
<5
1
2
21
23.6
5
91
27.8
25
<15
20.7
<5
159
25.8
41
<38
18.6
<10
102
20.3
21
28
16.7
5
373
92
76
14
20 - 34
35 - 49
50 - 64
65
Total
Notes:
25 - 39
40 - 54
55 - 69
70
Total
PAR represents the proportion (%) of cancer cases attributable to insufficient fruit and vegetable consumption
Excess attributable cases represent the number of cases attributable to insufficient fruit and vegetable consumption in 2012
137
Table 5.7
Cancer cases and proportions attributable to insufficient fruit and vegetable consumption in South Zone (2012)
Age at Exposure
(years)
Age at Outcome
(years)
Esophagus
Tot. Obs.
PAR (%)
Cases
Stomach
Tot. Obs.
PAR (%)
Cases
Lung
Tot. Obs.
Cases
PAR (%)
Men
20 - 34
35 - 49
50 - 64
65
Total
30 - 44
45 - 59
60 - 74
75
Total
<5
9
<5
<15
49.2
39.3
38
<5
5
11
<21
25.1
20.9
21.1
18
46
35
99
5.7
4.6
3.2
Women
20 - 34
35 - 49
50 - 64
65
Total
30 - 44
45 - 59
60 - 74
75
Total
<5
<5
33.7
-
<5
<5
6
<16
14.3
13.1
10.3
13
38
37
88
2.6
2.6
2.6
30 - 44
45 - 59
60 - 74
75
Total
<5
9
<5
15
45.3
39.3
38
<5
<10
17
30
22.4
17.4
17.3
31
84
72
187
4.4
3.7
2.9
Total
20 - 34
35 - 49
50 - 64
65
Total
PAR, population attributable risk
138
Table 5.7 continued

Age at Exposure
(years)
Cancer cases and proportions attributable to insufficient fruit and vegetable consumption in South Zone (2012)
Age at Outcome
(years

Tot. Obs. Cases
PAR (%)
Larynx
Tot. Obs. Cases
PAR (%)
Men
20 - 34
35 - 49
50 - 64
65
Total
25 - 39
40 - 54
55 - 69
70
Total
<5
7
5
7
<24
35.6
32.2
33.9
28.9
<5
<5
<5
23.6
25
-
Women
20 - 34
35 - 49
50 - 64
65
Total
25 - 39
40 - 54
55 - 69
70
Total
0
<5
0
<5
<5
9.5
10.4
8.7
8.1
25 - 39
40 - 54
55 - 69
70
Total
<5
8
5
<12
24
35.6
29.5
33.9
22.7
<5
<5
<5
23.6
25
-
Total
20 - 34
35 - 49
50 - 64
65
Total

Notes:
139
Table 5.8
Cancer cases and proportions attributable to insufficient fruit and vegetable consumption in Calgary Zone (2012)
Age at Exposure
(years)
Age at Outcome
(years)
Esophagus
Tot. Obs.
PAR (%)
Cases
Stomach
Tot. Obs.
PAR (%)
Cases
Lung
Tot. Obs.
PAR (%)
Cases
Men
20 - 34
35 - 49
50 - 64
65
Total
30 - 44
45 - 59
60 - 74
75
Total
9
21
12
42
38.8
43.5
41.9
<5
12
20
16
<53
26.1
21.6
23.6
22.8
<5
40
122
108
<275
5.9
4.6
4.2
1.9
Women
20 - 34
35 - 49
50 - 64
65
Total
30 - 44
45 - 59
60 - 74
75
Total
<5
6
5
3
<19
30.6
28.7
25.4
27.7
<5
5
13
8
<31
13.1
11.1
8.6
10.9
<5
60
127
96
<288
2.9
1.7
2.3
2.8
30 - 44
45 - 59
60 - 74
75
Total
<5
15
26
15
<61
30.6
34.7
40
39.1
5
17
33
24
79
18.3
18.5
17.7
18.8
6
100
249
204
559
4.9
2.8
3.2
2.3
Total
20 - 34
35 - 49
50 - 64
65
Total

Notes:
140
Table 5.8 continued

Age (years)
Men
Cancer cases and proportions attributable to insufficient fruit and vegetable consumption in Calgary Zone (2012)
Age at Outcome
(years

Tot. Obs. Cases
PAR (%)
Larynx
Tot. Obs. Cases
PAR (%)
20 - 34
35 - 49
50 - 64
65
Total
25 - 39
40 - 54
55 - 69
70
Total
5
24
59
22
110
32.2
31.9
27.5
24.9
<5
12
8
<25
21.1
16.4
19.1
Women
20 - 34
35 - 49
50 - 64
65
Total
25 - 39
40 - 54
55 - 69
70
Total
<5
8
12
13
<38
8.2
7.9
8
9.4
<5
<5
5
10.5
14.1
25 - 39
40 - 54
55 - 69
70
Total
<10
32
71
35
<148
25.4
25.9
24.2
19.2
<5
<17
<13
<30
21.1
15.6
17.8
Total
20 - 34
35 - 49
50 - 64
65
Total
141
Table 5.9
Cancer cases and proportions attributable to insufficient fruit and vegetable consumption in Central Zone (2012)
Age at Exposure
(years)
Age at Outcome
(years)
Esophagus
Tot. Obs.
PAR (%)
Cases
Stomach
Tot. Obs.
PAR (%)
Cases
Lung
Tot. Obs.
Cases
PAR (%)
Men
20 - 34
35 - 49
50 - 64
65
Total
30 - 44
45 - 59
60 - 74
75
Total
<5
6
7
5
<23
51.1
39.3
41.9
37.2
<5
<5
10
7
21
27.1
23.6
21.9
21.5
5
22
67
32
126
6.6
5
4.8
3.4
Women
20 - 34
35 - 49
50 - 64
65
Total
30 - 44
45 - 59
60 - 74
75
Total
<5
<5
<5
7
30.9
34.4
28.3
<5
<5
<5
<5
9
13.6
13
13.3
10
<5
21
85
45
<156
3.6
2.9
2.4
2.3
30 - 44
45 - 59
60 - 74
75
Total
<5
<11
<12
<10
<30
51.1
38.1
39.2
34.7
<5
<10
<15
<12
30
18.1
18.3
21.1
18
<10
43
152
77
<282
6.1
3.9
3.4
2.8
Total
20 - 34
35 - 49
50 - 64
65
Total

Notes:
142
Table 5.9 continued
Men
Cancer cases and proportions attributable to insufficient fruit and vegetable consumption in Central Zone (2012)
Larynx
Age at Outcome
(years
20 - 34
35 - 49
50 - 64
65
Total
25 - 39
40 - 54
55 - 69
70
Total
<5
10
13
5
<33
32.9
29.4
28.8
31.4
0
<5
<5
<5
7
18.4
17.2
18.9
18.6
20 - 34
35 - 49
50 - 64
65
Total
25 - 39
40 - 54
55 - 69
70
Total
<5
<5
<5
<5
10
9.9
9.4
9.1
7.8
<5
<5
12.1
20 - 34
35 - 49
50 - 64
65
Total
25 - 39
40 - 54
55 - 69
70
Total
<5
<15
<18
<10
<40
17.6
26.1
26.2
20.9
<5
<5
<5
<10
17.2
18.9
17
Women
Total

Tot. Obs. Cases
PAR (%)
Age (years)
Tot. Obs. Cases
PAR (%)
143
Table 5.10
Cancer cases and proportions attributable to insufficient fruit and vegetable consumption in Edmonton Zone (2012)
Age at Exposure
(years)
Age at Outcome
(years)
Esophagus
Tot. Obs.
PAR (%)
Cases
Stomach
Tot. Obs.
PAR (%)
Cases
Lung
Tot. Obs.
Cases
PAR (%)
Men
20 - 34
35 - 49
50 - 64
65
Total
30 - 44
45 - 59
60 - 74
75
Total
<5
19
26
13
<63
48.9
45.1
43.1
39.3
<5
11
24
15
<55
26.9
23.6
21.4
20.9
<5
40
165
120
<330
4.7
5.1
4
3.7
Women
20 - 34
35 - 49
50 - 64
65
Total
30 - 44
45 - 59
60 - 74
75
Total
5
<5
<10
29.8
29.7
<5
10
11
10
<36
14.9
15.8
11.7
11.9
<5
59
157
134
<355
3.3
3.2
3
2.9
30 - 44
45 - 59
60 - 74
75
Total
<5
19
31
<18
68
48.9
45.1
40.9
38
7
21
35
25
88
20.1
19.9
18.4
17.3
5
99
322
254
680
4.1
4
3.5
3.3
Total
20 - 34
35 - 49
50 - 64
65
Total

Notes:
144
Table 5.10 continued

Age at Exposure
(years)
Men
20 - 34
35 - 49
50 - 64
65
Total
Women
20 - 34
35 - 49
50 - 64
65
Total
Total
20 - 34
35 - 49
50 - 64
65
Total
Cancer cases and proportions attributable to insufficient fruit and vegetable consumption in Edmonton Zone (2012)
Age at Outcome
(years)

Tot. Obs. Cases
PAR (%)
Tot. Obs. Cases
Larynx
PAR (%)
25 - 39
40 - 54
55 - 69
70
Total
5
26
35
20
86
32.6
31.5
33.6
29.9
<5
10
8
<23
22.2
20.9
15.1
25 - 39
40 - 54
55 - 69
70
Total
<5
5
18
18
<46
10.5
10.3
9.1
8.8
<5
<5
<5
<5
12.1
10.8
12.6
25 - 39
40 - 54
55 - 69
70
Total
<10
31
53
38
<132
26.3
28.1
25.3
19.9
5
<15
<13
26
20.2
20
14.6
145
Table 5.11
Cancer cases and proportions attributable to insufficient fruit and vegetable consumption in North Zone (2012)
Age at Exposure
(years)
Men
20 - 34
35 - 49
50 - 64
65
Total
Women
20 - 34
35 - 49
50 - 64
65
Total
Age at Outcome
(years)
Esophagus
Tot. Obs. Cases
PAR (%)
Stomach
Tot. Obs. Cases PAR (%)
Lung
Tot. Obs. Cases
PAR (%)
30 - 44
45 - 59
60 - 74
75
Total
<5
6
5
<16
60.3
42.7
38.9
<5
6
8
<19
45.9
23.3
22.7
<5
21
68
36
<130
6.2
5.9
5.2
3.8
30 - 44
45 - 59
60 - 74
75
Total
<5
<5
<5
37.5
37.8
-
<5
<5
<5
6
<15
15.4
15.5
12.9
12
<5
18
72
29
<124
2.7
3.7
2.9
2.8
30 - 44
45 - 59
60 - 74
75
Total
5
<11
5
<21
55.7
42
38.9
<5
<10
<11
14
27
15.4
21.6
21.8
18.1
<5
39
140
65
250
3.6
4.9
4
3.4
Total
20 - 34
35 - 49
50 - 64
65
Total

Notes:
146
Table 5.11 continued

Age at Exposure
(years)
Men
20 - 34
35 - 49
50 - 64
65
Total
Women
20 - 34
35 - 49
50 - 64
65
Total
Total
20 - 34
35 - 49
50 - 64
65
Total
Cancer cases and proportions attributable to insufficient fruit and vegetable consumption in North Zone (2012)
Age at Outcome
(years)

Tot. Obs. Cases
PAR (%)
Tot. Obs. Cases
Larynx
PAR (%)
25 - 39
40 - 54
55 - 69
70
Total
7
15
6
28
34.2
29.8
29.2
<5
6
<5
<12
21.7
21.3
20.6
25 - 39
40 - 54
55 - 69
70
Total
<5
<5
<5
8
12
9.9
7.5
<5
<5
<5
13.8
13
25 - 39
40 - 54
55 - 69
70
Total
<5
<12
15
<11
36
12
31.1
29.8
20.5
<5
<11
<5
12
21.7
20.3
18.1
147
Table 5.12
Total cancer cases and respective proportions in 2012 attributable to insufficient fruit and vegetable intake by age and sex
Age Group at
Exposure
(years)
Age Group
at Outcome
(years)
20-34
30 - 44
40 - 54
Lung
Esophagus
Stomach
Larynx
Lung
Esophagus
Stomach
60 - 74
Larynx
Lung
25 - 39
35-49
50-64
45 - 59
55 - 69
65
Cancer Site
75
70
Total
Observed
Cases
Total
PAR
Men
Observed
Cases
Men PAR
(95% CI)
Women
Observed
Cases
Women PAR
(95% CI)
21
5
16
21
312
50
53
91
<15
947
84
95
159
<38
672
44
90
102
28
4.7
45.3
18.8
23.6
3.6
40.9
19.1
27.8
20.7
3.5
40.3
18.6
25.8
18.6
2.8
37.7
18.1
20.3
16.7
13
<5
6
12
141
41
30
74
10
468
69
65
127
33
331
37
57
60
21
5.6 (2.5,9.0)
48.2 (23.4,66.7)
26.4 (0,51.0)
34.0 (7.4,56.2)
5.0 (2.1,7.9)
42.8 (19.7,61.8)
23.7 (0,47.2)
32.0 (7.1,52.7)
21.5 (12.3,30.4)
4.4 (1.8,7.0)
42.4 (20.0,60.5)
22.1 (0,44.5)
30.1 (7.0,51.0)
19.4 (10.9,27.7)
3.1 (1.3,5.1)
39.4 (16.5,58.0)
21.9 (0,44.6)
28.4 (6.0,47.7)
17.8 (9.8,25.7)
8
<5
10
9
171
9
23
17
<5
479
15
30
32
<5
341
7
33
42
7
3.1 (1.2,4.9)
33.9 (14.0,52.5)
14.3 (0,31.7)
9.6 (0,39.5)
2.5 (1.1,4.1)
32.3 (12.7,51.5)
13.2 (0,30.5)
9.2 (0,37.6)
12.5 (6.3,18.8)
2.5 (1.0,4.1)
30.7 (13.0,48.6)
11.1 (0,25.0)
8.9 (0,36.8)
11.8 (6.0,18.0)
2.5 (1.1,4.1)
29.0 (12.3,45.5)
11.5 (0,26.0)
8.7 (0,34.6)
13.5 (7.4,19.9)
Esophagus
Stomach
Larynx
Lung
Esophagus
Stomach
Larynx

Notes:
148
Figure 5.1
Prevalence of sufficient ( 5 servings) and insufficient (< 5 servings) fruit and vegetable intake in
Alberta in 2007 by age and sex
149
Figure 5.2
Prevalence of insufficient (< 5 servings) fruit and vegetable intake in adults in Alberta by age
group and Alberta Health Services region, 2007
150
Figure 5.3
Prevalence of sufficient ( 5 servings) fruit and vegetable intake in adults in Alberta by age group
and Alberta Health Services region, 2007
151
Figure 5.4
Prevalence of insufficient (< 5 servings) fruit and vegetable intake in adults in Alberta by age
group and Alberta Health Services region, 2003
152
Figure 5.5
Prevalence of sufficient ( 5 servings) fruit and vegetable intake in adults in Alberta by age group
and Alberta Health Services region, 2003
153
Figure 5.6
Cancer cases attributable to insufficient fruit and vegetable intake and other known and
unknown cancer causes
154
CHAPTER 6
Cancer Incidence Attributable to Red and Processed

Meat Consumption in Alberta, Canada in 2012
155
SUMMARY
Red and processed meat consumption was substantially higher among men, where
approximately 40 60% of men consumed greater than 500g per week, while among women these
proportions ranged from approximately 15 25%. Red and processed meat consumption declined with
age in both sexes. The number of attributable cases of colorectal cancer were higher for red meat (9.5%)
compared to processed meat (3.9%). Given higher levels of red meat consumption in men, a greater
proportion of colorectal cancers were attributable to red meat (15.4%) compared to processed meat
(3.8%), while in women these estimates were much more similar (red meat = 1.8% vs. processed meat =
1.6%). Overall, approximately 12.4% of colorectal cancers and 1.5% of all cancers in Alberta in 2012
could be attributed to red and processed meat consumption (Table 6.1).
METHODS OVERVIEW
Population attributable risks (PARs) for both red and processed meat with respect to colorectal
cancer (as well as colon and rectal cancer individually) were estimated for Alberta. As described for
previous exposures, follow-up times from previously published cohort studies were examined to
evaluate appropriate reasonable latency periods between meat consumption and colorectal cancer
development. Average follow-up times between exposure data collection and colorectal cancer
incidence were between 10 and 14 years in published cohort studies deemed to be of high-quality.
However, data on meat consumption in Alberta was only available from data from Albertas Tomorrow
Project, collected between 2000 and 2009. Using cancer incidence data from 2012, the average latency
period examined in this analysis was therefore 8 years due to limitations surrounding prevalence data
availability. The latency periods used for this analysis are summarized in Table 6.2.
Risk estimates (Relative Risks (RR)) linking red and processed meat consumption with colorectal (and
colon and rectal cancers individually) were obtained from the 2011 report from the World Cancer
Research Funds Continuous Update Project, which specifically focused on colorectal cancer. The
estimates used in this analysis are shown in Table 6.3. An assumption was made that the increase in risk
for both of these exposures was logarithmic relative to intake and as such, the risk per gram of meat
intake was calculated using equation 6.1 where represents the exposure level in grams per day. (RRs
are shown in Table 6.3).
6.1: =
ln( )
As mentioned above, information on consumption of both red and processed meat in Alberta
was obtained from data collected within Albertas Tomorrow Project (ATP). The ATP is a population156
based cohort study conducted in Alberta, Canada and collection of the data of interest occurred
between 2000 and 2009. Participation in this study involved completing a baseline study questionnaire
and three months after enrollment into the study, participants completed a diet history questionnaire
(DHQ). The DHQ was composed of a cognitive-based food-frequency questionnaire (FFQ) developed by
the United States National Cancer Institute (NCI) as a tool to assess diet over the preceding 12-months.
ATP variables taken from this questionnaire were those that estimated the number of ounces of each of
red (beef, pork, lamb, veal, venison, liver etc.) and processed (cold cuts, sausage, ham, hot dogs) meat
consumed each day. These values were converted to grams per day for analysis (grams = ounces x
28.3495). Overall red and processed meat consumption was divided into deciles of intake (g/day). The
mean level of consumption along with the proportion of the population within each decile was
estimated for men and women in four age groups (35 44, 45 54, 55 64, 65 years). These data for
Alberta are shown in Tables 6.4 (red meat) and 6.10 (processed meat) and for each Alberta Health
Services zone in Tables 6.5 6.9 (red meat) and 6.11 6.15 (processed meat). The proportion of
Albertans who exceed the WCRFs recommended limit of 500g of red and processed meat intake per
week are shown for Alberta in Figure 6.1 and stratified by Alberta Health Services zone in Figure 6.2.
To estimate population attributable risks (PARs), the relative risk of meat consumption in each
of the ten consumption categories was estimated by multiplying the risk per gram of red or processed
meat intake by the mean consumption level within each category. The means utilized are summarized in
Tables 6.4 (red meat) and 6.10(processed meat) and for each Alberta Health Services zone in Tables 6.5
6.9 (red meat) and 6.11 6.15 (processed meat).
PARs were then estimated within each age-sex group according to the same method used for
fruit and vegetable consumption, using equation 6.2, where represents the proportion of the
population in each decile and the represents the excess relative risk (RR 1) for each decile
estimated as described in the previous paragraph.
6.2: =
(1 1 ) + (2 2 ) + + ( )
1 + (1 1 ) + (2 2 ) + + ( )
To estimate the total number of cancers at each site overall and by age-group and gender
attributable to red and processed meat consumption, PARs were applied to cancer incidence data
obtained from the Alberta Cancer Registry for 2012. The estimated PARs and excess attributable cancers
(EACs) are summarized in Tables 6.16 (red meat) and 6.22 (processed meat) for Alberta and for
individual Alberta Health Services zones in Tables 6.17 6.21 (red meat) and 6.23 6.27 (processed
meat). Tables 6.28 (red meat) and 6.29 (processed meat) show estimates for PAR for Alberta similar to
157
Tables 6.16 and 6.22 including 95% confidence intervals to demonstrate the precision around these
estimates. The total number of cancer cases for colorectal cancer, as well as colon and rectal cancers
separately, attributable to red and processed meat consumption are shown in Figures 6.3 (red meat)
and 6.4 (processed meat).
158
Table 6.1
Summary of cases and proportions of cancer in Alberta adults in 2012 attributable to red and processed meat intakea
Cancer Siteb
Red Meat
Colorectum
Colon
Rectum
Observed
Casesc
Total
Excess
Attributable
Casesd
%
Attributablee
Men
Women
Excess
Excess
Observed
%
Observed
%
Attributable
Attributable
c
e
c
Cases
Attributable Cases
Attributablee
Casesd
Casesd
1899
1151
748
181
66
68
9.5
5.7
9
1079
614
465
166
44
50
15.4
7.1
10.7
820
537
283
15
22
18
1.8
4.1
6.2

All Cancersg
1899
181
9.5
1079
166
15.4
820
15
1.8
15836
181
1.1
8155
166
2.0
7681
15
0.2
Processed Meat
Colorectum
Colon
Rectum
1899
1151
748
54
68
26
2.9
5.8
3.5
1079
614
465
41
47
20
3.8
7.6
4.3
820
537
283
13
21
6
1.6
4.0
2.2
1899
54
2.9
1079
41
3.8
820
13
1.6
All Cancersg
15836
54
0.3
8155
41
0.5
7681
13
0.2
a. Red and processed meat consumption data for Alberta from Albertas Tomorrow Project cohort. In this cohort diet history
questionnaire estimated the number of ounces of each of red (beef, pork, lamb, veal, venison, liver etc.) and processed (cold cuts,
sausage, ham, hot dogs) meat consumed each day
sites.
d. Number of cancer cases at individual cancer sites that can be attributed to red and processed meat consumption.
e. Proportion of cancers at individual cancer sites attributable to red and processed meat consumption. Calculated as excess attributable
f. Represents all cancers with a known association with red and processed meat consumption as listed in table. In this cases these values
represent colorectal cancer, as colon and rectal cancers are subsets of this type.
159
Table 6.2
Predetermined latency periods by cancer site used for population attributable risk
calculations
Cancer Site
Red Meat
Colorectal
Colorectal
Colorectal
Colon
Colon
Colon
Rectum
Sex
Latency Period*
All
Men
Women
All
Men
Women
All
8 years
8 years
8 years
8 years
8 years
8 years
8 years
Processed Meat
Colorectal
All
Colorectal
Men
Colorectal
Women
Colon
All
Colon
Men
Colon
Women
Rectum
All
*All prevalence data from Albertas Tomorrow Project
8 years
8 years
8 years
8 years
8 years
8 years
8 years
160
Table 6.3
Risk associations for risk associated with red and processed meat consumption and
colorectal cancer
Cancer Site
Gender
RR Estimate
Units
Risk per gram

per day
Source
Red Meat
Colorectal
Colorectal
Colorectal
Colon
Rectum
All
Men
Women
All
All
1.17
1.28
1.05
1.12
1.18
100 g/day
100 g/day
100 g/day
100 g/day
100 g/day
0.0016
0.0025
0.00049
0.0011
0.0017
WCRF, 2011
WCRF, 2011
WCRF, 2011
WCRF, 2011
WCRF, 2011
Processed Meat
Colorectal
Colorectal
Colorectal
Colon
Colon
Colon
Rectum
All
Men
Women
All
Men
Women
All
1.18
1.11
1.09
1.24
1.38
1.64
1.12
50 g/day
50 g/day
50 g/day
50 g/day
50 g/day
50 g/day
50 g/day
0.0033
0.0021
0.0017
0.0043
0.0064
0.0099
0.0023
WCRF, 2011
WCRF, 2011
WCRF, 2011
WCRF, 2011
WCRF, 2011
WCRF, 2011
WCRF, 2011
161
Table 6.4 Red meat consumption in grams per day and the proportion (%) and corresponding 95% confidence intervals of the population in
each of ten consumption categories by age/sex group in Alberta
35 44
Meat Consumption Category
(grams per day)
Grams per day % (95% CI)
1: < 14.5
2: 14.5 21.4
3: 21.5 27.9
4: 28.0 34.2
5: 34.3 41.3
6: 41.4 49.2
7: 49.3 59.2
8: 59.3 73.3
9: 73.4 100.3
10: 100.4
8.52
18.27
25.06
31.04
37.53
45.54
54.26
65.57
85.31
154.29
Mean grams per day
77.22
1: < 14.5
2: 14.5 21.4
3: 21.5 27.9
4: 28.0 34.2
5: 34.3 41.3
6: 41.4 49.2
7: 49.3 59.2
8: 59.3 73.3
9: 73.4 100.3
10: 100.4
Mean grams per day
9.28
18.05
24.86
30.97
37.54
45.07
54.21
65.65
84.45
131.99
43.20
2.7 (2.1,3.2)
4.0 (3.3,4.7)
4.9 (4.1,5.7)
6.6 (5.7,7.5)
7.5 (6.5,8.4)
8.4 (7.4,9.4)
11.3 (10.2,12.5)
14.1 (12.9,15.4)
16.8 (15.4,18.1)
23.7 (22.2,25.3)
10.2 (9.4,11.1)
11.5 (10.6,12.4)
12.0 (11.1,12.9)
11.4 (10.5,12.3)
12.3 (11.4,13.2)
10.5 (9.6,11.3)
10.7 (9.8,11.5)
9.1 (8.3,9.9)
7.8 (7.1,8.5)
4.5 (4.0,5.1)
45 54
8.67
18.09
24.58
31.10
37.65
45.60
54.17
65.98
85.73
154.03
55 64
65
Grams per day % (95% CI) Grams per day % (95% CI)
MEN
3.8 (3.1,4.4)
9.13
4.7 (3.8,5.5)
8.98
5.9 (4.4,7.4)
4.4 (3.7,5.0)
17.97
6.3 (5.4,7.3)
17.94
9.1 (7.3,11.0)
5.5 (4.8,6.3)
24.80
7.5 (6.5,8.6)
24.92
11.6 (9.5,13.6)
6.9 (6.1,7.7)
31.09
7.2 (6.2,8.3)
31.38
7.6 (5.9,9.3)
7.9 (7.0,8.7)
37.58
8.9 (7.8,10.1)
38.05
10.0 (8.1,11.9)
9.4 (8.5,10.4)
45.00
10.2 (9.0,11.4)
45.51
9.8 (7.8,11.7)
11.1 (10.0,12.1)
54.16
10.8 (9.6,12.0)
53.59
9.7 (7.8,11.5)
13.2 (12.1,14.3)
65.88
12.2 (10.9,13.4)
65.95
13.7 (11.5,15.9)
16.3 (15.1,17.5)
85.92
15.1 (13.8,16.5)
86.82
10.9 (8.9,12.9)
21.6 (20.2,22.9)
144.21
17.0 (15.5,18.4)
149.84
11.8 (9.7,13.9)
73.81
65.00
8.95
18.07
24.71
30.98
37.59
45.22
53.81
65.58
84.19
132.78
40.90
WOMEN
13.6 (12.7,14.4)
9.31
12.2 (11.3,13.0)
17.92
12.2 (11.4,13.1)
24.66
11.3 (10.5,12.1)
30.85
11.5 (10.7,12.3)
37.72
10.3 (9.5,11.1)
45.28
9.8 (9.0,10.5)
53.69
8.0 (7.3,8.7)
65.82
7.0 (6.4,7.7)
85.00
4.2 (3.7,4.7)
134.37
38.41
57.04
14.9 (13.8,15.9)
15.0 (13.9,16.1)
12.3 (11.3,13.3)
11.1 (10.1,12.1)
10.8 (9.8,11.7)
10.7 (9.8,11.7)
8.2 (7.4,9.1)
7.8 (7.0,8.7)
5.9 (5.2,6.6)
3.3 (2.7,3.8)
9.07
18.02
24.87
30.98
37.44
44.69
53.87
65.72
84.47
129.22
33.81
19.2 (17.3,21.1)
15.8 (14.0,17.6)
14.7 (12.9,16.4)
11.5 (9.9,13.1)
10.2 (8.7,11.7)
8.7 (7.3,10.1)
8.0 (6.7,9.3)
5.7 (4.5,6.8)
4.1 (3.1,5.1)
2.2 (1.5,2.9)
162
Table 6.5 Red meat consumption in grams per day and the proportion of the population (%) and corresponding 95% confidence intervals in each
of ten consumption categories by age/sex group in South Zone
35 44
(grams per day)
1: < 14.5
2: 14.5 21.4
3: 21.5 27.9
4: 28.0 34.2
5: 34.3 41.3
6: 41.4 49.2
7: 49.3 59.2
8: 59.3 73.3
9: 73.4 100.3
10: 100.4
12.38
18.03
24.81
31.32
37.84
45.26
54.85
65.67
86.13
156.24
Mean grams per day
76.76
1: < 14.5
2: 14.5 21.4
3: 21.5 27.9
4: 28.0 34.2
5: 34.3 41.3
6: 41.4 49.2
7: 49.3 59.2
8: 59.3 73.3
9: 73.4 100.3
10: 100.4
Mean grams per day
9.83
17.65
25.07
30.71
37.32
45.08
54.53
65.66
85.13
128.06
47.39
1.9 (0.4,3.4)
3.8 (1.7,6.0)
3.2 (1.2,5.1)
8.0 (5.0,11.0)
8.9 (5.8,12.1)
9.6 (6.3,12.8)
10.2 (6.9,13.6)
19.2 (14.8,23.5)
11.8 (8.2,15.4)
23.3 (18.6,28.0)
6.2 (4.2,8.2)
10.3 (7.8,12.8)
12.6 (9.9,15.3)
10.1 (7.6,12.6)
12.3 (9.6,15.0)
10.7 (8.1,13.2)
10.3 (7.8,12.8)
12.8 (10.0,15.6)
8.3 (6.1,10.6)
6.4 (4.4,8.4)
45 54
8.06
18.04
24.82
31.05
37.77
45.65
54.18
65.74
84.816
153.52
55 64
65
MEN
1.6 (0.4,2.8)
9.48
4.3 (2.1,6.5)
11.15
5.5 (1.2,9.8)
4.8 (2.8,6.8)
18.03
4.6 (2.3,6.8)
17.55
8.3 (3.1,13.4)
5.3 (3.2,7.4)
24.68
7.6 (4.8,10.5)
25.64
10.1 (4.4,15.8)
7.8 (5.3,10.3)
31.29
6.4 (3.8,9.1)
31.51
6.4 (1.8,11.0)
8.5 (5.9,11.1)
38.01
8.5 (5.5,11.6)
38.27
10.1 (4.4,15.8)
8.0 (5.5,10.6)
45.41
10.1 (6.8,13.3)
46.16
14.7 (8.0,21.3)
11.5 (8.5,14.5)
53.93
11.6 (8.1,15.0)
52.90
11.0 (5.1,16.9)
16.5 (13.0,20.0)
65.63
14.3 (10.5,18.1)
65.53
12.8 (6.6,19.1)
12.8 (9.7,16.0)
85.02
14.6 (10.8,18.5)
87.06
11.0 (5.1,16.9)
23.2 (19.2,27.1)
149.94
18.0 (13.8,22.1)
140.30
10.1 (4.4,15.8)
75.12
67.99
9.61
18.09
24.92
30.82
37.52
45.02
54.10
64.74
85.19
139.19
44.02
WOMEN
11.7 (9.3,14.1)
9.37
11.3 (8.9,13.7)
17.73
11.0 (8.7,13.3)
24.62
10.2 (7.9,12.4)
30.82
11.7 (9.3,14.1)
37.82
11.6 (9.2,14.0)
44.96
10.2 (7.9,12.4)
54.06
9.4 (7.3,11.6)
65.02
7.7 (5.8,9.7)
86.57
132.37
39.16
55.29
12.6 (9.7,15.4)
14.9 (11.8,18.0)
12.8 (9.8,15.6)
12.3 (9.5,15.2)
10.6 (7.9,13.3)
11.2 (8.4,13.9)
7.6 (5.3,9.9)
8.4 (6.0,10.8)
6.5 (4.3,8.6)
3.1 (1.6,4.7)
9.64
18.05
24.62
31.52
37.97
45.36
53.20
64.43
85.93
180.66
35.66
20.0 (14.5,25.5)
14.0 (9.2,18.8)
16.0 (10.9,21.1)
10.0 (5.8,14.2)
10.0 (5.8,14.2)
8.5 (4.6,12.4)
7.5 (3.8,11.2)
7.0 (3.5,10.5)
5.0 (2.0,8.0)
2.0 (0.1,3.9)
163
of ten consumption categories by age/sex group in Calgary Zone
35 44
(grams per day)
1: < 14.5
2: 14.5 21.4
3: 21.5 27.9
4: 28.0 34.2
5: 34.3 41.3
6: 41.4 49.2
7: 49.3 59.2
8: 59.3 73.3
9: 73.4 100.3
10: 100.4
8.66
18.18
25.07
30.98
37.78
45.61
54.21
65.23
85.58
142.63
Mean grams per day
70.75
1: < 14.5
2: 14.5 21.4
3: 21.5 27.9
4: 28.0 34.2
5: 34.3 41.3
6: 41.4 49.2
7: 49.3 59.2
8: 59.3 73.3
9: 73.4 100.3
10: 100.4
Mean grams per day
9.11
18.00
24.96
31.03
37.55
44.73
54.05
65.44
83.11
124.17
38.46
45 54
55 64
65
Grams per day % (95% CI) Grams per day % (95% CI) Grams per day % (95% CI)
MEN
3.3 (2.1,4.4)
7.90
4.7 (3.4,5.9)
8.14
4.6 (3.0,6.2)
7.12
7.5 (4.0,11.0)
4.8 (3.4,6.2)
18.05
5.4 (4.0,6.8)
17.97
7.4 (5.4,9.5)
18.38
8.9 (5.1,12.7)
5.8 (4.3,7.3)
24.63
5.2 (3.9,6.6)
24.65
8.2 (6.1,10.4)
24.31
15.9 (11.0,20.8)
7.0 (5.3,8.6)
30.98
8.4 (6.7,10.1)
31.30
7.1 (5.1,9.1)
32.39
7.9 (4.3,11.6)
7.6 (5.9,9.3)
37.39
8.8 (7.1,10.6)
37.58
8.7 (6.5,10.9)
38.59
7.5 (4.0,11.0)
8.9 (7.1,10.8)
45.44
9.8 (8.0,11.6)
45.10
11.7 (9.2,14.2)
44.68
10.8 (6.6,14.9)
11.9 (9.8,14.0)
54.25
12.7 (10.7,14.7)
54.39
10.9 (8.5,13.4)
52.77
11.2 (7.0,15.4)
12.7 (10.5,14.8)
66.36
10.8 (8.9,12.8)
65.83
11.6 (9.1,14.1)
67.58
11.2 (7.0,15.4)
17.4 (15.0,19.9)
86.23
16.1 (13.8,18.3)
85.91
14.6 (11.8,17.3)
86.41
8.9 (5.1,12.7)
20.6 (18.0,23.2)
143.96
18.0 (15.7,20.4)
145.13
15.1 (12.3,17.9)
139.84
10.3 (6.2,14.3)
12.3 (10.7,14.0)
14.0 (12.2,15.8)
13.7 (11.9,15.4)
11.7 (10.0,13.3)
11.7 (10.1,13.4)
11.3 (9.7,12.9)
9.8 (8.3,11.3)
6.9 (5.6,8.1)
5.4 (4.2,6.5)
3.3 (2.4,4.2)
66.90
62.48
8.68
18.13
24.76
31.00
37.68
45.07
53.67
65.94
83.95
128.35
38.13
WOMEN
14.3 (12.6,16.0)
9.17
14.5 (12.8,16.2)
17.65
13.1 (11.4,14.7)
24.77
11.8 (10.2,13.3)
30.97
11.9 (10.4,13.5)
37.77
9.6 (8.1,11.0)
45.31
8.8 (7.4,10.2)
53.59
6.5 (5.3,7.7)
65.63
6.1 (5.0,7.3)
83.73
3.4 (2.5,4.3)
124.18
35.20
4.6 (3.0,6.2)
51.83
18.1 (15.8,20.4)
16.7 (14.4,18.9)
12.0 (10.0,13.9)
9.9 (8.1,11.7)
10.6 (8.7,12.4)
9.7 (7.9,11.5)
8.9 (7.2,10.7)
7.2 (5.6,8.7)
4.9 (3.6,6.2)
2.1 (1.2,2.9)
9.51
17.73
24.72
30.57
37.66
44.41
53.67
65.16
87.40
124.83
31.44
21.0 (17.0,25.0)
14.2 (10.7,17.6)
16.2 (12.6,19.8)
13.7 (10.3,17.1)
10.9 (7.8,14.0)
9.6 (6.7,12.5)
6.3 (3.9,8.7)
3.0 (1.4,4.7)
3.5 (1.7,5.4)
1.5 (0.3,2.7)
164
of ten consumption categories by age/sex group in Central Zone
35 44
(grams per day)
1: < 14.5
2: 14.5 21.4
3: 21.5 27.9
4: 28.0 34.2
5: 34.3 41.3
6: 41.4 49.2
7: 49.3 59.2
8: 59.3 73.3
9: 73.4 100.3
10: 100.4
6.99
18.89
25.77
31.07
37.25
46.06
53.69
66.19
85.24
156.24
Mean grams per day
88.70
1: < 14.5
2: 14.5 21.4
3: 21.5 27.9
4: 28.0 34.2
5: 34.3 41.3
6: 41.4 49.2
7: 49.3 59.2
8: 59.3 73.3
9: 73.4 100.3
10: 100.4
Mean grams per day
9.22
18.43
24.81
31.11
37.78
45.65
54.65
65.63
85.72
135.97
48.92
0.7 (0.0,1.5)
2.3 (0.9,3.8)
4.4 (2.5,6.4)
5.6 (3.4,7.8)
6.7 (4.4,9.1)
8.1 (5.6,10.7)
9.8 (7.0,12.6)
13.5 (10.3,16.7)
16.1 (12.6,19.5)
32.8 (28.4,37.2)
7.9 (6.1,9.7)
7.8 (6.0,9.5)
9.6 (7.6,11.6)
11.3 (9.1,13.4)
10.8 (8.7,12.9)
11.3 (9.1,13.4)
13.4 (11.1,15.7)
12.9 (10.7,15.2)
9.4 (7.4,11.3)
5.8 (4.2,7.3)
45 54
8.72
17.99
24.36
31.82
38.01
45.90
53.79
65.77
84.88
154.13
55 64
65
MEN
2.7 (1.4,4.0)
10.25
3.0 (1.4,4.6)
9.96
4.0 (1.3,6.8)
3.0 (1.6,4.4)
18.33
6.0 (3.7,8.2)
17.75
10.1 (5.9,14.2)
5.8 (4.0,7.7)
25.14
6.0 (3.7,8.2)
24.87
10.1 (5.9,14.2)
4.8 (3.1,6.6)
31.17
5.0 (3.0,7.1)
30.90
7.0 (3.5,10.6)
5.7 (3.8,7.5)
37.80
7.3 (4.9,9.8)
37.36
11.6 (7.1,16.0)
8.5 (6.3,10.7)
45.37
8.5 (5.9,11.1)
45.68
8.0 (4.3,11.8)
9.7 (7.3,12.0)
54.31
10.5 (7.6,13.4)
54.51
11.1 (6.7,15.4)
15.0 (12.1,17.9)
66.72
13.7 (10.5,17.0)
65.88
17.1 (11.9,22.3)
18.2 (15.1,21.2)
86.78
19.0 (15.3,22.7)
87.53
8.5 (4.7,12.4)
26.7 (23.1,30.2)
145.51
21.1 (17.2,24.9)
162.37
12.6 (8.0,17.2)
81.37
73.06
8.62
17.73
24.44
31.03
37.68
45.47
53.56
65.50
84.33
130.29
46.14
WOMEN
10.4 (8.5,12.2)
9.27
10.8 (8.9,12.6)
18.13
10.4 (8.5,12.2)
24.42
11.0 (9.1,13.0)
30.93
11.8 (9.8,13.8)
37.87
9.7 (7.9,11.5)
45.72
9.8 (8.0,11.6)
53.79
9.6 (7.8,11.4)
65.63
10.2 (8.3,12.0)
85.11
6.5 (5.0,8.0)
134.71
42.15
60.01
11.0 (8.9,13.0)
14.1 (11.8,16.4)
12.3 (10.2,14.5)
11.2 (9.1,13.3)
11.2 (9.1,13.3)
9.9 (7.9,11.9)
9.8 (7.8,11.8)
7.8 (6.0,9.6)
8.4 (6.6,10.3)
4.3 (2.9,5.6)
8.933
18.18
24.88
31.07
37.10
45.31
54.16
65.61
82.64
131.85
32.98
13.8 (10.3,17.3)
16.8 (13.0,20.5)
13.6 (10.1,17.0)
11.7 (8.4,14.9)
9.0 (6.1,11.9)
9.3 (6.4,12.2)
8.5 (5.7,11.3)
7.2 (4.6,9.8)
7.2 (4.6,9.8)
2.9 (1.2,4.6)
165
of ten consumption categories by age/sex group in Edmonton Zone
35 44
(grams per day)
1: < 14.5
2: 14.5 21.4
3: 21.5 27.9
4: 28.0 34.2
5: 34.3 41.3
6: 41.4 49.2
7: 49.3 59.2
8: 59.3 73.3
9: 73.4 100.3
10: 100.4
7.58
18.51
24.93
30.88
37.14
45.22
54.00
65.58
85.66
161.10
Mean grams per day
74.69
1: < 14.5
2: 14.5 21.4
3: 21.5 27.9
4: 28.0 34.2
5: 34.3 41.3
6: 41.4 49.2
7: 49.3 59.2
8: 59.3 73.3
9: 73.4 100.3
10: 100.4
Mean grams per day
9.20
18.11
24.65
30.82
37.59
45.14
53.90
65.79
82.79
132.76
39.47
45 54
55 64
65
MEN
3.6 (2.2,4.9)
8.89
5.4 (3.9,6.9)
9.41
6.2 (4.5,8.0)
9.57
7.5 (4.4,10.6)
4.3 (2.8,5.7)
18.04
3.8 (2.6,5.1)
18.05
6.5 (4.7,8.3)
17.76
10.0 (6.5,13.5)
5.6 (4.0,7.3)
24.59
6.5 (4.9,8.2)
24.76
9.1 (7.0,11.2)
25.01
9.6 (6.2,13.1)
7.0 (5.2,8.9)
31.14
6.9 (5.2,8.5)
30.83
9.1 (7.0,11.2)
31.00
9.6 (6.2,13.1)
8.4 (6.4,10.4)
37.68
9.2 (7.3,11.1)
37.29
10.9 (8.7,13.2)
38.07
11.7 (8.0,15.5)
8.0 (6.0,9.9)
45.57
10.4 (8.4,12.4)
44.82
9.6 (7.4,11.7)
45.72
9.2 (5.9,12.6)
11.4 (9.1,13.7)
54.60
10.7 (8.7,12.7)
53.98
11.4 (9.0,13.7)
54.02
8.9 (5.6,12.2)
14.4 (11.9,17.0)
65.95
13.2 (10.9,15.4)
65.74
10.2 (8.0,12.5)
66.05
11.7 (8.0,15.5)
16.4 (13.7,19.1)
85.66
16.0 (13.6,18.4)
85.43
14.0 (11.5,16.5)
85.96
11.7 (8.0,15.5)
20.9 (17.9,23.9)
172.43
17.9 (15.4,20.4)
131.93
12.9 (10.4,15.3)
143.00
10.0 (6.5,13.5)
13.1 (11.2,14.9)
11.9 (10.1,13.7)
12.8 (11.0,14.7)
12.7 (10.8,14.5)
12.3 (10.5,14.2)
10.2 (8.5,11.8)
9.5 (7.9,11.2)
7.7 (6.2,9.2)
6.7 (5.3,8.1)
3.0 (2.1,4.0)
72.22
57.02
8.85
18.21
24.74
31.00
37.53
45.16
53.85
65.79
82.81
123.91
35.13
WOMEN
18.2 (16.2,20.2)
8.96
13.4 (11.6,15.1)
17.86
13.9 (12.1,15.7)
24.67
12.0 (10.3,13.7)
30.68
9.7 (8.2,11.2)
37.41
9.1 (7.6,10.6)
45.06
10.6 (9.0,12.1)
53.88
6.7 (5.4,8.0)
66.10
4.6 (3.5,5.7)
84.59
1.8 (1.1,2.5)
142.20
34.49
53.47
17.1 (14.8,19.4)
16.3 (14.1,18.6)
13.0 (11.0,15.1)
12.7 (10.6,14.7)
10.9 (9.0,12.8)
10.8 (8.9,12.7)
6.6 (5.1,8.1)
6.7 (5.2,8.2)
4.0 (2.8,5.2)
1.9 (1.0,2.7)
8.99
18.32
24.74
31.05
36.96
44.15
53.83
66.86
82.81
104.96
30.53
23.4 (19.3,27.6)
16.1 (12.5,19.7)
14.1 (10.7,17.5)
10.8 (7.8,13.9)
10.1 (7.1,13.0)
7.6 (5.0,10.2)
8.8 (6.0,11.6)
5.8 (3.5,8.1)
2.3 (0.8,3.7)
1.0 (0.0,2.0)
166
of ten consumption categories by age/sex group in North Zone
35 44
(grams per day)
1: < 14.5
2: 14.5 21.4
3: 21.5 27.9
4: 28.0 34.2
5: 34.3 41.3
6: 41.4 49.2
7: 49.3 59.2
8: 59.3 73.3
9: 73.4 100.3
10: 100.4
8.68
17.95
24.79
31.19
37.78
45.64
54.73
65.54
84.26
159.72
Mean grams per day
82.73
1: < 14.5
2: 14.5 21.4
3: 21.5 27.9
4: 28.0 34.2
5: 34.3 41.3
6: 41.4 49.2
7: 49.3 59.2
8: 59.3 73.3
9: 73.4 100.3
10: 100.4
Mean grams per day
9.72
18.11
24.89
31.11
37.42
44.96
54.12
65.81
85.56
137.37
48.42
45 54
55 64
65
MEN
2.4 (1.1,3.7)
10.661
2.5 (1.3,3.8)
8.93
4.2 (2.3,6.0)
8.15
3.1 (0.1,6.0)
3.7 (2.1,5.3)
18.36
4.4 (2.7,6.0)
17.42
6.0 (3.8,8.3)
18.40
6.9 (2.6,11.3)
3.9 (2.3,5.5)
24.52
4.4 (2.7,6.0)
24.96
5.3 (3.2,7.4)
25.64
12.3 (6.7,18.0)
5.2 (3.3,7.1)
30.75
5.7 (3.8,7.6)
31.17
7.2 (4.7,9.6)
31.18
4.6 (1.0,8.2)
5.7 (3.8,7.7)
37.75
5.9 (4.0,7.8)
37.68
7.9 (5.3,10.4)
38.44
7.7 (3.1,12.3)
7.6 (5.4,9.8)
45.64
9.4 (7.1,11.8)
44.48
10.9 (7.9,13.8)
45.61
7.7 (3.1,12.3)
12.0 (9.3,14.8)
53.69
9.9 (7.5,12.3)
54.17
9.5 (6.7,12.2)
53.14
5.4 (1.5,9.3)
13.9 (11.0,16.8)
65.97
13.1 (10.4,15.8)
65.42
13.0 (9.8,16.1)
64.48
17.7 (11.1,24.2)
19.6 (16.3,23.0)
86.43
17.6 (14.6,20.7)
86.30
14.3 (11.1,17.7)
87.86
16.1 (9.8,22.5)
25.9 (22.2,29.6)
147.71
27.1 (23.5,30.6)
150.55
21.8 (17.9,25.7)
158.31
18.5 (11.8,25.1)
7.4 (5.7,9.2)
10.9 (8.8,13.0)
10.0 (8.0,11.9)
10.1 (8.1,12.1)
14.9 (12.5,17.2)
8.5 (6.6,10.3)
11.3 (9.2,13.4)
8.9 (7.0,10.8)
11.6 (9.4,13.7)
6.4 (4.8,8.0)
79.61
71.56
9.59
17.99
24.67
30.96
37.46
45.38
53.97
65.63
84.72
139.46
45.77
WOMEN
10.6 (8.7,12.4)
10.33
8.9 (7.2,10.7)
18.19
11.3 (9.4,13.2)
24.80
10.4 (8.6,12.3)
30.89
12.7 (10.7,14.7)
37.83
12.7 (10.7,14.7)
45.32
9.9 (8.1,11.7)
53.19
9.4 (7.7,11.2)
66.47
8.2 (6.5,9.8)
85.54
5.8 (4.4,7.2)
136.69
44.19
70.27
13.0 (10.5,15.6)
11.7 (9.2,14.1)
11.5 (9.1,13.9)
9.6 (7.3,11.8)
10.4 (8.1,12.8)
12.9 (10.3,15.4)
8.0 (6.0,10.1)
10.2 (7.8,12.5)
6.5 (4.6,8.4)
6.2 (4.4,8.1)
7.96
17.72
25.27
31.15
37.81
44.38
54.17
65.83
85.95
118.08
35.08
17.0 (12.3,21.8)
17.8 (13.0,22.7)
13.7 (9.3,18.0)
10.0 (6.2,13.7)
11.2 (7.2,15.2)
8.3 (4.8,11.8)
9.1 (5.5,12.8)
6.2 (3.2,9.3)
2.5 (0.5,4.5)
4.2 (1.6,6.7)
167
Table 6.10 Processed meat consumption in grams per day and the proportion of the population (%) and corresponding 95% confidence intervals
in each of ten consumption categories by age/sex group, Alberta.
35 44
(grams per day)
1: < 1.7
2: 1.7 3.1
3: 3.1 4.5
4: 4.5 6.2
5: 6.2 8.2
6: 8.2 11.0
7: 11.1 15.0
8: 15.0 21.5
9: 21.5 32.6
10: 32.6
0.88
2.40
3.67
5.25
7.23
9.59
12.90
17.96
26.51
56.94
Mean grams per day
7.19
1: < 1.7
2: 1.7 3.1
3: 3.1 4.5
4: 4.5 6.2
5: 6.2 8.2
6: 8.2 11.0
7: 11.1 15.0
8: 15.0 21.5
9: 21.5 32.6
10: 32.6
Mean grams per day
0.97
2.43
3.68
5.24
8
9.57
12.69
17.85
24.94
49.80
5.38
2.7 (2.1,3.3)
2.7 (2.1,3.2)
4.7 (3.9,5.4)
6.1 (5.2,7.0)
9.3 (8.2,10.3)
9.7 (8.7,10.8)
12.0 (10.8,13.2)
13.9 (12.7,15.2)
16.8 (15.4,18.1)
22.1 (20.6,23.6)
9.7 (8.8,10.5)
8.3 (7.5,9.0)
10.4 (9.5,11.2)
11.1 (10.2,11.9)
12.6 (11.7,13.5)
10.8 (10.0,11.7)
10.9 (10.0,11.7)
10.9 (10.0,11.7)
9.2 (8.4,10.1)
6.2 (5.5,6.9)
45 54
Grams per day

0.92
2.45
3.72
5.24
7.17
9.53
12.79
18.11
26.83
56.57
% (95% CI)
MEN
3.9 (3.2,4.5)
3.0 (2.5,3.6)
5.7 (5.0,6.5)
7.6 (6.7,8.5)
9.7 (8.8,10.7)
8.8 (7.8,9.7)
11.9 (10.8,12.9)
14.4 (13.3,15.6)
14.6 (13.4,15.8)
20.4 (19.0,21.7)
55 64
Grams per
% (95% CI)
day
0.93
2.45
3.71
5.23
7.25
9.55
12.76
18.11
26.41
54.45
6.92
6.27
0.99
2.41
3.65
5.21
7.16
9.50
12.83
17.93
26.30
47.89
4.78
WOMEN
13.7 (12.8,14.5)
1.02
10.9 (10.1,11.7)
2.38
12.7 (11.8,13.5)
3.66
12.6 (11.7,13.4)
5.25
11.9 (11.1,12.8)
7.23
9.2 (8.4,9.9)
9.56
9.3 (8.5,10.0)
12.80
8.0 (7.3,8.7)
17.90
7.5 (6.8,8.2)
26.11
4.3 (3.8,4.8)
46.11
4.42
5.4 (4.5,6.3)
5.5 (4.6,6.4)
8.5 (7.4,9.6)
9.5 (8.4,10.7)
10.4 (9.2,11.6)
10.0 (8.8,11.1)
11.5 (10.3,12.8)
12.2 (11.0,13.5)
13.0 (11.7,14.3)
13.9 (12.5,15.2)
65
Grams per day
% (95% CI)
0.97
2.45
3.66
5.24
7.21
9.61
12.95
18.23
26.81
50.70
6.3 (4.8,7.9)
6.3 (4.8,7.9)
8.0 (6.3,9.8)
9.7 (7.8,11.5)
12.2 (10.1,14.3)
10.6 (8.6,12.6)
13.0 (10.8,15.1)
11.5 (9.4,13.5)
11.2 (9.2,13.3)
11.2 (9.1,13.2)
6.02
16.8 (15.7,18.0)
13.2 (12.1,14.2)
13.6 (12.6,14.6)
12.2 (11.2,13.2)
11.7 (10.7,12.7)
8.1 (7.3,8.9)
7.7 (6.9,8.6)
6.7 (5.9,7.4)
5.4 (4.7,6.1)
4.5 (3.9,5.2)
0.96
2.37
3.68
5.17
7.17
9.60
12.89
17.63
26.09
47.36
4.22
20.0 (18.1,22.0)
14.7 (12.9,16.4)
13.6 (11.9,15.3)
11.9 (10.3,13.4)
9.1 (7.7,10.5)
7.6 (6.3,8.9)
6.0 (4.9,7.2)
6.7 (5.5,7.9)
6.1 (4.9,7.3)
4.2 (3.2,5.2)
168
Table 6.11 Processed meat consumption in grams per day and the proportion of the population (%) and corresponding 95% confidence
intervals in each of ten consumption categories by age/sex group, South Zone
35 44
(grams per day)
1: < 1.7
2: 1.7 3.1
3: 3.1 4.5
4: 4.5 6.2
5: 6.2 8.2
6: 8.2 11.0
7: 11.1 15.0
8: 15.0 21.5
9: 21.5 32.6
10: 32.6
1.13
2.39
3.58
5.26
7.20
9.49
12.98
17.74
26.23
55.09
Mean grams per day
22.50
1: < 1.7
2: 1.7 3.1
3: 3.1 4.5
4: 4.5 6.2
5: 6.2 8.2
6: 8.2 11.0
7: 11.1 15.0
8: 15.0 21.5
9: 21.5 32.6
10: 32.6
Mean grams per day
1.03
2.44
3.68
5.08
7.27
9.50
12.86
17.80
25.86
45.83
13.16
0.3 (0.0,0.9)
2.9 (1.0,4.7)
4.5 (2.2,6.8)
7.0 (4.2,9.9)
8.0 (5.0,11.0)
13.1 (9.4,16.8)
13.1 (9.4,16.8)
13.1 (9.4,16.8)
16.9 (12.8,21.1)
21.1 (16.6,25.6)
45 54
Grams per day

0.89
2.36
3.75
5.23
7.24
9.55
12.82
18.01
26.85
59.40
% (95% CI)
MEN
3.0 (1.4,4.6)
2.1 (0.7,3.4)
6.9 (4.5,9.3)
6.4 (4.1,8.7)
11.0 (8.1,13.9)
7.8 (5.3,10.3)
12.2 (9.1,15.2)
14.7 (11.4,18.0)
16.5 (13.0,20.0)
19.5 (15.8,23.2)
55 64
Grams per
% (95% CI)
day
22.43
8.0 (5.8,10.2)
5.2 (3.3,7.0)
10.1 (7.6,12.6)
10.3 (7.8,12.8)
12.4 (9.7,15.2)
11.0 (8.4,13.6)
12.1 (9.4,14.8)
11.9 (9.2,14.6)
11.4 (8.8,14.0)
7.6 (5.4,9.8)
1.07
2.45
3.61
5.18
7.17
9.51
12.86
17.760962
26.584343
48.751995
10.230154
1.08
2.44
3.74
5.29
7.13
9.71
12.71
18.41
26.60
52.29
5.5 (3.0,8.0)
4.6 (2.3,6.8)
10.7 (7.3,14.0)
9.4 (6.3,12.6)
9.4 (6.3,12.6)
9.4 (6.3,12.6)
9.2 (6.0,12.3)
12.8 (9.2,16.4)
13.7 (10.0,17.4)
15.2 (11.3,19.1)
17.80
WOMEN
12.0 (9.6,14.4)
9.9 (7.7,12.1)
12.4 (10.0,14.9)
12.9 (10.4,15.4)
13.7 (11.2,16.3)
9.4 (7.3,11.6)
9.0 (6.9,11.1)
8.6 (6.5,10.7)
7.6 (5.6,9.5)
4.4 (2.9,6.0)
0.92
2.34
3.66
5.28
7.31
9.54
12.83
17.62
26.88
47.90
9.17
65
Grams per day
% (95% CI)
1.13
2.43
3.69
5.13
7.26
9.76
12.76
17.90
26.91
58.06
3.7 (0.1,7.2)
6.4 (1.8,11.0)
11.0 (5.1,16.9)
8.3 (3.1,13.4)
7.3 (2.4,12.2)
12.8 (6.6,19.1)
9.2 (3.8,14.6)
13.8 (7.3,20.2)
14.7 (8.0,21.3)
12.8 (6.6,19.1)
17.85
16.5 (13.2,19.7)
13.5 (10.6,16.5)
11.2 (8.4,13.9)
13.1 (10.2,16.1)
12.9 (10.0,15.8)
7.6 (5.3,9.9)
9.6 (7.0,12.2)
5.5 (3.5,7.5)
5.1 (3.2,7.0)
4.9 (3.0,6.8)
0.86
2.32
3.51
5.19
7.49
9.45
12.47
18.09
24.95
52.78
7.79
22.0 (16.3,27.7)
14.0 (9.2,18.8)
17.0 (11.8,22.2)
9.5 (5.4,13.6)
7.0 (3.5,10.5)
11.5 (7.1,15.9)
5.0 (2.0,8.0)
5.5 (2.3,8.7)
5.5 (2.3,8.7)
3.0 (0.6,5.4)
169
intervals in each of ten consumption categories by age/sex group, Calgary Zone
35 44
(grams per day)
1: < 1.7
2: 1.7 3.1
3: 3.1 4.5
4: 4.5 6.2
5: 6.2 8.2
6: 8.2 11.0
7: 11.1 15.0
8: 15.0 21.5
9: 21.5 32.6
10: 32.6
0.91
2.36
3.70
5.21
7.26
9.63
12.68
18.15
26.96
54.73
Mean grams per day
21.25
1: < 1.7
2: 1.7 3.1
3: 3.1 4.5
4: 4.5 6.2
5: 6.2 8.2
6: 8.2 11.0
7: 11.1 15.0
8: 15.0 21.5
9: 21.5 32.6
10: 32.6
Mean grams per day
0.96
2.44
3.75
5.22
7.22
9.58
12.73
17.93
25.69
52.72
11.08
45 54
55 64
65
MEN
3.9 (2.7,5.2)
0.99
4.8 (3.5,6.2)
0.94
5.2 (3.5,7.0)
1.06
7.5 (4.0,11.0)
2.6 (1.6,3.6)
2.42
4.0 (2.8,5.2)
2.34
5.9 (4.0,7.7)
2.38
8.4 (4.7,12.1)
5.9 (4.4,7.4)
3.62
5.9 (4.5,7.3)
3.72
6.8 (4.8,8.8)
3.48
8.9 (5.1,12.7)
6.0 (4.5,7.5)
5.20
8.0 (6.4,9.7)
5.23
10.9 (8.5,13.4)
5.18
13.6 (9.0,18.1)
9.6 (7.7,11.5)
7.17
9.9 (8.1,11.7)
7.28
13.5 (10.8,16.1)
7.10
12.2 (7.8,16.5)
10.5 (8.5,12.4)
9.53
9.4 (7.6,11.2)
9.47
10.8 (8.4,13.2)
9.64
9.8 (5.8,13.8)
11.4 (9.4,13.5)
12.72
11.1 (9.2,13.1)
12.80
11.4 (8.9,13.9)
13.16
10.3 (6.2,14.3)
14.4 (12.1,16.7)
18.19
14.6 (12.5,16.8)
18.36
12.0 (9.5,14.6)
18.00
9.8 (5.8,13.8)
16.8 (14.4,19.2)
26.40
13.8 (11.7,15.9)
26.70
10.5 (8.1,12.8)
27.54
11.7 (7.4,16.0)
18.9 (16.3,21.4)
54.77
18.4 (16.1,20.8)
51.06
13.0 (10.4,15.6)
45.21
7.9 (4.3,11.6)
11.5 (9.8,13.1)
10.1 (8.5,11.6)
10.4 (8.8,11.9)
11.5 (9.9,13.1)
13.1 (11.4,14.8)
10.2 (8.7,11.7)
9.6 (8.1,11.1)
11.1 (9.5,12.7)
7.5 (6.1,8.8)
5.1 (4.0,6.2)
20.17
16.11
1.01
2.39
3.66
5.21
7.20
9.46
12.82
18.04
25.83
49.59
9.28
WOMEN
15.7 (13.9,17.4)
1.00
12.6 (11.0,14.2)
2.37
12.8 (11.2,14.4)
3.64
12.1 (10.5,13.7)
5.26
11.9 (10.3,13.5)
7.23
7.6 (6.3,8.9)
9.51
8.5 (7.2,9.9)
12.69
8.0 (6.7,9.3)
18.04
7.3 (6.0,8.6)
25.45
3.5 (2.6,4.4)
46.40
8.49
13.09
19.6 (17.2,22.0)
15.7 (13.6,17.9)
13.3 (11.2,15.3)
10.7 (8.9,12.6)
11.7 (9.8,13.6)
6.2 (4.8,7.7)
6.7 (5.2,8.2)
6.2 (4.8,7.7)
5.2 (3.8,6.5)
4.6 (3.4,5.9)
1.01
2.37
3.68
5.30
7.07
9.65
13.04
17.22
26.39
43.80
8.63
19.0 (15.1,22.9)
15.4 (11.9,19.0)
14.9 (11.4,18.4)
12.2 (8.9,15.4)
10.1 (7.2,13.1)
6.1 (3.7,8.4)
4.8 (2.7,6.9)
6.8 (4.3,9.3)
5.1 (2.9,7.2)
5.6 (3.3,7.8)
170
intervals in each of ten consumption categories by age/sex group, Central Zone
35 44
(grams per day)
1: < 1.7
2: 1.7 3.1
3: 3.1 4.5
4: 4.5 6.2
5: 6.2 8.2
6: 8.2 11.0
7: 11.1 15.0
8: 15.0 21.5
9: 21.5 32.6
10: 32.6
1.06
2.50
3.60
5.29
7.14
9.65
12.91
17.95
26.74
59.34
Mean grams per day
26.72
1: < 1.7
2: 1.7 3.1
3: 3.1 4.5
4: 4.5 6.2
5: 6.2 8.2
6: 8.2 11.0
7: 11.1 15.0
8: 15.0 21.5
9: 21.5 32.6
10: 32.6
Mean grams per day
0.93
2.48
3.68
5.32
7.16
9.71
12.54
17.76
26.44
48.39
12.86
45 54
55 64
65
MEN
1.9 (0.6,3.1)
0.99
2.3 (1.1,3.5)
0.89
3.7 (1.9,5.4)
0.90
8.5 (4.7,12.4)
1.4 (0.3,2.5)
2.52
2.7 (1.4,4.0)
2.41
6.9 (4.5,9.2)
2.46
6.5 (3.1,10.0)
4.7 (2.7,6.6)
3.79
4.7 (3.0,6.3)
3.77
7.5 (5.1,10.0)
3.56
4.5 (1.6,7.4)
4.7 (2.7,6.6)
5.25
7.2 (5.1,9.2)
5.16
6.4 (4.1,8.7)
5.43
9.1 (5.1,13.0)
8.6 (6.0,11.3)
7.25
8.3 (6.1,10.5)
7.21
11.2 (8.2,14.2)
7.27
13.1 (8.4,17.8)
6.5 (4.2,8.8)
9.46
9.7 (7.3,12.0)
9.70
11.4 (8.5,14.4)
9.44
11.6 (7.1,16.0)
13.0 (9.8,16.2)
12.89
12.3 (9.7,15.0)
12.62
13.3 (10.1,16.4)
13.06
16.6 (11.4,21.8)
14.2 (10.9,17.5)
17.86
14.7 (11.8,17.5)
18.17
11.4 (8.5,14.4)
17.99
13.6 (8.8,18.3)
18.4 (14.7,22.0)
26.58
15.3 (12.4,18.2)
25.88
13.3 (10.1,16.4)
25.88
7.0 (3.5,10.6)
26.7 (22.6,30.9)
57.73
22.8 (19.5,26.2)
54.83
14.9 (11.5,18.2)
48.15
9.6 (5.5,13.6)
6.6 (4.9,8.2)
6.5 (4.8,8.1)
9.9 (7.9,11.9)
11.3 (9.1,13.4)
13.2 (10.9,15.4)
12.4 (10.2,14.7)
11.8 (9.7,14.0)
12.0 (9.8,14.2)
9.3 (7.3,11.2)
7.2 (5.4,8.9)
23.63
18.08
0.95
2.46
3.60
5.22
7.14
9.59
12.79
17.96
26.89
49.52
10.61
WOMEN
11.7 (9.8,13.7)
1.06
9.7 (7.9,11.5)
2.41
13.3 (11.2,15.3)
3.685
12.9 (10.8,14.9)
5.21
10.8 (8.9,12.7)
7.27
11.2 (9.3,13.2)
9.48
10.6 (8.7,12.4)
12.71
7.4 (5.8,8.9)
18.09
7.1 (5.5,8.6)
26.43
5.4 (4.0,6.8)
45.07
9.36
13.96
13.5 (11.2,15.8)
12.1 (9.9,14.3)
15.0 (12.6,17.4)
11.2 (9.1,13.3)
11.8 (9.6,13.9)
10.6 (8.6,12.7)
8.1 (6.3,9.9)
7.8 (6.0,9.6)
5.3 (3.8,6.8)
4.6 (3.2,6.0)
0.95
2.43
3.69
5.15
7.06
9.87
13.08
17.96
26.33
47.28
9.28
18.6 (14.7,22.6)
12.5 (9.2,15.8)
13.3 (9.9,16.7)
12.5 (9.2,15.8)
9.6 (6.6,12.6)
7.4 (4.8,10.1)
8.0 (5.2,10.7)
6.7 (4.1,9.2)
6.7 (4.1,9.2)
4.8 (2.6,7.0)
171
intervals in each of ten consumption categories by age/sex group, Edmonton Zone
35 44
(grams per day)
1: < 1.7
2: 1.7 3.1
3: 3.1 4.5
4: 4.5 6.2
5: 6.2 8.2
6: 8.2 11.0
7: 11.1 15.0
8: 15.0 21.5
9: 21.5 32.6
10: 32.6
0.78
2.44
3.71
5.29
7.21
9.55
12.89
18.07
26.26
60.77
Mean grams per day
23.89
1: < 1.7
2: 1.7 3.1
3: 3.1 4.5
4: 4.5 6.2
5: 6.2 8.2
6: 8.2 11.0
7: 11.1 15.0
8: 15.0 21.5
9: 21.5 32.6
10: 32.6
Mean grams per day
0.94
2.39
3.62
5.30
7.10
9.51
12.61
17.77
25.52
49.32
11.75
45 54
55 64
65
MEN
3.3 (2.0,4.6)
0.78
3.6 (2.4,4.8)
0.89
6.9 (5.1,8.8)
0.93
6.0 (3.3,8.8)
3.6 (2.2,4.9)
2.44
3.1 (2.0,4.3)
2.55
5.4 (3.8,7.0)
2.45
6.0 (3.3,8.8)
4.4 (2.9,5.9)
3.81
5.0 (3.5,6.4)
3.69
8.6 (6.5,10.6)
3.73
10.0 (6.5,13.5)
6.6 (4.8,8.4)
5.21
7.4 (5.7,9.2)
5.22
9.7 (7.5,11.8)
5.21
7.8 (4.7,11.0)
9.2 (7.1,11.3)
7.07
10.1 (8.2,12.1)
7.38
8.9 (6.8,10.9)
7.28
12.5 (8.6,16.3)
9.1 (7.0,11.2)
9.50
8.1 (6.3,9.9)
9.45
8.7 (6.7,10.8)
9.71
9.6 (6.2,13.1)
10.3 (8.1,12.5)
12.70
11.6 (9.5,13.7)
12.86
12.3 (9.9,14.7)
12.73
13.5 (9.5,17.5)
14.0 (11.5,16.6)
18.14
14.9 (12.5,17.2)
17.95
12.5 (10.1,14.9)
18.20
10.3 (6.8,13.9)
17.7 (15.0,20.5)
27.09
14.5 (12.2,16.8)
26.56
14.7 (12.1,17.3)
26.72
11.4 (7.7,15.1)
21.7 (18.7,24.7)
59.32
21.6 (18.9,24.3)
54.87
12.3 (9.9,14.7)
53.01
12.8 (8.9,16.7)
11.5 (9.7,13.2)
8.3 (6.8,9.9)
10.4 (8.7,12.1)
11.0 (9.2,12.7)
12.3 (10.5,14.2)
9.9 (8.3,11.6)
11.2 (9.5,13.0)
9.5 (7.9,11.2)
9.4 (7.8,11.0)
6.4 (5.0,7.8)
23.10
16.99
0.93
2.43
3.67
5.21
7.11
9.49
12.86
17.88
26.53
44.07
9.60
WOMEN
16.2 (14.3,18.1)
1.06
10.8 (9.2,12.4)
2.39
12.4 (10.7,14.2)
3.68
11.9 (10.3,13.6)
5.23
11.5 (9.9,13.2)
7.18
8.1 (6.7,9.5)
9.57
9.5 (8.0,11.0)
13.01
7.5 (6.1,8.8)
17.50
7.5 (6.1,8.8)
26.19
4.5 (3.4,5.5)
46.04
8.47
16.26
19.6 (17.2,22.1)
11.4 (9.4,13.3)
14.3 (12.2,16.4)
12.6 (10.5,14.6)
12.3 (10.3,14.4)
7.4 (5.8,9.0)
7.0 (5.4,8.6)
5.9 (4.5,7.4)
5.5 (4.1,6.8)
4.0 (2.8,5.2)
0.97
2.38
3.70
5.06
7.17
9.53
12.95
17.73
26.35
51.24
8.37
20.6 (16.7,24.6)
15.9 (12.3,19.5)
11.8 (8.7,15.0)
12.3 (9.1,15.6)
9.3 (6.5,12.2)
7.3 (4.8,9.9)
6.3 (3.9,8.7)
6.0 (3.7,8.4)
7.3 (4.8,9.9)
3.0 (1.3,4.7)
172
intervals in each of ten consumption categories by age/sex group, North Zone
35 44
(grams per day)
1: < 1.7
2: 1.7 3.1
3: 3.1 4.5
4: 4.5 6.2
5: 6.2 8.2
6: 8.2 11.0
7: 11.1 15.0
8: 15.0 21.5
9: 21.5 32.6
10: 32.6
0.85
2.31
3.63
5.25
7.29
9.60
13.16
17.54
25.99
54.17
Mean grams per day
23.64
1: < 1.7
2: 1.7 3.1
3: 3.1 4.5
4: 4.5 6.2
5: 6.2 8.2
6: 8.2 11.0
7: 11.1 15.0
8: 15.0 21.5
9: 21.5 32.6
10: 32.6
Mean grams per day
1.07
2.44
3.66
5.21
7.16
9.50
12.77
17.82
26.41
51.18
12.35
45 54
55 64
65
MEN
2.0 (0.8,3.2)
0.9424
4.7 (3.0,6.4)
0.96
4.9 (2.8,6.9)
0.91
3.8 (0.5,7.2)
2.4 (1.1,3.7)
2.51
2.4 (1.1,3.6)
2.52
4.6 (2.6,6.6)
2.69
3.1 (0.1,6.0)
3.0 (1.5,4.4)
3.69
6.7 (4.7,8.7)
3.67
9.9 (7.1,12.8)
3.894
5.4 (1.5,9.3)
6.1 (4.1,8.1)
5.36
8.4 (6.2,10.6)
5.24
10.4 (7.5,13.3)
5.27
9.2 (4.2,14.2)
10.2 (7.6,12.7)
7.22
9.4 (7.1,11.8)
7.12
8.6 (5.9,11.2)
7.13
14.6 (8.5,20.7)
10.0 (7.5,12.5)
9.61
8.4 (6.2,10.6)
9.53
9.7 (6.9,12.5)
9.50
10.8 (5.4,16.1)
13.9 (11.0,16.8)
12.88
12.8 (10.1,15.5)
12.68
10.4 (7.5,13.3)
13.10
13.8 (7.9,19.8)
13.2 (10.3,16.0)
18.26
13.1 (10.4,15.8)
17.74
12.5 (9.4,15.6)
18.48
11.5 (6.0,17.0)
14.1 (11.1,17.0)
27.42
14.1 (11.3,16.9)
26.18
13.2 (10.0,16.4)
26.60
13.8 (7.9,19.8)
25.2 (21.5,28.9)
51.67
20.0 (16.8,23.2)
59.23
15.7 (12.3,19.2)
48.23
13.8 (7.9,19.8)
8.1 (6.3,9.9)
8.8 (6.9,10.7)
11.0 (8.9,13.1)
10.8 (8.7,12.8)
11.6 (9.4,13.7)
11.6 (9.4,13.7)
10.9 (8.8,13.0)
10.5 (8.5,12.6)
10.8 (8.7,12.8)
6.0 (4.4,7.5)
20.53
18.93
1.03
2.36
3.67
5.20
7.16
9.46
12.83
18.04
25.97
48.60
10.32
WOMEN
10.1 (8.3,11.9)
1.02
10.3 (8.4,12.1)
2.38
12.4 (10.4,14.4)
3.64
13.7 (11.6,15.7)
5.26
12.3 (10.4,14.3)
7.14
10.9 (9.1,12.8)
9.72
9.1 (7.4,10.9)
12.77
8.8 (7.1,10.6)
18.09
8.3 (6.6,9.9)
26.05
4.0 (2.9,5.2)
45.70
9.67
17.19
12.7 (10.2,15.3)
12.9 (10.3,15.4)
13.0 (10.5,15.6)
14.6 (11.9,17.2)
9.7 (7.4,11.9)
9.4 (7.2,11.6)
8.6 (6.5,10.8)
8.0 (6.0,10.1)
6.2 (4.4,8.1)
4.8 (3.2,6.5)
0.94
2.36
3.81
5.15
7.33
9.44
12.41
17.41
26.05
47.40
8.50
21.2 (16.0,26.3)
15.3 (10.8,19.9)
12.0 (7.9,16.1)
11.6 (7.6,15.7)
8.3 (4.8,11.8)
7.9 (4.5,11.3)
5.4 (2.5,8.2)
8.7 (5.2,12.3)
5.4 (2.5,8.2)
4.2 (1.6,6.7)
173
Table 6.16
Cancer cases and proportions attributable to red meat intake in Alberta (2012)
Age at Exposure
(years)
Colorectal
Age at Outcome
(years)
Total
Observed
Cases
35 - 44
45 - 54
55 - 64
65
Total
43 - 52
53 - 62
63 - 72
73
Total
Women
35 - 44
45 - 54
55 - 64
65
Total
43 - 52
53 - 62
63 - 72
73
Total
Colon
PAR (%)
EAC*
Total
Observed
Cases
96
280
320
383
1079
17.9
17.2
15.3
13.6
17
48
49
52
166
81
181
202
356
820
2.1
2
1.9
1.6
2
4
4
6
15
Rectum
PAR (%)
EAC*
Total
Observed
Cases
38
139
177
260
614
8.5
8.2
7.2
6.4
3
11
13
17
44
42
105
125
265
537
4.8
4.6
4.3
3.8
2
5
5
10
22
PAR (%)
EAC*
58
141
143
123
465
12.3
11.8
10.4
9.2
7
17
15
11
50
39
76
77
91
283
7
6.6
6.3
5.5
3
5
5
5
18
Men
Total
177
10.7
19
80
6.6
5
97
10.2
10
461
11.2
52
244
6.6
16
217
10
22
522
10.1
53
302
6
18
220
9
20
739
7.8
58
525
5.1
27
214
7.6
16
1899
181
1151
66
748
68
35 - 44
45 - 54
55 - 64
65
Total
43 - 52
53 - 62
63 - 72
73
Total
174
Table 6.17
Age at Exposure
(years)
Cancer cases and proportions attributable to red meat intake in South Zone (2012)
Age at Outcome
(years)
Colorectal
Total
Observed
PAR (%)
Cases
Colon
Total
Observed
Cases
Rectum
PAR (%)
Total
Observed
Cases
PAR (%)
Men
73
Total
<5
32
27
31
<95
17.8
17.5
16
13.1
<5
19
15
24
<63
8.5
8.3
7.5
6.1
<5
13
12
7
<37
12.2
12
10.9
8.9
Women
35 - 44
45 - 54
55 - 64
65
Total
43 - 52
53 - 62
63 - 72
73
Total
<10
20
27
23
<80
2.3
2.1
1.9
1.7
5
13
15
15
48
5.3
4.9
4.4
4
<5
7
12
8
<32
7.7
7.1
6.4
5.8
Total
35 - 44
45 - 54
55 - 64
65
Total
43 - 52
53 - 62
63 - 72
73
Total
12
7.5
<10
5.8
52
11.6
32
6.9
54
8.9
30
6
54
8.3
39
5.3
172
<111
<10
20
24
15
<69
9.9
10.3
8.6
7.3
35 - 44
45 - 54
55 - 64
43 - 52
53 - 62
63 - 72
65
Total
175
Table 6.18
Cancer cases and proportions attributable to red meat intake in Calgary Zone (2012)
Age at Exposure
(years)
Age at Outcome
(years)
Colorectal
Total
Observed
PAR (%)
Cases
Colon
Total
Observed
Cases
PAR (%)
Rectum
Total
Observed
PAR (%)
Cases
Men
35 - 44
45 - 54
55 - 64
65
Total
43 - 52
53 - 62
63 - 72
73
Total
29
91
95
127
342
16.5
15.7
14.7
12.4
10
45
58
90
203
7.8
7.4
6.9
5.8
19
46
37
37
139
11.3
10.7
10
8.4
Women
35 - 44
45 - 54
55 - 64
65
Total
43 - 52
53 - 62
63 - 72
73
Total
37
67
59
105
268
1.9
1.9
1.7
1.5
24
35
38
81
178
4.3
4.3
3.9
3.5
13
32
21
24
90
6.2
6.2
5.7
5.1
Total
35 - 44
43 - 52
32
78
58
61
229
9.2
8.9
8.5
7.1
66
8.3
34
5.3
45 - 54
53 - 62
158
9.8
80
6
55 - 64
63 - 72
154
9.8
96
5.8
65
73
232
7.5
171
4.7
Total
Total
610
381
176
Table 6.19
Age at Exposure
(years)
Cancer cases and proportions attributable to red meat intake in Central Zone (2012)
Age at Outcome
(years)
Colorectal
Total
Observed
PAR (%)
Cases
Colon
Total
Observed
Cases
PAR (%)
Rectum
Total
Observed
PAR (%)
Cases
Men
73
Total
17
35
51
57
160
20.3
18.8
17
14.3
6
18
22
40
86
9.7
8.9
8.1
6.7
11
17
29
17
74
14
12.9
11.6
9.7
Women
35 - 44
45 - 54
55 - 64
65
Total
43 - 52
53 - 62
63 - 72
73
Total
5
17
28
65
115
2.4
2.2
2
1.8
<5
11
17
47
<80
5.4
5.2
4.7
4.3
<5
6
11
18
<40
7.9
7.5
6.8
6.2
Total
35 - 44
45 - 54
55 - 64
65
Total
43 - 52
53 - 62
63 - 72
73
Total
<16
23
40
35
<114
12.7
11.5
10.3
7.9
35 - 44
45 - 54
55 - 64
43 - 52
53 - 62
63 - 72
65
Total
22
16.2
<11
8.6
52
13.4
29
7.5
79
11.7
39
6.6
122
7.7
87
5.4
275
<166
177
Table 6.20
Age at Exposure
(years)
Cancer cases and proportions attributable to red meat intake in Edmonton Zone (2012)
Age at Outcome
(years)
Colorectal
Total
Observed
PAR (%)
Cases
Colon
Total
Observed
Cases
PAR (%)
Rectum
Total
Observed
PAR (%)
Cases
Men
73
Total
29
84
119
122
354
17.5
17
13.5
12.7
15
38
68
79
200
8.3
8
6.3
6
14
46
51
43
154
11.9
11.6
9.2
8.6
Women
35 - 44
45 - 54
55 - 64
65
Total
43 - 52
53 - 62
63 - 72
73
Total
24
54
63
133
274
1.9
1.7
1.7
1.5
6
34
40
98
178
4.4
3.9
3.9
3.4
18
20
23
35
96
6.4
5.7
5.6
5
Total
35 - 44
45 - 54
55 - 64
65
Total
43 - 52
53 - 62
63 - 72
73
Total
32
66
74
78
250
8.8
9.8
8.1
7
35 - 44
45 - 54
55 - 64
43 - 52
53 - 62
63 - 72
65
Total
53
10.4
21
7.2
138
11
72
6.1
182
9.4
108
5.4
255
6.9
177
4.6
628
378
178
Table 6.21
Age at Exposure
(years)
Cancer cases and proportions attributable to red meat intake in North Zone (2012)
Age at Outcome
(years)
Colorectal
Total
Observed
PAR (%)
Cases
Colon
Total
Observed
Cases
PAR (%)
Rectum
Total
Observed
PAR (%)
Cases
Men
73
Total
17
38
28
46
129
19.1
18.4
16.8
16.5
6
19
14
27
66
9.1
8.8
7.9
7.8
11
19
14
19
63
13.1
12.6
11.4
11.3
Women
35 - 44
45 - 54
55 - 64
65
Total
43 - 52
53 - 62
63 - 72
73
Total
<10
23
25
30
<88
2.3
2.2
2.1
1.7
5
12
15
24
56
5.4
5.1
4.9
3.9
<5
11
10
6
<32
7.8
7.4
7.2
5.7
Total
35 - 44
45 - 54
55 - 64
65
Total
43 - 52
53 - 62
63 - 72
73
Total
<16
30
24
25
<95
12.3
10.7
9.7
9.9
35 - 44
45 - 54
55 - 64
43 - 52
53 - 62
63 - 72
65
Total
<27
14.2
11
7.4
61
12.3
31
7.3
53
9.9
29
6.4
76
10.7
51
6
<217
122
179
Table 6.22
Cancer cases and proportions attributable to processed meat intake in Alberta (2012)
Age at Exposure
(years)
Colorectal
Age at Outcome
(years)
Total
Observed
Cases
35 - 44
45 - 54
55 - 64
65
Total
43 - 52
53 - 62
63 - 72
73
Total
Women
35 - 44
45 - 54
55 - 64
65
Total
43 - 52
53 - 62
63 - 72
73
Total
Colon
PAR (%)
EAC*
Total
Observed
Cases
96
280
320
383
1079
4.8
4.5
3.6
3.2
5
13
12
12
41
81
181
202
356
820
2.1
1.7
1.5
1.5
2
3
3
5
13
Rectum
PAR (%)
EAC*
Total
Observed
Cases
38
139
177
260
614
9.9
9.3
7.5
6.6
4
13
13
17
47
42
105
125
265
537
5.1
4.3
3.9
3.7
2
4
5
10
21
PAR (%)
EAC*
58
141
143
123
465
5.2
4.9
3.9
3.5
3
7
6
4
20
39
76
77
91
283
2.7
2.2
2
2
1
2
2
2
6
Men
Total
177
3.6
6
80
7.4
6
97
4.2
4
461
3.4
16
244
7.1
17
217
4
9
522
2.8
15
302
6
18
220
3.3
7
739
2.4
18
525
5.1
27
214
2.8
6
1899
54
1151
68
748
26
35 - 44
45 - 54
55 - 64
65
Total
43 - 52
53 - 62
63 - 72
73
Total
180
Table 6.23
Age at Exposure
(years)
Cancer cases and proportions attributable to processed meat intake in South Zone (2012)
Age at Outcome
(years)
Colorectal
Total
Observed
PAR (%)
Cases
Colon
Total
Observed
Cases
PAR (%)
Rectum
Total
Observed
PAR (%)
Cases
Men
73
Total
<5
32
27
31
<95
4.7
4.7
3.7
3.7
<5
19
15
24
<63
9.5
9.5
7.6
7.7
<5
13
12
7
<37
5.1
5.1
4
4
Women
35 - 44
45 - 54
55 - 64
65
Total
43 - 52
53 - 62
63 - 72
73
Total
<10
20
27
23
<80
2.3
1.8
1.6
1.3
5
13
15
15
48
5.6
4.4
4
3.4
<5
7
12
8
<32
3
2.3
2.1
1.8
Total
35 - 44
45 - 54
55 - 64
65
Total
43 - 52
53 - 62
63 - 72
73
Total
<10
20
24
15
<69
4
4.1
3.1
2.8
35 - 44
45 - 54
55 - 64
43 - 52
53 - 62
63 - 72
65
Total
<15
3.1
<10
6.3
52
3.5
32
7.5
54
2.6
30
5.8
54
2.7
39
6
<175
<111
181
Table 6.24
Cancer cases and proportions attributable to processed meat intake in Calgary Zone (2012)
Age at Exposure
(years)
Age at Outcome
(years)
Colorectal
Total
Observed
PAR (%)
Cases
Colon
Total
Observed
Cases
PAR (%)
Rectum
Total
Observed
PAR (%)
Cases
Men
73
Total
29
91
95
127
342
4.4
4.2
3.4
2.7
10
45
58
90
203
9
8.6
6.9
5.6
19
46
37
37
139
4.8
4.6
3.6
2.9
Women
35 - 44
45 - 54
55 - 64
65
Total
43 - 52
53 - 62
63 - 72
73
Total
37
67
59
105
268
1.9
1.6
1.5
1.5
24
35
38
81
178
4.8
4
3.7
3.8
13
32
21
24
90
2.5
2.1
1.9
2
Total
35 - 44
45 - 54
55 - 64
65
Total
43 - 52
53 - 62
63 - 72
73
Total
32
78
58
61
229
3.9
3.5
3
2.6
35 - 44
45 - 54
55 - 64
43 - 52
53 - 62
63 - 72
65
Total
66
3
34
6
158
3.1
80
6.6
154
2.6
96
5.6
232
2.2
171
4.7
610
381
182
Table 6.25
Cancer cases and proportions attributable to processed meat intake in Central Zone (2012)
Age at Exposure
(years)
Age at Outcome
(years)
Colorectal
Total
Observed
PAR (%)
Cases
Colon
Total
Observed
Cases
PAR (%)
Rectum
Total
Observed
PAR (%)
Cases
Men
73
Total
17
35
51
57
160
5.5
4.9
3.8
2.9
6
18
22
40
86
11.2
10
7.7
6
11
17
29
17
74
6
5.3
4.1
3.2
Women
35 - 44
45 - 54
55 - 64
65
Total
43 - 52
53 - 62
63 - 72
73
Total
5
17
28
65
115
2.2
1.8
1.6
1.6
<5
11
17
47
<80
5.5
4.6
4
4
<5
6
11
18
<40
2.9
2.4
2.1
2.1
Total
35 - 44
45 - 54
55 - 64
65
Total
43 - 52
53 - 62
63 - 72
73
Total
<15
23
40
35
<113
5.3
4.6
3.5
2.6
35 - 44
45 - 54
55 - 64
43 - 52
53 - 62
63 - 72
65
Total
22
4.8
<11
9.8
52
3.9
29
7.9
79
3
39
6.1
122
2.2
87
4.9
275
<166
183
Table 6.26
Cancer cases and proportions attributable to processed meat intake in Edmonton Zone
(2012)
Age at Exposure
(years)
Age at Outcome
(years)
Colorectal
Total
Observed
PAR (%)
Cases
Colon
Total
Observed
PAR (%)
Cases
Rectum
Total
Observed
PAR (%)
Cases
Men
35 - 44
43 - 52
45 - 54
55 - 64
65
Total
53 - 62
63 - 72
73
Total
29
84
119
122
354
5
4.8
3.5
3.4
15
38
68
79
200
10.1
9.8
7.3
7
14
46
51
43
154
5.4
5.2
3.8
3.7
Women
35 - 44
45 - 54
55 - 64
65
Total
43 - 52
53 - 62
63 - 72
73
Total
24
54
63
133
274
2
1.7
1.5
1.4
6
34
40
98
178
5.1
4.1
3.7
3.6
18
20
23
35
96
2.7
2.2
1.9
1.9
Total
35 - 44
45 - 54
55 - 64
65
Total
43 - 52
53 - 62
63 - 72
73
Total
32
66
74
78
250
3.9
4.3
3.2
2.9
53
3.6
21
8.7
138
3.6
72
7.1
182
2.8
108
5.9
255
2.4
177
5.1
628
378
184
Table 6.27
Cancer cases and proportions attributable to processed meat intake in North Zone (2012)
Age at Exposure
(years)
Age at Outcome
(years)
Colorectal
Total
Observed
PAR (%)
Cases
Colon
Total
Observed
Cases
PAR (%)
Rectum
Total
Observed
PAR (%)
Cases
Men
73
Total
17
38
28
46
129
4.9
4.3
3.9
3.6
6
19
14
27
66
10
8.7
8.1
7.3
11
19
14
19
63
5.3
4.6
4.3
3.9
Women
35 - 44
45 - 54
55 - 64
65
Total
43 - 52
53 - 62
63 - 72
73
Total
<10
23
25
30
<88
2.1
1.8
1.7
1.5
5
12
15
24
56
5.3
4.4
4.2
3.7
<5
11
10
6
<32
2.8
2.3
2.2
1.9
Total
35 - 44
45 - 54
55 - 64
65
Total
43 - 52
53 - 62
63 - 72
73
Total
<15
30
24
25
<94
4.9
3.8
3.4
3.4
35 - 44
45 - 54
55 - 64
43 - 52
53 - 62
63 - 72
65
Total
<27
4.1
11
7.9
61
3.3
31
7.1
53
2.9
29
6.1
76
2.7
51
5.6
<217
122
185
Table 6.28
Total cancer cases and respective proportions in 2012 attributable to red meat intake by age and sex
Age
Group at
Exposure
Age
Group at
Outcome
35-44
43 - 52
Cancer Site
Total
Observed
Cases
Total PAR (%)
80
97
177
45-54
53 - 62
244
217
461
55-64
63 - 72
302
220
522
65
73
525
214
Colorectal
739
Colon
Rectum
Colorectal
Colon
Rectum
Colorectal
Colon
Rectum
Colorectal
Colon
Rectum
6.6
10.2
10.7
6.6
10
11.2
6
9
10.1
5.1
7.6
7.8
Men
Observed
Cases
Men PAR %
(95% CI)
Women
Observed
Cases
Women PAR %
(95% CI)
38
58
96
139
141
280
177
143
320
260
123
383
8.5 (0,18.5)
12.3 (0,24.7)
17.9 (0,67.3)
8.2 (0,17.8)
11.8 (0,23.7)
17.2 (0,65.6)
7.2 (0,15.8)
10.4 (0,21.1)
15.3 (0,60.4)
6.4 (0,14.1)
9.2 (0,19.2)
13.6 (0,56.1)
42
39
81
105
76
181
125
77
202
265
91
356
4.8 (0,10.7)
7.0 (0,14.5)
2.1 (0,14.4)
4.6 (0,10.2)
6.6 (0,13.9)
2.0 (0,13.4)
4.3 (0,9.5)
6.3 (0,13.0)
1.9 (0,13.0)
3.8 (0,8.4)
5.5 (0,11.5)
1.6 (0,11.5)
Notes:
186
Table 6.29
Total cancer cases and respective proportions in 2012 attributable to processed meat intake by age and sex
Age
Group at
Exposure
Age
Group at
Outcome
35-44
43 - 52
Cancer Site
Total
Observed
Cases
Total PAR (%)
80
7.4
97
4.2
177
3.6
45-54
53 - 62
244
7.1
217
4
461
3.4
55-64
63 - 72
302
6
220
3.3
522
2.8
65
73
525
5.1
214
2.8
Colorectal
739
2.4
Colon
Rectum
Colorectal
Colon
Rectum
Colorectal
Colon
Rectum
Colorectal
Colon
Rectum
Men
Observed
Cases
Men PAR %
(95% CI)
Women
Observed
Cases
Women PAR %
(95% CI)
38
58
96
139
141
280
177
143
320
260
123
383
9.9 (5.7,13.9)
5.2 (0,11.2)
4.8 (0,16.0)
9.3 (5.2,13,3)
4.9 (0,10.5)
4.5 (0,15.5)
7.5 (4.2,10.7)
3.9 (0,8.4)
3.6 (0,12.7)
6.6 (3.8,9.5)
3.5 (0,7.4)
3.2 (0,11.0)
42
39
81
105
76
181
125
77
202
265
91
356
5.1 (2.8,7.4)
2.7 (0,5.7)
2.1 (0,6.9)
4.3 (2.4,6.1)
2.2 (0,4.9)
1.7 (0,5.9)
3.9 (2.2,5.6)
2.0 (0,4.4)
1.5 (0,5.2)
3.7 (2.1,5.4)
2.0 (0,4.2)
1.5 (0,4.2)
Notes:
187
Figure 6.1
Prevalence of men and women exceeding WCRF guideline of 500g/week of red and
processed meat consumption by age group in Alberta
188
Figure 6.2
Prevalence of men and women exceeding WCRF guideline of 500g/week of red and
processed meat consumption by age group and Alberta Health Services Region
189
Figure 6.3
Cancer cases attributable to red meat intake and other known and unknown cancer causes
190
Figure 6.4
Cancer cases due to processed meat consumption and other known and unknown causes
191
CHAPTER 7
Cancer Incidence Attributable to Insufficient Fibre

Consumption in Alberta, Canada in 2012
192
SUMMARY
A 23g/day guideline from previous research was used to define sufficient fibre intake in this
analysis. Mean fibre consumption levels ranged from 20.5 21.1 g/day among men and 18.0 18.9
g/day among women in Albertas Tomorrow Project cohort. Using this information, approximately 6.6%
of colorectal cancers in men and 5.2% of colorectal cancers in women could be attributed to insufficient
fibre consumption. When examined separately, proportions attributable to insufficient fibre intake were
higher in men (7.8%) than women (3.8%) for colon cancer, but similar across genders (men = 5.4% vs.
women = 5.9%) for rectal cancer. Overall, approximately 0.7% of all cancers in Alberta could be
attributable to insufficient fibre consumption (Table 7.1).
METHODS OVERVIEW
Population attributable risks (PARs) related to insufficient fibre consumption were estimated for
colorectal cancer, as well as for colon and rectal cancers individually. As described in previous chapters
for other exposures in this document, follow-up times from cohort studies in the existing peer-reviewed
literature were examined to determine the most appropriate latency period between fibre consumption
and colorectal cancer development. Observed follow-up times following assessment of fibre
consumption in previously published cohort studies ranged from 6 to 20 years., Detailed information on
fibre consumption in Alberta by both sex and age group was only available from data from Albertas
Tomorrow Project (ATP). For this data source the average latency period was 8 years with ATP data
collected between 2000 and 2009 and was therefore used for analyses. Latency periods used for this
analysis are summarized in Table 7.2.
Relative risks (RRs) linking fibre intake to colorectal cancer, as well as colon and rectal cancer
individually, were obtained from the World Cancer Research Fund (WCRF) Continuous Update Project
publication on colorectal cancer from 2011. As fibre intake is considered protective for colorectal
cancer, the risk associated with each decrease of 1 gram per day of fibre intake was estimated according
to equation 7.1, where represents the exposure level in grams per day of the original RR (Table 7.2).
7.1: =
1
ln
Levels of fibre consumption in Alberta were obtained from data from ATP data. As described in
Chapter 5, ATP is a population-based cohort study conducted in Alberta, Canada that includes a diet
history questionnaire (DHQ) as part of baseline data collection. Data used in this analysis were collected
between 2000 and 2009, where data from the DHQ were used to estimate total dietary fibre intake in
193
grams per day. Previous PAR analysis conducted in the United Kingdom (Parkin, 2011) used a guideline
of 23 g/day of fibre intake to evaluate attributable risks related to colorectal cancer. This is within the
range of 21 38 g/day of both dietary and functional fibre intake recommended by Health Canada and
to maintain consistency with earlier estimations, this 23 g/day cut-off was used in this analysis. Total
dietary fibre intake from ATP data was divided into deciles using all data and the mean level of
consumption with each decile was estimated. The deficit between this mean and the 23 g/day guideline
and proportion of the population, was then estimated for men and women in four age groups (35 44,
45 54, 55 64, 65). These values are summarized for Alberta in Table 7.4 and for individual Alberta
Health Services zones in Tables 7.5 7.8. The proportions of ATP participants with fibre intake below
the 23 g/day cut-off by age group and sex are shown in Figure 7.1, while similar data for individual
Alberta Health Services zones are shown in Figure 7.2.
Excess relative risk (ERR) in each fibre consumption category was estimated using the following
equation 7.2:
7.2: = exp 1
where represents the increase in risk associated with a 1 gram decrease in fibre consumption per day
and represents the deficit in consumption (< 23 g/day) of fibre in consumption category .
PARs related to insufficient fibre consumption for colorectal cancer, as well as for colon and rectal
cancers separately, were then estimated according to the equation 7.3:
7.3: =
(1 1 ) + (2 2 ) + + ( )
1 + [(1 1 ) + (2 2 ) + + ( )]
where represents the proportion of the population in consumption category and is the
excess relative risk for consumption category , calculated from equation 7.2. To estimate the total
number of cancers at each site overall and by age-group and gender attributable to insufficient fibre
consumption, PARs were applied to cancer incidence data obtained from the Alberta Cancer Registry for
2012. Estimates of PAR and excess attributable cases (EACs) for Alberta are summarized in Table 7.10,
where PAR estimates for individual Alberta Health Services zones are shown in Tables 7.11 7.15. Table
7.16 shows estimates for PAR for Alberta similar to Table 7.10 including 95% confidence intervals to
demonstrate the precision around these estimates. The total number of cancer cases for colorectal
cancer, as well as colon and rectal cancers separately, attributable to insufficient fibre consumption are
shown in Figure 7.3.
194
Table 7.1 Summary of cases and proportions of cancer in Alberta in 2012 attributable to insufficient fibre consumptiona
Cancer Siteb
Colorectum
Colon
Rectum
a.
b.
c.
d.
e.
f.
g.
Total
Men
Women
Excess
Excess
Excess
Observed
%
Observed
%
Observed
%
Attributable
Attributable
Attributable
e
c
e
c
e
Casesc
Attributable
Cases
Attributable
Cases
Attributable
Casesd
Casesd
Casesd
1899
114
6
1079
71
6.6
820
42
5.2
1151
68
6
614
48
7.8
537
21
3.8
748
42
5.6
465
25
5.4
283
17
5.9
1899
114
1079
71
6.6
820
42
5.2
All Cancersg
15836
114
0.7
8155
71
0.9
7681
42
0.5
Fibre consumption in Alberta by age-sex group assessed using data from Albertas Tomorrow Project.
Cancer incidence data obtained from the Alberta Cancer Registry. Data from 2012 was used for observed cancer cases for all cancer
sites.
Number of observed cancer cases in Alberta in 2012 at individual cancer sites.
Number of cancer cases at individual cancer sites that can be attributed to insufficient fibre consumption.
Proportion of cancers at individual cancer sites attributable to insufficient fibre consumption. Calculated as excess attributable
Represents all cancers with a known association with insufficient fibre consumption, as listed in table. Here this represents colorectal
cancer, as colon and rectal cancers are subsets of this.
Represents all incident cancers in Alberta in 2012 in all age groups.
195
Table 7.2
Predetermined latency periods by cancer site used for population attributable

risk calculations
Cancer Site
Sex
Latency Period*
Colorectal
All
8 years
Colorectal
Men
8 years
Colorectal
Women
8 years
Colon
All
8 years
Colon
Men
8 years
Colon
Women
8 years
Rectum
All
8 years
Rectum
Men
8 years
Rectum
Women
8 years
*All prevalence data from Albertas Tomorrow Project
196
Table 7.3
Risk associations for risk associated with insufficient fibre consumption and colorectal
cancer
Cancer Site
Gender
RR Estimate
Units
Risk per gram

per day
Source
Colorectal
Colorectal
Colorectal
Colon
Colon
Colon
Rectum
Rectum
Rectum
All
Men
Women
All
Men
Women
All
Men
Women
0.90
0.88
0.92
0.89
0.86
0.94
0.91
0.90
0.91
10 g/day
10 g/day
10 g/day
10 g/day
10 g/day
10 g/day
10 g/day
10 g/day
10 g/day
0.011
0.013
0.0083
0.012
0.015
0.0062
0.0094
0.011
0.0094
WCRF, 2011
WCRF, 2011
WCRF, 2011
WCRF, 2011
WCRF, 2011
WCRF, 2011
WCRF, 2011
WCRF, 2011
WCRF, 2011
197
Table 7.4 Fibre consumption in grams per day, deficit from 23 g/day guideline and the proportion of the population (%) and corresponding 95%
confidence intervals in each of ten consumption categories by age/sex group in Alberta
Fibre Consumption
Category (grams per
day)
35 44
Deficit
Grams per
from 23
day
g/day
45 54
Deficit
Grams
from 23
per day
g/day
1: < 9.38
2: 9.38 11.84
3: 11.85 13.89
4: 13.90 15.73
5: 15.74 17.63
6: 17.64 19.75
7: 19.76 22.17
8: 22.18 25.47
9: 25.48 30.68
10: 30.69
Mean grams per day
7.35
10.69
12.85
14.83
16.68
18.63
20.87
23.71
27.77
40.10
21.14
15.65
12.31
10.15
8.17
6.32
4.36
2.13
0
0
0
6.7 (5.8,7.6)
8.0 (7.0,9.0)
8.8 (7.8,9.9)
9.0 (8.0,10.1)
9.1 (8.0,10.1)
10.6 (9.5,11.7)
10.6 (9.5,11.7)
11.2 (10.1,12.3)
11.6 (10.5,12.8)
14.3 (13.1,15.6)
7.29
10.66
12.83
14.82
16.74
18.63
20.92
23.74
27.80
38.97
20.54
15.71
12.34
10.17
8.18
6.26
4.37
2.08
0
0
0
1: < 9.38
2: 9.38 11.84
3: 11.85 13.89
4: 13.90 15.73
5: 15.74 17.63
6: 17.64 19.75
7: 19.76 22.17
8: 22.18 25.47
9: 25.48 30.68
10: 30.69
Mean grams per day
7.29
10.66
12.94
14.82
16.66
18.72
20.87
23.72
27.75
39.03
17.96
15.71
12.34
10.06
8.18
6.34
4.28
2.13
0
0
0
12.1 (11.2,13.0)
11.3 (10.4,12.2)
11.8 (10.9,12.7)
11.2 (10.3,12.1)
10.0 (9.1,10.8)
9.9 (9.1,10.8)
9.3 (8.5,10.1)
8.9 (8.1,9.7)
8.5 (7.7,9.3)
7.1 (6.4,7.8)
7.08
10.70
12.89
14.82
16.69
18.68
20.95
23.70
27.74
38.62
18.28
15.92
12.30
10.11
8.18
6.31
4.31
2.05
0
0
0
55 64
Deficit
Grams
Grams
%
from 23
%
per day
per day
g/day
MEN
7.8 (7.0,8.7)
7.28
15.72
8.1 (7.0,9.1)
7.49
8.1 (7.2,9.0)
10.77
12.23
9.6 (8.4,10.7)
10.46
8.7 (7.8,9.6)
12.84
10.16
9.1 (8.0,10.2)
12.91
9.7 (8.7,10.7)
14.91
8.09
9.0 (7.9,10.1)
14.78
10.3 (9.3,11.3) 16.67
6.33
9.2 (8.1,10.3)
16.67
9.6 (8.6,10.5)
18.67
4.33
9.4 (8.2,10.5)
18.69
10.5 (9.5,11.5) 20.94
2.06
10.0 (8.9,11.2) 20.93
10.6 (9.6,11.6) 23.79
0
11.1 (9.9,12.4) 23.61
11.7 (10.7,12.8) 27.90
0
11.7 (10.5,13.0) 27.84
13.1 (12.0,14.2) 38.22
0
12.8 (11.5,14.1) 38.98
20.32
20.45
WOMEN
11.3 (10.5,12.1) 7.19
11.6 (10.7,12.4) 10.66
10.7 (9.9,11.5) 12.92
10.6 (9.8,11.4) 14.82
10.4 (9.6,11.2) 16.62
9.9 (9.2,10.7)
18.70
9.4 (8.7,10.2)
20.97
9.4 (8.7,10.2)
23.73
8.6 (7.9,9.4)
27.73
8.0 (7.3,9.7)
37.99
18.94
15.81
12.34
10.08
8.18
6.38
4.30
2.03
0
0
0
11.1 (10.2,12.1)
9.6 (8.7,10.5)
9.7 (8.8,10.6)
9.8 (8.9,10.7)
10.5 (9.5,11.4)
9.4 (8.5,10.3)
10.1 (9.2,11.1)
10.8 (9.9,11.8)
9.7 (8.8,10.6)
9.3 (8.4,10.2)
7.17
10.70
13.01
14.83
16.69
18.74
20.88
23.86
27.73
37.88
18.51
65
Deficit
from 23
g/day
15.51
12.54
10.09
8.22
6.33
4.31
2.07
0
0
0
8.0 (6.3,9.8)
8.5 (6.7,10.2)
9.4 (7.6,11.3)
7.9 (6.2,9.7)
8.9 (7.1,10.7)
10.7 (8.7,12.7)
10.2 (8.2,12.1)
10.6 (8.6,12.6)
14.2 (11.9,16.4)
11.6 (9.5,13.6)
15.83
12.30
9.99
8.17
6.31
4.26
2.12
0
0
0
10.6 (9.1,12.1)
10.3 (8.8,11.8)
9.9 (8.4,11.3)
10.0 (8.5,11.5)
10.2 (8.8,11.7)
12.0 (10.4,13.6)
12.2 (10.6,13.8)
8.0 (6.6,9.3)
8.8 (7.4,10.1)
8.0 (6.7,9.3)
198
confidence intervals in each of ten consumption categories by age/sex group in South Zone
35 44
Fibre Consumption
Deficit
Category (grams Grams per
from 23
per day)
day
g/day
1: < 9.38
2: 9.38 11.84
3: 11.85 13.89
4: 13.90 15.73
5: 15.74 17.63
6: 17.64 19.75
7: 19.76 22.17
8: 22.18 25.47
9: 25.48 30.68
10: 30.69
Mean grams per
day
7.46
10.63
12.90
14.87
16.79
18.68
20.97
23.84
28.03
41.25
1: < 9.38
2: 9.38 11.84
3: 11.85 13.89
4: 13.90 15.73
5: 15.74 17.63
6: 17.64 19.75
7: 19.76 22.17
8: 22.18 25.47
9: 25.48 30.68
10: 30.69
Mean grams per
day
7.25
10.66
12.93
14.88
16.64
18.61
20.99
23.91
27.86
38.52
15.54
12.37
10.11
8.13
6.21
4.32
2.03
0
0
0
%
7.7 (4.7,10.6)
8.3 (5.2,11.4)
8.9 (5.8,12.1)
7.0 (4.2,9.9)
10.9 (7.4,14.3)
9.6 (6.3,12.8)
13.7 (9.9,17.6)
9.3 (6.0,12.5)
9.6 (6.3,12.8)
15.0 (11.1,19.0)
21.24
17.07
45 54
Deficit
Grams per
from 23
day
g/day
7.41
10.55
12.94
14.71
16.72
18.49
20.80
23.67
27.94
40.36
15.59
12.45
10.06
8.29
6.28
4.51
2.20
0
0
0
19.83
15.75
12.34
10.07
8.12
6.36
4.39
2.01
0
0
0
14.6 (11.7,17.5)
11.4 (8.8,14.0)
12.4 (9.7,15.2)
10.8 (8.3,13.4)
9.4 (7.0,11.8)
11.6 (8.9,14.2)
9.6 (7.2,12.0)
8.2 (5.9,10.4)
7.1 (5.0,9.2)
5.0 (3.2,6.8)
7.05
10.75
12.91
14.73
16.68
18.65
20.91
23.70
27.49
39.44
17.82
Grams per
day
MEN
8.7 (6.1,11.4)
8.7 (6.1,11.4)
10.1 (7.3,12.9)
9.4 (6.7,12.1)
9.9 (7.1,12.7)
10.1 (7.3,12.9)
10.1 (7.3,12.9)
11.5 (8.5,14.5)
11.7 (8.7,14.7)
9.9 (7.1,12.7)
7.22
11.02
12.86
14.85
16.65
18.49
20.85
23.81
27.56
40.91
55 64
Deficit
from 23
g/day
15.78
11.99
10.14
8.15
6.35
4.51
2.15
0
0
0
%
8.5 (5.5,11.6)
9.2 (6.0,12.3)
10.7 (7.3,14.0)
7.9 (5.0,10.8)
11.0 (7.6,14.4)
7.6 (4.8,10.5)
10.4 (7.1,13.7)
10.1 (6.8,13.3)
11.3 (7.9,14.7)
13.4 (9.7,17.1)
20.46
15.95
12.25
10.09
8.27
6.32
4.35
2.09
0
0
0
WOMEN
11.3 (8.9,13.7)
6.84
12.4 (10.0,14.9)
10.69
12.0 (9.6,14.4)
12.94
11.3 (8.9,13.7)
14.94
10.0 (7.8,12.2)
16.56
10.4 (8.2,12.7)
18.78
9.9 (7.7,12.1)
20.84
7.9 (5.9,9.9)
23.92
7.4 (5.5,9.4)
27.94
38.31
18.47514
65
Deficit
Grams per
from 23
day
g/day
7.81
10.39
12.58
14.95
17.01
18.60
20.82
23.68
27.36
41.38
15.19
12.62
10.42
8.05
5.99
4.40
2.18
0
0
0
11.0 (5.1,16.9)
9.2 (3.8,14.6)
9.2 (3.8,14.6)
9.2 (3.8,14.6)
6.4 (1.8,11.0)
11.0 (5.1,16.9)
11.9 (5.8,18.0)
12.8 (6.6,19.1)
11.9 (5.8,18.0)
7.3 (2.4,12.2)
15.68
12.51
9.95
8.23
6.49
4.32
2.11
0
0
0
10.5 (6.2,14.8)
10.5 (6.2,14.8)
8.5 (4.6,12.4)
12.0 (7.5,16.5)
9.0 (5.0,13.0)
10.5 (6.2,14.8)
14.5 (9.6,19.4)
9.0 (5.0,13.0)
8.0 (4.2,11.8)
7.5 (3.8,11.2)
19.30
16.16
12.31
10.06
8.06
6.44
4.22
2.16
0
0
0
10.2 (7.6,12.8)
10.2 (7.6,12.8)
12.8 (9.8,15.6)
9.6 (7.0,12.2)
11.2 (8.4,13.9)
9.2 (6.7,11.7)
9.6 (7.0,12.2)
10.2 (7.6,12.8)
9.2 (6.7,11.7)
7.8 (5.5,10.2)
7.32
10.49
13.05
14.77
16.51
18.68
20.89
24.17
27.88
37.55
18.45
199
confidence intervals in each of ten consumption categories by age/sex group in Calgary Zone
35 44
Fibre
Deficit
Grams per
Consumption
from 23
Category (grams
day
g/day
per day)
45 54
Deficit
Grams per
from 23
day
g/day
1: < 9.38
2: 9.38 11.84
3: 11.85 13.89
4: 13.90 15.73
5: 15.74 17.63
6: 17.64 19.75
7: 19.76 22.17
7.29
10.70
12.96
14.86
16.63
18.65
20.82
15.71
12.30
10.04
8.14
6.37
4.35
2.18
5.7 (4.2,7.2)
8.7 (6.9,10.6)
9.7 (7.8,11.6)
9.1 (7.2,10.9)
8.2 (6.4,9.9)
10.0 (8.1,12.0)
11.2 (9.2,13.3)
7.38
10.68
12.81
14.74
16.79
18.67
20.91
15.62
12.32
10.19
8.26
6.21
4.33
2.09
8: 22.18 25.47
9: 25.48 30.68
10: 30.69
23.65
27.70
39.10
0
0
0
23.71
27.67
39.10
0
0
0
Mean grams per

day
21.00
12.0 (9.9,14.1)
11.3 (9.3,13.4)
14.1
(11.8,16.3)
1: < 9.38
7.30
15.70
10.9 (9.3,12.5)
7.30
2: 9.38 11.84
3: 11.85 13.89
10.67
12.89
12.33
10.11
4: 13.90 15.73
14.84
8.16
5: 15.74 17.63
6: 17.64 19.75
7: 19.76 22.17
8: 22.18 25.47
9: 25.48 30.68
10: 30.69
Mean grams per
day
16.66
18.76
20.84
23.64
27.75
37.71
18.10
6.34
4.24
2.16
0
0
0
11.3 (9.7,12.9)
11.9
(10.2,13.5)
11.6
(10.0,13.2)
9.7 (8.2,11.2)
10.3 (8.7,11.8)
9.7 (8.2,11.2)
7.7 (6.4,9.1)
9.6 (8.1,11.1)
7.5 (6.1,8.8)
55 64
Deficit
Grams per
from 23
day
g/day
MEN
7.8 (6.1,9.4)
7.19
8.1 (6.5,9.8)
10.64
10.3 (8.4,12.1) 13.02
10.3 (8.4,12.1) 15.08
10.0 (8.2,11.8) 16.71
8.8 (7.1,10.6)
18.62
10.5 (8.6,12.3) 20.98
15.81
12.36
9.98
7.92
6.29
4.38
2.03
6.8 (4.8,8.8)
12.2 (9.7,14.8)
6.8 (4.8,8.8)
9.8 (7.5,12.2)
8.1 (6.0,10.2)
11.2 (8.8,13.7)
11.9 (9.4,14.4)
8.01
10.69
12.69
14.72
16.58
18.81
20.94
14.99
12.31
10.31
8.28
6.42
4.19
2.06
0
0
0
10.0 (7.6,12.3)
11.9 (9.4,14.4)
11.2 (8.8,13.7)
23.82
27.88
37.20
0
0
0
10.2 (8.3,12.0)
11.1 (9.1,13.0)
13.1
(11.0,15.1)
23.66
27.96
38.875
15.70
11.2 (9.7,12.7)
7.38
15.62
10.68
12.90
12.32
10.10
10.62
12.93
14.82
8.18
11.2 (9.7,12.7)
11.8
(10.3,13.4)
11.0 (9.5,12.6)
16.66
18.68
20.94
23.66
27.88
39.25
18.29
6.34
4.32
2.06
0
0
0
9.9 (8.5,11.4)
10.1 (8.7,11.6)
9.2 (7.8,10.6)
8.9 (7.6,10.3)
8.5 (7.2,9.9)
8.0 (6.7,9.3)
20.37
65
Deficit
Grams per
from 23
day
g/day
20.15
20.75
7.5 (4.0,11.0)
10.8 (6.6,14.9)
7.5 (4.0,11.0)
6.1 (2.9,9.3)
9.3 (5.5,13.2)
9.3 (5.5,13.2)
14.9
(10.2,19.7)
8.9 (5.1,12.7)
10.3 (6.2,14.3)
15.4
(10.6,20.3)
7.63
15.37
10.9 (7.8,14.0)
12.38
10.07
12.2
(10.2,14.1)
10.2 (8.4,12.0)
9.8 (8.0,11.6)
10.76
13.11
12.24
9.89
9.6 (6.7,12.5)
10.1 (7.2,13.1)
14.75
8.25
10.3 (8.4,12.1)
14.79
8.21
10.6 (7.6,13.7)
16.56
18.69
20.99
23.76
27.62
39.25
18.78
6.44
4.31
2.01
0
0
0
10.7 (8.9,12.6)
8.4 (6.7,10.1)
8.9 (7.2,10.7)
10.7 (8.9,12.6)
9.1 (7.4,10.9)
9.6 (7.8,11.4)
16.69
18.74
20.82
24.03
27.95
38.68
18.51
6.31
4.26
2.18
0
0
0
11.4 (8.3,14.5)
10.6 (7.6,13.7)
12.2 (8.9,15.4)
8.1 (5.4,10.8)
9.1 (6.3,11.9)
7.3 (4.8,9.9)
200
confidence intervals in each of ten consumption categories by age/sex group in Central Zone
35 44
Fibre
Consumption
Deficit
Grams per
Category (grams
from 23
day
per day)
g/day
1: < 9.38
2: 9.38 11.84
3: 11.85 13.89
4: 13.90 15.73
5: 15.74 17.63
6: 17.64 19.75
7: 19.76 22.17
8: 22.18 25.47
9: 25.48 30.68
10: 30.69
Mean grams per
day
6.92
10.78
12.75
14.81
16.73
18.68
20.78
23.83
27.90
38.72
1: < 9.38
2: 9.38 11.84
3: 11.85 13.89
4: 13.90 15.73
5: 15.74 17.63
6: 17.64 19.75
7: 19.76 22.17
8: 22.18 25.47
9: 25.48 30.68
10: 30.69
Mean grams per
day
7.40
10.63
13.08
14.82
16.78
18.73
20.86
23.78
27.59
39.10
16.08
12.23
10.25
8.19
6.27
4.32
2.22
0
0
0
Grams
per day
5.6 (3.4,7.8)
7.2 (4.8,9.7)
7.4 (5.0,9.9)
11.9 (8.8,14.9)
10.9 (8.0,13.9)
11.9 (8.8,14.9)
8.8 (6.2,11.5)
11.2 (8.2,14.1)
12.3 (9.2,15.4)
12.8 (9.6,16.0)
6.92
10.64
12.86
14.84
16.77
18.68
21.04
23.86
27.95
39.19
20.80
18.08
45 54
Deficit
from 23
g/day
16.08
12.36
10.14
8.16
6.23
4.32
1.96
0
0
0
20.86
15.60
12.37
9.92
8.18
6.22
4.27
2.14
0
0
0
11.2 (9.0,13.3)
12.4 (10.2,14.7)
12.6 (10.3,14.8)
11.4 (9.2,13.5)
9.9 (7.9,11.9)
8.4 (6.6,10.3)
9.3 (7.3,11.2)
8.7 (6.8,10.6)
8.4 (6.6,10.3)
7.8 (6.0,9.5)
6.83
10.73
12.88
14.92
16.71
18.63
20.94
23.83
27.70
37.42
18.24
55 64
Deficit
Grams
Grams
%
from 23
%
per day
per day
g/day
MEN
7.5 (5.4,9.6)
7.22
15.78
8.2 (5.7,10.8)
6.89
8.8 (6.6,11.1)
10.74
12.26
8.0 (5.5,10.6)
10.44
6.2 (4.2,8.1)
12.75
10.25
9.6 (6.8,12.4)
13.16
10.2 (7.8,12.6) 14.84
8.16
10.5 (7.6,13.4) 14.62
12.0 (9.4,14.6) 16.57
6.43
9.4 (6.7,12.1)
16.82
9.3 (7.0,11.7)
18.74
4.26
9.6 (6.8,12.4)
18.78
9.7 (7.3,12.0)
20.95
2.05
7.1 (4.7,9.5)
21.01
10.7 (8.2,13.1) 23.90
0
11.7 (8.7,14.7) 23.51
11.5 (8.9,14.1) 27.93
0
14.6 (11.3,18.0) 27.69
14.2 (11.4,17.0) 37.05
0
11.2 (8.2,14.2) 42.06
20.12
16.17
12.27
10.12
8.08
6.29
4.37
2.06
0
0
0
WOMEN
10.4 (8.6,12.3)
7.54
12.4 (10.4,14.4) 10.75
8.6 (6.9,10.3)
12.94
11.2 (9.3,13.2) 14.87
11.4 (9.5,13.4) 16.71
9.1 (7.3,10.8)
18.71
11.0 (9.1,13.0) 20.99
10.0 (8.1,11.8) 23.82
8.0 (6.4,9.7)
27.84
7.7 (6.1,9.4)
37.37
18.86
65
Deficit
from 23
g/day
16.11
12.56
9.84
8.38
6.18
4.23
1.99
0
0
0
8.0 (4.3,11.8)
9.1 (5.1,13.0)
9.6 (5.5,13.6)
8.5 (4.7,12.4)
9.6 (5.5,13.6)
10.1 (5.9,14.2)
9.6 (5.5,13.6)
9.6 (5.5,13.6)
17.1 (11.9,22.3)
9.1 (5.1,13.0)
16.03
12.23
9.99
8.11
6.34
4.27
2.17
0
0
0
12.0 (8.7,15.2)
9.8 (6.8,12.8)
8.5 (5.7,11.3)
10.1 (7.1,13.2)
10.4 (7.3,13.4)
13.6 (10.1,17.0)
12.5 (9.2,15.8)
7.4 (4.8,10.1)
7.2 (4.6,9.8)
8.5 (5.7,11.3)
20.28
15.46
12.25
10.06
8.13
6.29
4.29
2.01
0
0
0
10.3 (8.2,12.3)
9.0 (7.1,10.9)
9.5 (7.5,11.4)
10.3 (8.2,12.3)
12.3 (10.7,15.2)
10.7 (8.7,12.8)
10.8 (8.8,12.9)
8.8 (6.9,10.7)
8.4 (6.6,10.3)
9.3 (7.4,11.3)
6.97
10.77
13.01
14.89
16.66
18.73
20.83
23.77
27.79
39.01
18.46
201
confidence intervals in each of ten consumption categories by age/sex group in Edmonton Zone
35 44
Fibre
Consumption
Deficit
Grams per
Category (grams
from 23
day
per day)
g/day
1: < 9.38
2: 9.38 11.84
3: 11.85 13.89
7.47
10.75
12.77
15.53
12.25
10.23
Grams per
day
7.3 (5.4,9.2)
7.7 (5.8,9.6)
9.2 (7.1,11.3)
7.19
10.71
12.91
45 54
Deficit
from 23
g/day
15.81
12.29
10.09
55 64
65
Deficit
Deficit
Grams per
Grams per
%
from 23
%
from 23
%
day
day
g/day
g/day
MEN
7.0 (5.3,8.7)
7.71
15.29
8.3 (6.3,10.3)
7.38
15.62
6.8 (3.8,9.7)
8.1 (6.3,9.9)
10.79
12.21
9.3 (7.2,11.4)
10.42
12.58
7.1 (4.1,10.1)
7.8 (6.0,9.5)
12.81
10.19
9.6 (7.4,11.7)
13.01
9.99
11.4 (7.7,15.1)
4: 13.90 15.73
14.89
8.12
7.8 (5.9,9.8)
14.95
8.05
8.4 (6.6,10.3)
14.89
8.11
8.2 (6.2,10.2)
14.88
8.12
9.2 (5.9,12.6)
5: 15.74 17.63
6: 17.64 19.75
7: 19.76 22.17
8: 22.18 25.47
9: 25.48 30.68
10: 30.69
Mean grams per
day
16.64
18.54
20.90
23.80
27.81
40.25
6.36
4.46
2.10
0
0
0
9.9 (7.7,12.1)
11.1 (8.8,13.4)
10.2 (8.0,12.4)
11.0 (8.7,13.3)
10.6 (8.3,12.8)
15.1 (12.5,17.7)
16.64
18.59
20.91
23.73
27.79
39.25
6.36
4.41
2.09
0
0
0
10.2 (8.2,12.2)
10.4 (8.4,12.4)
10.5 (8.5,12.5)
10.1 (8.2,12.1)
14.1 (11.8,16.4)
13.4 (11.2,15.6)
16.72
18.78
20.92
23.97
28.09
37.85
6.28
4.22
2.08
0
0
0
9.3 (7.2,11.4)
10.9 (8.7,13.2)
9.8 (7.7,12.0)
11.2 (8.9,13.5)
9.7 (7.5,11.8)
13.7 (11.2,16.2)
16.59
18.68
21.03
23.35
27.85
37.96
6.41
4.32
1.97
0
0
0
8.2 (5.0,11.4)
12.8 (8.9,16.7)
7.8 (4.7,11.0)
10.3 (6.8,13.9)
16.0 (11.7,20.3)
10.3 (6.8,13.9)
1: < 9.38
2: 9.38 11.84
3: 11.85 13.89
4: 13.90 15.73
5: 15.74 17.63
6: 17.64 19.75
7: 19.76 22.17
8: 22.18 25.47
9: 25.48 30.68
10: 30.69
Mean grams per
day
7.17
10.72
12.93
14.74
16.62
18.71
20.88
23.69
27.79
39.79
15.89
12.30
10.14
8.09
6.18
4.33
1.96
0
0
0
8.8 (6.0,11.6)
12.1 (8.9,15.3)
11.6 (8.4,14.7)
7.8 (5.2,10.4)
9.6 (6.7,12.5)
11.1 (8.0,14.2)
12.6 (9.3,15.9)
8.3 (5.6,11.0)
9.6 (6.7,12.5)
8.6 (5.8,11.3)
21.21
17.90
21.03
15.83
12.28
10.07
8.26
6.38
4.29
2.12
0
0
0
13.3 (11.4,15.2)
10.4 (8.7,12.1)
11.7 (9.9,13.5)
11.4 (9.6,13.1)
9.9 (8.2,11.5)
9.1 (7.5,10.7)
9.4 (7.8,11.0)
9.5 (7.9,11.2)
8.6 (7.0,10.1)
6.8 (5.4,8.2)
6.96
10.68
12.90
14.77
16.69
18.72
21.00425
23.61
27.66
38.81
18.32
20.35
16.04
12.32
10.10
8.23
6.31
4.28
2.00
0
0
0
WOMEN
12.3 (10.6,14.0) 6.82
11.1 (9.5,12.7) 10.66
10.9 (9.3,12.5) 12.91
9.8 (8.3,11.4)
14.86
10.0 (8.4,11.6) 16.64
9.8 (8.2,11.3)
18.69
8.9 (7.4,10.3)
20.97
9.6 (8.1,11.2)
23.61
9.2 (7.7,10.7)
27.85
8.3 (6.9,9.8)
36.67
18.76
20.28
16.18
12.34
10.09
8.14
6.36
4.31
2.03
0
0
0
11.6 (9.6,13.5)
10.5 (8.6,12.4)
8.9 (7.2,10.7)
9.6 (7.8,11.4)
8.2 (6.5,9.8)
9.3 (7.6,11.1)
11.2 (9.3,13.1)
11.5 (9.5,13.4)
10.4 (8.5,12.3)
8.8 (7.0,10.5)
7.11
10.70
12.86
14.91
16.82
18.67
21.04
23.75
27.63
37.04
18.70
202
confidence intervals in each of ten consumption categories by age/sex group in North Zone
35 44
Fibre
Consumption
Deficit
Grams per
Category (grams
from 23
day
per day)
g/day
1: < 9.38
2: 9.38 11.84
3: 11.85 13.89
7.45
10.57
12.76
15.55
12.43
10.24
8.0 (5.7,10.2)
7.8 (5.5,10.0)
8.0 (5.7,10.2)
45 54
Deficit
Grams
from 23
per day
g/day
7.48
10.66
12.66
55 64
Grams Deficit from

per day
23 g/day
15.52
12.34
10.34
8.9 (6.6,11.2)
6.9 (4.9,8.9)
8.7 (6.5,11.0)
MEN
6.85
10.82
12.81
16.15128
12.18314
10.19186
%
9.0 (6.3,11.7)
8.1 (5.5,10.7)
9.9 (7.1,12.8)
65
Deficit
Grams per
from 23
day
g/day
7.47
10.05
12.805
15.53
12.95
10.20
%
9.2 (4.2,14.2)
6.2 (2.0,10.3)
8.5 (3.7,13.2)
4: 13.90 15.73
14.74
8.27
9.4 (7.0,11.9)
14.83
8.17
10.4 (8.0,12.9)
14.77
8.230811
8.6 (5.9,11.2)
14.71
8.29
6.2 (2.0,10.3)
5: 15.74 17.63
6: 17.64 19.75
7: 19.76 22.17
8: 22.18 25.47
9: 25.48 30.68
10: 30.69
Mean grams per
day
16.67
18.67
20.92
23.56
27.62
41.33
6.33
4.33
2.09
0
0
0
6.8 (4.7,9.0)
10.4 (7.8,12.9)
9.6 (7.1,12.1)
11.3 (8.6,14.0)
14.1 (11.1,17.0)
14.6 (11.7,17.6)
16.79
18.71
20.90
23.75
27.80
37.38
6.22
4.29
2.10
0
0
0
9.4 (7.1,11.8)
9.4 (7.1,11.8)
11.6 (9.0,14.2)
11.1 (8.6,13.6)
9.8 (7.4,12.1)
13.8 (11.0,16.6)
16.67
18.54
20.99
23.59
27.78
37.68
6.333077
4.459546
2.009778
0
0
0
9.0 (6.3,11.7)
5.1 (3.0,7.2)
10.4 (7.5,13.3)
13.0 (9.8,16.1)
12.3 (9.2,15.4)
14.6 (11.3,17.9)
16.55
18.46
20.59
23.87
28.43
39.68
6.45
4.54
2.41
0
0
0
10.8 (5.4,16.1)
9.2 (4.2,14.2)
6.9 (2.6,11.3)
13.8 (7.9,19.8)
13.8 (7.9,19.8)
15.4 (9.2,21.6)
1: < 9.38
2: 9.38 11.84
3: 11.85 13.89
4: 13.90 15.73
5: 15.74 17.63
6: 17.64 19.75
7: 19.76 22.17
8: 22.18 25.47
9: 25.48 30.68
10: 30.69
Mean grams per
day
7.39
10.63
12.91
14.87
16.62
18.74
20.82
23.74
27.82
40.42
16.26
12.32
9.91
8.24
6.30
4.12
2.25
0
0
0
10.8 (6.9,14.7)
9.1 (5.5,12.8)
10.0 (6.2,13.7)
10.8 (6.9,14.7)
10.4 (6.5,14.2)
14.5 (10.1,19.0)
9.5 (5.8,13.2)
7.0 (3.8,10.3)
10.0 (6.2,13.7)
7.9 (4.5,11.3)
21.51
18.27
20.31
15.61
12.37
10.09
8.13
6.38
4.26
2.18
0
0
0
11.8 (9.7,13.9)
11.4 (9.3,13.6)
10.5 (8.5,12.6)
10.2 (8.2,12.2)
11.1 (9.0,13.2)
11.0 (8.9,13.1)
8.2 (6.4,10.1)
10.5 (8.5,12.6)
7.4 (5.7,9.2)
7.7 (5.9,9.4)
7.15
10.67
12.87
14.85
16.69
18.71
20.92
23.76
27.82
38.06
18.55
20.63
15.85
12.33
10.13
8.15
6.31
4.29
2.08
0
0
0
WOMEN
11.0 (9.1,12.9)
7.30
11.3 (9.4,13.2)
10.60
9.9 (8.1,11.7)
12.89
9.8 (8.0,11.6)
14.69
10.8 (9.0,12.7)
16.61
10.4 (8.6,12.3)
18.69
8.6 (6.9,10.2)
21.05
10.4 (8.5,12.2)
23.66
9.4 (7.7,11.2)
27.49
8.4 (6.7,10.1)
39.19
19.93
21.56
15.70
12.40
10.11
8.31
6.39
4.31
1.95
0
0
0
10.6 (8.3,13.0)
7.6 (5.6,9.6)
8.3 (6.2,10.4)
8.8 (6.6,10.9)
9.8 (7.6,12.1)
9.7 (7.4,11.9)
9.8 (7.6,12.1)
13.0 (10.5,15.6)
11.5 (9.1,13.9)
10.8 (8.4,13.1)
6.74
10.68
13.09
14.76
16.69
18.88
20.75
23.55
27.41
36.79
18.34
203
Table 7.10
Cancer cases and proportions attributable to insufficient fibre intake in Alberta (2012)
Age at Exposure
(years)
Colorectal
Age at Outcome
(years)
Total
Observed
Cases
35 - 44
45 - 54
55 - 64
65
Total
43 - 52
53 - 62
63 - 72
73
Total
Women
35 - 44
45 - 54
55 - 64
65
Total
43 - 52
53 - 62
63 - 72
73
Total
Colon
PAR (%)
EAC*
Total
Observed
Cases
96
280
320
383
1079
6.3
6.6
6.7
6.6
6
19
22
25
71
81
181
202
356
820
5.5
5.3
5
5.1
4
10
10
18
42
Rectum
PAR (%)
EAC*
Total
Observed
Cases
38
139
177
260
614
7.4
7.8
8
7.8
3
11
14
20
48
42
105
125
265
537
4.1
4
3.7
3.8
177
5.9
11
80
461
6.1
28
244
522
6.1
32
302
739
5.9
43
525
1899
114
1151
5.7
6.2
6.2
5.8
PAR (%)
EAC*
58
141
143
123
465
5.2
5.5
5.6
5.4
3
8
8
7
25
2
4
5
10
21
39
76
77
91
283
6.2
6
5.6
5.8
2
5
4
5
17
5
15
19
30
68
97
217
220
214
748
5.6
5.7
5.6
5.6
5
12
12
12
42
Men
Total
35 - 44
45 - 54
55 - 64
65
Total
43 - 52
53 - 62
63 - 72
73
Total
204
Table 7.11
Cancer cases and proportions attributable to insufficient fibre intake in South Zone (2012)
Age at Exposure
(years)
Age at Outcome
(years)
Colorectal
Total
Observed
PAR (%)
Cases
Colon
Total
Observed
PAR (%)
Cases
Rectum
Total
Observed
PAR (%)
Cases
Men
35 - 44
43 - 52
45 - 54
55 - 64
65
Total
53 - 62
63 - 72
73
Total
<5
32
27
31
<95
6.5
7
6.9
7.2
<5
19
15
24
<63
7.6
8.3
8.2
8.5
<5
13
12
7
<37
<5
13
12
7
<37
Women
35 - 44
45 - 54
55 - 64
65
Total
43 - 52
53 - 62
63 - 72
73
Total
<10
20
27
23
<80
5.9
5.6
5.2
5.1
5
13
15
15
48
4.4
4.2
3.9
3.8
<5
7
12
8
<32
<5
7
12
8
<32
Total
35 - 44
45 - 54
55 - 64
65
Total
43 - 52
53 - 62
63 - 72
73
Total
12
6.1
<10
4.9
52
6.5
32
6.6
54
6.1
30
6
54
6.3
39
6.7
172
<111
<10
20
24
15
<69
<10
20
24
15
205
Table 7.12
Cancer cases and proportions attributable to insufficient fibre intake in Calgary Zone (2012)
Age at Exposure
(years)
Age at Outcome
(years)
Colorectal
Total
Observed
PAR (%)
Cases
Colon
Total
Observed
Cases
PAR (%)
Rectum
Total
Observed
PAR (%)
Cases
Men
35 - 44
45 - 54
55 - 64
65
Total
43 - 52
53 - 62
63 - 72
73
Total
29
91
95
127
342
6.2
6.8
6.7
6.4
10
45
58
90
203
7.4
8
7.9
7.6
19
46
37
37
139
5.1
5.6
5.6
5.3
Women
35 - 44
45 - 54
55 - 64
65
Total
43 - 52
53 - 62
63 - 72
73
Total
37
67
59
105
268
5.4
5.4
5.2
5.1
24
35
38
81
178
4
4
3.8
3.8
13
32
21
24
90
6.1
6.1
5.8
5.8
Total
35 - 44
45 - 54
55 - 64
65
Total
43 - 52
53 - 62
63 - 72
73
Total
32
78
58
61
229
5.5
5.8
5.7
5.5
66
5.8
34
5
158
6.2
80
6.2
154
6.1
96
6.3
232
5.8
171
5.8
610
381
206
Table 7.13
Cancer cases and proportions attributable to insufficient fibre intake in Central Zone (2012)
Age at Exposure
(years)
Age at Outcome
(years)
Colorectal
Total
Observed
PAR (%)
Cases
Colon
Total
Observed
Cases
PAR (%)
Rectum
Total
Observed
PAR (%)
Cases
Men
73
Total
17
35
51
57
160
6.3
6.5
6.7
6.8
6
18
22
40
86
7.4
7.7
8
8
11
17
29
17
74
5.2
5.4
5.6
5.6
Women
35 - 44
45 - 54
55 - 64
65
Total
43 - 52
53 - 62
63 - 72
73
Total
5
17
28
65
115
5.5
5.2
4.9
5.2
<5
11
17
47
<80
4.1
3.9
3.7
3.9
<5
6
11
18
<40
6.2
5.9
5.5
5.9
Total
35 - 44
45 - 54
55 - 64
65
Total
43 - 52
53 - 62
63 - 72
73
Total
<16
23
40
35
<114
5.4
5.5
5.6
5.7
35 - 44
45 - 54
55 - 64
43 - 52
53 - 62
63 - 72
65
Total
22
6.1
<11
6.6
52
6.1
29
6.2
79
6.1
39
6.1
122
5.9
87
5.8
275
<166
207
Table 7.14
Cancer cases and proportions attributable to insufficient fibre intake in Edmonton Zone
(2012)
Age at Exposure
(years)
Age at Outcome
(years)
Colorectal
Total
Observed
PAR (%)
Cases
Colon
Total
Observed
PAR (%)
Cases
Rectum
Total
Observed
PAR (%)
Cases
Men
35 - 44
43 - 52
45 - 54
55 - 64
65
Total
53 - 62
63 - 72
73
Total
29
84
119
122
354
6.4
6.3
6.7
6.5
15
38
68
79
200
7.5
7.4
8
7.6
14
46
51
43
154
5.3
5.2
5.6
5.3
Women
35 - 44
45 - 54
55 - 64
65
Total
43 - 52
53 - 62
63 - 72
73
Total
24
54
63
133
274
5.5
5.4
5
5
6
34
40
98
178
4.1
4
3.7
3.7
18
20
23
35
96
6.3
6.1
5.6
5.6
Total
35 - 44
45 - 54
55 - 64
65
Total
43 - 52
53 - 62
63 - 72
73
Total
32
66
74
78
250
5.8
5.4
5.6
5.5
53
6
21
6.6
138
5.9
72
5.8
182
6.1
108
6.4
255
5.7
177
5.5
628
378
208
Table 7.15
Age at Exposure
(years)
Cancer cases and proportions attributable to insufficient fibre intake in North Zone (2012)
Age at Outcome
(years)
Colorectal
Total
Observed
PAR (%)
Cases
Colon
Total
Observed
Cases
PAR (%)
Rectum
Total
Observed
PAR (%)
Cases
Men
73
Total
17
38
28
46
129
6.3
6.7
6.6
6.3
6
19
14
27
66
7.4
7.9
7.8
7.4
11
19
14
19
63
5.2
5.5
5.5
5.2
Women
35 - 44
45 - 54
55 - 64
65
Total
43 - 52
53 - 62
63 - 72
73
Total
<10
23
25
30
<88
5.4
5.2
4.5
5.1
5
12
15
24
56
4
3.8
3.4
3.8
<5
11
10
6
<32
6.1
5.8
5.1
5.8
Total
35 - 44
45 - 54
55 - 64
65
Total
43 - 52
53 - 62
63 - 72
73
Total
<16
30
24
25
<95
5.3
5.6
5.3
5.3
35 - 44
45 - 54
55 - 64
43 - 52
53 - 62
63 - 72
65
Total
<27
6
11
5.9
61
6.1
31
6.3
53
5.6
29
5.5
76
5.8
51
5.7
<217
122
209
Table 7.16
Total cancer cases and respective proportions in 2012 attributable to insufficient fibre intake by age and sex
Age
Group at
Exposure
Age
Group at
Outcome
35-44
43 - 52
Cancer Site
Total
Observed
Cases
Total PAR (%)
80
5.7
97
5.6
177
5.9
45-54
53 - 62
244
6.2
217
5.7
461
6.1
55-64
63 - 72
302
6.2
220
5.6
522
6.1
65
73
525
5.8
214
5.6
Colorectal
739
5.9
Colon
Rectum
Colorectal
Colon
Rectum
Colorectal
Colon
Rectum
Colorectal
Colon
Rectum
Men
Observed
Cases
Men PAR %
(95% CI)
Women
Observed
Cases
Women PAR %
(95% CI)
38
58
96
139
141
280
177
143
320
260
123
383
7.4 (0.7,7.8)
5.2 (0,12.2)
6.3 (0.1,7.1)
7.8 (0.9,9.1)
5.5 (0,13.9)
6.6 (0.2,8.1)
8.0 (0.9,9.4)
5.6 (0,14.3)
6.7 (0.3,8.6)
7.8 (0.9,9.3)
5.4 (0,14.1)
6.6 (0.2,8.5)
42
39
81
105
76
181
125
77
202
265
91
356
4.1 (0,10.8)
6.2 (0,14.6)
5.5 (1.2,7.5)
4.0 (0,10.4)
6.0 (0,14.3)
5.3 (1.1,7.1)
3.7 (0,9.1)
5.6 (0,12.3)
5.0 (1.0,6.3)
3.8 (0,9.7)
5.8 (0,13.5)
5.1 (1.1,6.9)
Notes:
210
Figure 7.1
Proportion of men and women in Alberta with insufficient fibre intake (<23 g/day) by age
group
211
Figure 7.2
Proportion of men and women in Alberta with insufficient fibre intake (<23 g/day) by age
group and Alberta Health Services region
212
Figure 7.3
Cancer cases attributable to insufficient fibre intake and other known and unknown cancer
causes
213
CHAPTER 8
Cancer Incidence Attributable to Excess Salt Intake in

214
SUMMARY
A 5.75 g/day guideline suggested by Health Canada was used to define the suggested level of
daily salt intake. Mean salt consumption levels were 8.6 g/day among men and 6.4 g/day among women
in Albertas Tomorrow Project (ATP) cohort. Approximately 20% of stomach cancers in men and 5% of
stomach cancers in women could be attributed to excess salt intake. Overall, approximately 12% of
incident stomach cancers in Alberta in 2012 could be attributable to excess salt consumption (Table 8.1).
METHODS OVERVIEW
Data on salt intake from ATP were used for measures of salt intake in the Alberta population.
ATP is a population-based cohort study conducted in Alberta, Canada that includes a diet history
questionnaire (DHQ) as part of baseline data collection. Data used in this analysis were collected
between 2000 and 2009, where data from the DHQ were used to estimate total sodium intake in
milligrams per day. The mean daily salt intake of Albertans in grams is shown in Table 8.6 (Figure 8.1)
and by AHS zone in Table 8.3 (Figure 8.2).
To estimate the PARs, mean daily sodium intake values from Albertas Tomorrow Project cohort
were converted to grams of salt per day:
( )
2.5
8.1: ( ) =
1000
An excess relative risk of 0.08 for stomach cancer per gram of salt per day based on findings
from the World Cancer Research Fund was used to estimate the relative risk of stomach cancer
associated with x grams of salt intake using the following equation:
8.2: () =
exp(0.08)
exp(0.08 5.75)
where represents the mean salt intake in grams per day and 5.75 represents the guideline level of salt
intake in grams per day suggested by Health Canada. The excess number of cases of stomach cancer due
to excess salt intake (above the guideline) was then estimated using the following equation from Parkin,
2011:
8.3: # =
PARs were then created by expressing the number of excess cases as a proportion of the total number
observed in each group.
215
Estimates of PAR as well as the number of stomach cancer cases attributable to excess salt
consumption are presented in Table 8.4. PAR estimates by AHS Zone are shown in Table 8.5. Table 8.6
shows estimates of PAR for Alberta similar to Table 8.4 including 95% confidence intervals to
demonstrate the precision of our estimates.
216
Table 8.1
Summary of cases and proportions of cancer in Alberta in 2012 attributable to excess

salt intakea
Stomach Cancere
All Associated
Cancersf
All Cancersg
Men
Casesb
Excess Attributable Casesc
% Attributabled
153
25
16.4
153
25
16.4
8155
25
0.3
Women
Cases
Excess Attributable Cases
% Attributable
88
3
3.4
88
3
3.4
7681
3
0
Total
Cases
% Attributable
241
28
11.7
241
28
11.7
15836
28
0.2
a. Salt intake prevalence from Albertas Tomorrow Project Cohort. Excess salt intake defined as
more than 5.75 g/day of salt.
b. Number of observed cancer cases in Alberta in 2012 at individual cancer sites.
c. Number of stomach cancer cases that can be attributed to excess salt intake.
d. Proportion of cancers at individual cancer sites attributable to excess salt intake. Calculated as
excess attributable cases/observed cases.
e. Cancer incidence data obtained from the Alberta Cancer Registry. Data from 2012 was used for
observed cancer cases for all cancer sites (only stomach cancer in this case).
f. Represents all cancers with a known association with excess salt intake (only stomach cancer in
this case).
217
Table 8.2
Mean daily salt intake in Alberta (Alberta Tomorrow Project)

Age
Mean daily salt intake (g/day) (SE)
Men
35-44
45-54
55-64
65
Total
9.35 (0.08)
8.7 0(0.06)
7.95 (0.07)
7.60(0.11)
8.60 (0.04)
Women
35-44
45-54
55-64
65
Total
6.81 (0.04)
6.44 (0.04)
6.20 (0.04)
5.87 (0.06)
6.44 (0.02)
CI, confidence intervals; g/day, grams per day; Standard Error (SE)
218
Table 8.3
Mean daily salt intake (g/day) in Alberta by health region (data from Albertas Tomorrow
Project)
Mean daily salt intake (g/day) (SE)
Age (years)
South
Calgary
Central
Edmonton
North
35-44
9.40 (0.245)
8.80 (0.116)
9.97 (0.221)
9.29 (0.152)
9.84 (0.182)
45-54
8.56 (0.177)
8.25 (0.106)
9.05 (0.161)
8.85 (0.152)
9.01 (0.152)
55-64
8.11 (0.214)
7.74 (0.131)
8.16 (0.161)
7.72 (0.127)
8.31 (0.182)
65
7.52 (0.356)
7.35 (0.205)
7.51 (0.239)
7.45 (0.176)
8.53 (0.36)
Total
8.56 (0.115)
8.25 (0.065)
8.87 (0.098)
8.51 (0.079)
9.06 (0.096)
35-44
6.87 (0.122)
6.55 (0.068)
7.10 (0.097)
6.69 (0.078)
7.10 (0.105)
45-54
6.45 (0.108)
6.26 (0.063)
6.65 (0.082)
6.25 (0.068)
6.75 (0.089)
55-64
6.22 (0.122)
5.95 (0.077)
6.32 (0.089)
6.04 (0.076)
6.69 (0.113)
65
5.87 (0.187)
5.72 (0.114)
6.03 (0.127)
5.79 (0.122)
6.00 (0.162)
Total
6.45 (0.064)
6.24 (0.038)
6.61 (0.048)
6.29 (0.041)
6.78 (0.055)
Men
Women
g/day, grams per day; Se, Standard error
219
Table 8.4
Observed stomach cancer cases in Alberta (2012) and proportions attributable to excess
salt intake
Age at Exposure
Stomach Cancer
Age at Outcome
Total Observed
Cases
Men
35-44
45-54
55-64
65
Total
43-52
53-62
63-72
65
Total
Women
35-44
45-54
55-64
65
Total
43-52
53-62
63-72
65
Total
PAR (%)
EAC
6
31
50
66
153
25.0
21.0
16.1
13.7
2
7
8
9
25
14
13
22
39
88
8.1
5.3
3.6
1.0
1
1
1
3
13.2
16.4
12.3
9.0
3
7
9
9
28
Total
35-44
43-52
20
45-54
53-62
44
55-64
63-72
72
65
65
105
Total
Total
241
Notes:
Cases represent the total number of cases of stomach cancer observed in 2012 in Alberta
PAR represents the proportion (%) of cancer cases attributable to excess salt intake
Excess attributable cases represent the number of cases attributable to excess salt intake
Results by zone are included in Table 8.5
220
Table 8.5
Observed stomach cancer cases in each Alberta Health Services Zones (2012) and proportions
attributable to excess salt intake
Age at
Outcome
Age at
Outcome
South
Total
Obs.
PAR (%)
Cases
Calgary
Total
Obs.
PAR (%)
Cases
Central
Total
Obs.
PAR (%)
Cases
Edmonton
Total
Obs.
PAR (%)
Cases
North
Total
Obs.
PAR (%)
Cases
Men
35-44
43-52
45-54
53-62
55-64
63-72
65
65
Total
Total
<5
<5
11
19
20.1
17.2
13.2
<5
12
16
19
< 52
21.7
18.1
14.8
12.0
<5
<5
7
9
20
28.7
23.2
17.5
13.1
22.1
<5
11
17
19
< 54
24.7
21.9
14.6
12.7
<5
6
8
< 19
22.9
18.5
19.9
<5
<5
6
11
5.4
3.7
0.9
<5
<5
9
12
26
6.2
4.0
1.6
-
<5
<5
<5
9
10.3
6.9
2.2
6.6
7
5
8
11
31
7.2
3.9
2.3
0.3
<5
<5
<5
6
11
10.2
7.7
7.3
2.0
< 12
16
25
30
< 90
13.6
16.3
10.6
8.2
13.5
<5
<5
7
14
< 30
10.2
12.8
16.9
12.2
Women
35-44
43-52
45-54
53-62
55-64
63-72
65
65
Total
Total
Total
<5
11.4
<5
14.9
45-54
53-62
5
17.2
< 17
15.3
5
16.7
55-64
63-72
8
10.4
25
10.0
7
17.5
65
65
17
8.9
31
7.2
< 14
9.8
Total
Total
30
< 81
29
PAR, population attributable risk (%); Total Obs. Cases, Total observed cases
35-44
43-52
221
Table 8.6
Observed stomach cancer cases in Alberta (2012) and proportions attributable to excess
salt intake
Age at
Outcome
Total
Observed
Cases
Total
PAR (%)
Men
Observed
Cases
Men PAR (%)

(95% CI)
Women
Observed
Cases
Women PAR (%)

(95% CI)
35-44
43-52
20
13.2
25.0 (0,45.3)
14
8.1 (0,16.6)
45-54
53-62
44
16.4
31
21.0 (0,39.1)
13
5.3 (0,11.1)
55-64
63-72
72
12.3
50
16.1 (0,30.7)
22
3.6 (0,7.5)
65
65
105
66
13.7 (0,27.1)
39
1.0 (0,2.8)
Age at
Exposure
Notes:
95% confidence intervals are not available for totals, as the data are stratified by sex.
Therefore, prevalence estimates for men and women combined were calculated for the
analyses and measures of uncertainty needed for the calculation of confidence intervals
were not available.
222
Mean Salt Consumption (g/day)

Figure 8.1
Mean daily salt intake in Alberta (data from Albertas Tomorrow Project)
Note: The dashed line represents the recommended guideline for salt intake (5.75 g/day)
223
Consumption (g/day)
Consumption (g/day)
Consumption (g/day)
Consumption (g/day)
Figure 8.2
Mean daily salt intake in Alberta by health region (data from Albertas Tomorrow
Project)
Note: The dashed line represents the recommended guideline for salt intake (5.75 g/day)
224
CHAPTER 9
Cancer Incidence Attributable to Suboptimal Vitamin D

Intake in Alberta, Canada in 2012
225
SUMMARY
According to Health Canada, the recommended level of daily vitamin D intake is 600
international units (IU) per day. Mean vitamin D consumption from diet and supplements combined
were 358 IU/day among men and 388 IU/day among women in Albertas Tomorrow Project (ATP)
cohort. In men, approximately 11% of colon cancers and 9% of rectal cancers could be attributed to
insufficient vitamin D intake from diet and supplements. In women, approximately 8% of colon, 7% of
rectal and 2% of breast cancers could be attributed to insufficient vitamin D intake from diet and
supplements. Overall, approximately 5% of incident colon, rectal and breast cancers in Alberta in 2012
could be attributable to insufficient vitamin D intake from diet and supplements, equating to 1% of all
incident cancers in Alberta in 2012 (Table 9.1).
METHODS OVERVIEW
Estimates of Vitamin D intake from diet and supplements were available from the ATP cohort.
ATP is a population-based cohort study conducted in Alberta, Canada that includes a diet history
questionnaire (DHQ) as part of baseline data collection. Data used in this analysis were collected
between 2000 and 2009, where data from the DHQ were used to estimate total vitamin D intake in
micrograms (g) per day.
Relative risks (RR) associated with vitamin D intake for all cancer sites were obtained from the
peer-reviewed literature and the World Cancer Research Funds Continuous Update Project report on
colorectal cancer (Table 9.2).
All measures of vitamin D intake were converted to IU by multiplying any measures in g/day by
40. As the recommended level of vitamin D intake by Health Canada is 600 IU per day for the majority of
the population, this cutoff was used for the analysis. The mean daily vitamin D intake of Albertans
through diet, supplements and diet and supplements combined is shown in Table 9.3 (Figures 9.1 9.3)
for Alberta and by zone in Tables 9.4 (Figure 9.4), 9.5 (Figure 9.5) and 9.6 (Figure 9.6), respectively.
To estimate the relative risk at a specific level of intake, the following formula was used:
9.1: =
exp( 100 600 )

exp( 100 100 )
226
where the excess relative risk was 1 minus the cancer specific relative risk (Table 9.2). The excess
number of cases of cancer due to suboptimal vitamin D intake was then estimated using the following
equation:
8.2: # =
Population attributable risks (PAR) were then created by expressing the number of excess cases as a
proportion of the total number observed in each group.
Estimates of PAR as well as the number of site-specific cancer cases attributable to suboptimal
vitamin D intake from diet are presented in Table 9.7. PAR estimates for dietary intake of vitamin D by
AHS Zone are shown in Tables 9.8 - 9.12. Table 9.13 presents estimates of PAR for Alberta similar to
Table 9.7 including 95% confidence intervals to indicate the precision of our estimates. The total number
of cancer cases at each site attributable to suboptimal vitamin D intake from diet and other causes are
shown in Figure 4.1. Estimates of PAR and the number of colon cancer cases attributable to suboptimal
vitamin D supplement intake are presented in Table 9.14 and by AHS Zone in Table 9.15. Estimates
including 95% confidence intervals for vitamin D intake through supplements are shown in Table 9.16.
Estimates of PAR and the number of site-specific cancer cases attributable to suboptimal
vitamin D intake from diet and supplements combined are presented in Table 9.17 and by zone in Tables
9.18 9.22. Estimates including 95% confidence intervals for vitamin D intake through diet and
supplements are shown in Table 9.23. The total number of cancer cases at each site attributable to
suboptimal vitamin D intake from diet and diet and supplements combined as well as other causes is
shown in Figures 9.8 and 9.9, respectively.
Results based on vitamin D consumption through diet and supplements are presented
separately as well as combined. It is important to note that the mean consumption value for the
combined variable is the most accurate measure of vitamin D intake and therefore the PARs calculated
using this variable should be considered as the best estimates.
227
Table 9.1
Summary of cases and proportions of cancer in Alberta in 2012 attributable to insufficient vitamin D intakea
Total
Men
Women
Excess
Excess
Excess
Exposure
Cancer Siteb
Observed
%
Observed
%
Observed
%
Attributable
Attributable
Attributable
e
Casesc
Attributable
Cases
Attributable
Cases
Attributable
Casesd
Cases
Cases
Vitamin D
748
309
41.3
465
187
40.1
283
122
43.2
Rectum
from Diet
1151
47
4.1
614
24
3.9
537
23
4.3
Colon
Colorectum
1899
355
18.7
1079
195
18
820
161
19.6
1899
356
18.7
1079
211
19.5
820
145
17.7
g
15836
356
2.2
8155
211
2.6
7681
145
1.9
All Cancers
Vitamin D
Colon
1151
271
23.5
614
159
25.8
537
112
20.9
from
1151
271
23.5
614
159
25.8
537
112
20.9
Supplements
All Cancers
15836
271
1.7
8155
159
1.9
7681
112
1.5
Vitamin D
Breast
2128
41
1.9
2128
41
1.9
from Diet
Colon
1151
112
9.7
614
68
11
537
44
8.2
and
Rectum
748
64
8.5
465
44
9.4
283
20
7.2
Supplements
4027
217
5.4
1079
111
10.3
2948
106
3.6
All Cancers
15836
217
1.4
8155
111
1.4
7681
106
1.4
a. Vitamin D intake prevalence from Albertas Tomorrow Project Cohort. Insufficient vitamin D intake defined as less than 600 IU/day of vitamin D.
b. Cancer incidence data obtained from the Alberta Cancer Registry. Data from 2012 was used for observed cancer cases for all cancer sites.
d. Number of cancer cases at individual cancer sites that can be attributed to insufficient vitamin D intake.
e. Proportion of cancers at individual cancer sites attributable to insufficient vitamin D intake. Calculated as excess attributable cases/observed cases.
f. Represents all cancers with a known association with insufficient vitamin D intake.
228
Table 9.2
Risk associated with 100 IU/day of vitamin D by cancer sites of interest
Cancer site
Sex
Exposure
RRa
Source
Breast
ERR
(1-RR)
Women
Diet and supplements
0.99
0.01
Kim, 2014
Colorectum
All
Diet
0.95
0.05
1.00
World Cancer Research

Fund, 2011
Diet
0.99
0.01
Supplements
0.99
0.01
0.93
0.07
Diet
0.87
0.13
Colon
Rectal
All
All
0.96
0.04

Fund, 2011
Fund, 2011
ERR, excess relative risk; RR, relative risk

a
Protective effects associated with intake of 100 IU/day of vitamin D
229
Table 9.3
Age
(years)
Mean daily vitamin D intake from diet and supplements in Alberta (Albertas Tomorrow
Project)
Diet
Mean daily Vitamin D intake (IU/day) (SE)

Diet and Supplements
Supplements
Combined
Men
35-44
45-54
55-64
65
Total
242 (3.1)
211 (2.4)
194 (2.6)
193 (4.5)
214 (1.5)
117 (3.2)
129 (3.1)
172 (4.2)
204 (7.5)
143 (1.9)
259 (4.6)
340 (3.9)
366 (4.9)
397 (8.7)
358 (2.5)
Women
35-44
45-54
55-64
65
Total
178 (1.8)
168 (1.5)
161 (1.7)
160 (2.7)
168 (0.9)
168 (2.8)
204 (2.9)
277 (3.8)
299 (6.3)
220 (1.8)
346 (3.3)
372 (3.3)
437 (4.2)
458 (6.9)
388 (2.0)
IU/day, international units per day; Standard Error (SE)
230
Table 9.4
Mean daily vitamin D intake from diet in Alberta health regions (Albertas Tomorrow Project)
Age (years)
Mean daily vitamin D intake from diet (IU/day) (SE)

South
Calgary
Central
Edmonton
North
35-44
260 (10.1)
223 (5.0)
251 (8.3)
245 (6.5)
254 (7.7)
45-54
216 (8.1)
201 (4.2)
219 (6.2)
206 (4.7)
225 (6.0)
55-64
205 (9.0)
188 (5.0)
198 (5.9)
188 (4.5)
201 (6.2)
65
179 (12.6)
194 (10.2)
148 (10.5)
188 (6.8)
213 (12.4)
Total
221 (4.9)
205 (2.7)
219 (3.7)
210 (2.8)
227 (3.7)
35-44
183 (5.3)
171 (3.0)
190 (4.9)
175 (3.6)
179 (4.1)
45-54
167 (4.4)
162 (2.6)
175 (3.7)
168 (2.9)
173 (3.8)
55-64
161 (4.8)
156 (3.3)
163 (3.8)
158 (3.3)
169 (4.3)
65
157 (7.3)
160 (5.7)
159 (5.2)
158 (5.1)
164 (7.6)
Total
169 (2.6)
163 (1.6)
174 (2.2)
167 (1.8)
173 (2.2)
Men
Women
g/day, grams per day; Standard error, SE
231
Table 9.5
Mean daily vitamin D intake from supplements in Alberta health regions (Albertas
Tomorrow Project)
Age (years)
Mean daily vitamin D intake from supplements (IU/day) (SE)

South
Calgary
Central
Edmonton
North
35-44
124 (10)
125 (5.8)
100 (8.0)
120 (6.6)
107 (7.2)
45-54
112 (8.2)
147 (5.8)
118 (7.0)
134 (6.2)
115 (7.3)
55-64
161 (11.6)
203 (8.7)
164 (10.2)
171 (7.6)
144 (9.9)
65
160 (19.8)
218 (16)
212 (16.7)
205 (13.8)
206 (19.5)
Total
133 (5.5)
158 (3.7)
137 (4.8)
148 (3.8)
127 (4.6)
35-44
168 (8.3)
182 (5.2)
156 (6.7)
156 (5.5)
171 (6.9)
45-54
192 (8.0)
213 (5.5)
200 (7.0)
209 (5.8)
195 (6.8)
55-64
275 (10.8)
278 (7.4)
275 (8.3)
274 (7.5)
282 (9.4)
65
269 (17.9)
301 (12.7)
287 (13.2)
320 (12.3)
303 (16.0)
Total
214 (5.1)
225 (3.3)
219 (4.2)
220 (3.6)
217 (4.3)
Men
Women
g/day, grams per day; Standard error, SE
232
Table 9.6 Mean daily vitamin D intake from diet and supplements combined in Alberta and AHS
Zones (Albertas Tomorrow Project)
Age
(years)
Mean daily Vitamin D intake from diet and supplements (IU/day) (SE)
South
Calgary
Central
Edmonton
North
35-44
385 (15.1)
348 (7.7)
351 (11.9)
365 (9.6)
361 (10.8)
45-54
328 (11.9)
348 (7)
337 (9.5)
340 (7.8)
341 (9.4)
55-64
366 (15.6)
392 (9.9)
362 (12.1)
359 (8.8)
345 (11.6)
65
339 (25.2)
412 (20.1)
403 (19.5)
393 (14.5)
419 (22.8)
Total
355 (7.7)
363 (4.6)
355 (6)
358 (4.7)
354 (5.9)
35-44
351 (9.9)
352 (6)
346 (8.3)
332 (6.6)
350 (8)
45-54
359 (9.3)
375 (6.3)
374 (8.1)
377 (6.6)
367 (7.8)
55-64
436 (11.9)
434 (8.1)
438 (9.1)
432 (8.2)
451 (10.9)
65
426 (19.1)
461 (13.7)
445 (14.4)
478 (13.4)
467 (18.6)
Total
383 (5.7)
389 (3.7)
393 (4.7)
387 (4)
390 (4.9)
Men
Women
IU/day, international units per day; SE, standard error
233
Table 9.7
Observed cancer cases in Alberta (2012) and proportions attributable to suboptimal vitamin D intake from diet
Cancer Site
Age at
Exposure
Age at
Outcome
Colorectum
Total
observed
cases
Colon
PAR (%)
EAC
Total
observed
cases
Rectum
PAR (%)
EAC
Total
observed
cases
PAR (%)
EAC
Men
35-44
45-54
55-64
65
Total
43-52
53-62
63-72
73
Total
96
280
320
383
1079
16.4
17.7
18.4
18.4
16
49
59
71
195
38
139
177
260
614
3.5
3.8
4.0
4.0
1
5
7
10
24
58
141
143
123
465
37.2
39.7
41.0
41.1
22
56
59
51
187
Women
35-44
45-54
55-64
65
Total
43-52
53-62
63-72
73
Total
81
181
202
356
820
19.0
19.4
19.7
19.8
15
35
40
70
161
42
105
125
265
537
4.1
4.2
4.3
4.3
2
4
5
11
23
39
76
77
91
283
42.2
43.0
43.5
43.6
16
33
34
40
122
Total
35-44
43-52
177
17.6
31
45-54
53-62
461
18.4
85
55-64
63-72
522
18.9
99
65
73
739
19.1
141
Total
Total
1899
355
80
244
302
525
1151
3.8
4.0
4.1
4.2
3
10
12
22
47
97
217
220
214
748
39.2
40.8
41.9
42.2
38
89
92
90
309
Notes for current and following tables:

Cases represent the total number of site-specific cancer cases in 2012
PAR represents the proportion (%) of cancer cases attributable to suboptimal dietary vitamin D intake
Excess attributable cases represent the number of cases attributable to suboptimal dietary vitamin D intake
PAR for breast cancer only available for diet and supplementary vitamin D intake combined, as a relative risk was only available for combined
exposure
234
Table 9.8
Age at
Exposure
Observed cancer cases in the South Zone health region (2012) and proportions attributable to suboptimal vitamin D intake from diet
Age at
Outcome
Colorectum
Total observed
PAR (%)
cases
Cancer Site
Colon
Total observed
PAR (%)
cases
Rectum
Total observed
PAR (%)
cases
Men
35-44
45-54
55-64
65
Total
43-52
53-62
63-72
73
Total
<5
32
27
31
< 95
15.6
17.5
17.9
19.0
<5
19
15
24
< 63
3.3
3.8
3.9
4.1
<5
13
12
7
< 37
35.7
39.3
40.2
42.1
Women
35-44
45-54
55-64
65
Total
43-52
53-62
63-72
73
Total
8
20
27
23
78
18.8
19.5
19.7
19.9
5
13
15
15
48
4.1
4.2
4.3
4.3
<5
7
12
8
< 32
41.9
43.0
43.5
43.7
< 13
52
54
54
< 173
17.8
18.2
18.8
19.3
< 10
32
30
39
< 111
4.0
4.0
4.1
4.2
6
20
24
15
65
38.8
40.6
41.8
43.0
Total
35-44
43-52
45-54
53-62
55-64
63-72
65
73
Total
Total
235
Table 9.9
Observed cancer cases in the Calgary Zone health region (2012) and proportions attributable to suboptimal vitamin D intake from
diet
Age at
Exposure
Age at
Outcome
Colorectum
Total observed
PAR (%)
cases
Cancer Site
Colon
Total observed
PAR (%)
cases
Rectum
Total observed
PAR (%)
cases
Men
35-44
45-54
55-64
65
Total
43-52
53-62
63-72
73
Total
29
91
95
127
342
17.2
18.1
18.6
18.4
10
45
58
90
203
3.7
3.9
4.0
4.0
19
46
37
37
139
38.7
40.5
41.4
41.0
Women
35-44
45-54
55-64
65
Total
43-52
53-62
63-72
73
Total
37
67
59
105
268
19.3
19.7
19.9
19.7
24
35
38
81
178
4.2
4.3
4.3
4.3
13
32
21
24
90
42.8
43.4
43.9
43.5
Total
35-44
45-54
55-64
65
Total
43-52
53-62
63-72
73
Total
66
158
154
232
610
18.4
18.8
19.1
19.0
34
80
96
171
381
4.1
4.1
4.2
4.1
32
78
58
61
229
40.4
41.7
42.3
42.0
236
Table 9.10
Age at
Exposure
Observed cancer cases in the Central Zone health region (2012) and proportions attributable to suboptimal vitamin D intake from
diet
Age at
Outcome
Colorectum
Total observed
PAR (%)
cases
Cancer Site
Colon
Total observed
PAR (%)
cases
Rectum
Total observed
PAR (%)
cases
Men
35-44
45-54
55-64
65
Total
43-52
53-62
63-72
73
Total
17
35
51
57
160
16.0
17.3
18.2
20.2
6
18
22
40
86
3.4
3.7
3.9
4.4
11
17
29
17
74
36.5
39.0
40.7
44.4
Women
35-44
45-54
55-64
65
Total
43-52
53-62
63-72
73
Total
5
17
28
65
115
18.5
19.2
19.6
19.8
<5
11
17
47
< 80
4.0
4.2
4.3
4.3
<5
6
11
18
< 40
41.3
42.5
43.3
43.6
Total
35-44
45-54
55-64
65
Total
43-52
53-62
63-72
73
Total
22
52
79
122
275
16.6
17.9
18.7
20.0
< 11
29
39
87
< 166
3.6
3.9
4.1
4.4
< 16
23
40
35
< 114
37.5
39.9
41.4
44.0
237
Table 9.11 Observed cancer cases in the Edmonton Zone health region (2012) and proportions attributable to suboptimal vitamin D intake from
diet
Age at
Exposure
Age at
Outcome
Colorectum
Total observed
PAR (%)
cases
Cancer Site
Colon
Total observed
PAR (%)
cases
Rectum
Total observed
PAR (%)
cases
Men
35-44
45-54
55-64
65
Total
43-52
53-62
63-72
73
Total
29
84
119
122
354
16.3
17.9
18.6
18.6
15
38
68
79
200
3.5
3.9
4.0
4.0
14
46
51
43
154
37.0
40.1
41.5
41.5
Women
35-44
45-54
55-64
65
Total
43-52
53-62
63-72
73
Total
24
54
63
133
274
19.1
19.4
19.8
19.8
6
34
40
98
178
4.2
4.2
4.3
4.3
18
20
23
35
96
42.4
43.0
43.7
43.7
53
138
182
255
628
17.6
18.5
19.0
19.2
21
72
108
177
378
3.7
4.0
4.1
4.2
32
66
74
78
250
40.0
41.0
42.2
42.5
Total
35-44
43-52
45-54
53-62
55-64
63-72
65
73
Total
Total
238
Table 9.12
Age at
Exposure
Observed cancer cases in the North Zone health region (2012) and proportions attributable to suboptimal vitamin D intake from
diet
Age at
Outcome
Colorectum
Total observed
PAR (%)
cases
Cancer Site
Colon
Total observed
PAR (%)
cases
Rectum
Total observed
PAR (%)
cases
Men
35-44
45-54
55-64
65
Total
43-52
53-62
63-72
73
Total
17
38
28
46
129
15.9
17.1
18.1
17.6
6
19
14
27
66
3.4
3.7
3.9
3.8
11
19
14
19
63
36.3
38.6
40.5
39.5
Women
35-44
45-54
55-64
65
Total
43-52
53-62
63-72
73
Total
7
23
25
30
85
19.0
19.2
19.4
19.6
5
12
15
24
56
4.1
4.2
4.2
4.3
<5
11
10
6
< 32
42.2
42.6
42.9
43.3
Total
35-44
45-54
55-64
65
Total
43-52
53-62
63-72
73
Total
24
61
53
76
214
16.8
17.9
18.7
18.4
11
31
29
51
122
3.7
3.9
4.1
4.0
< 16
30
24
25
< 95
37.2
40
41.5
40.4
239
Table 9.13
Observed cancer cases in Alberta (2012) and proportions attributable to suboptimal vitamin D intake from diet
Age at
Exposure
Age at
Outcome
Cancer Site
Men
Observed
Cases
Men PAR (%)

(95% CI)
Women
Observed
Cases
Women PAR
(%)
(95% CI)
Total
Observed
Cases
35-44
43-52
Colorectum
96
16.4 (8.5,23.3)
81
19.0 (9.9,27.0)
177
17.6
Colon
38
3.5 (0,23.2)
42
4.1 (0,26.1)
80
3.8
Rectum
58
37.2 (0,63.1)
39
42.2 (0,69.7)
97
39.2
Colorectum
280
17.7 (9.2,25.2)
181
19.4 (10.2,27.6)
461
18.4
Colon
139
3.8 (0,24.9)
105
4.2 (0,26.8)
244
Rectum
141
39.7 (0,66.6)
76
43.0 (0,70.2)
217
40.8
Colorectum
320
18.4 (9.5,26.1)
202
19.7 (10.3,28.1)
522
18.9
Colon
177
4.0 (0,25.6)
125
4.3 (0,27.3)
302
4.1
Rectum
143
41.0 (0,68.2)
77
43.5 (0,70.5)
220
41.9
Colorectum
383
18.4 (9.6,26.2)
356
19.8 (10.3,27.8)
739
19.1
Colon
260
4.0 (0,25.5)
265
4.3 (0,27.3)
525
4.2
Rectum
123
41.1 (0,68.0)
91
43.6 (0,70.6)
214
42.2
45-54
55-64
65
53-62
63-72
73
Total PAR (%)

Notes:
95% confidence intervals are not available for totals, as the data on vitamin D intake are stratified by sex. Therefore, prevalence
estimates for men and women combined were calculated for the analyses and measures of uncertainty needed for the
calculation of confidence intervals were not available.
240
Table 9.14
Observed colon cancer cases in Alberta (2012) and proportions attributable to suboptimal
vitamin D supplement intake
Cancer Site
Age at Exposure
Age at Outcome
Colon
Total observed
cases
PAR (%)
EAC
Men
35-44
45-54
55-64
65
Total
43-52
53-62
63-72
73
Total
38
139
177
260
614
28.7
28.1
25.9
24.2
11
39
46
63
159
Women
35-44
45-54
55-64
65
Total
43-52
53-62
63-72
73
Total
42
105
125
265
537
26.1
24.2
20.3
19.0
11
25
25
50
112
27.3
26.4
23.6
21.6
22
64
71
113
271
Total
35-44
43-52
80
45-54
53-62
244
55-64
63-72
302
65
73
525
Total
Total
1151
Notes:
Cases represent the total number of cancer cases in 2012
PAR represents the proportion (%) of cancer cases attributable to suboptimal supplemental
vitamin D intake
Excess attributable cases represent the number of cases attributable to suboptimal
supplemental vitamin D intake
PAR for supplementary vitamin D intake only available for colon cancer, as relative risks for the
other cancer sites were not available for this exposure
241
Table 9.15
Age at
Exposure
Observed colon cancer cases in Alberta health regions (2012) and proportions attributable to suboptimal vitamin D supplement
intake
South
Calgary
Total
observed
PAR (%)
cases
Central
Total
observed
PAR (%)
cases
Edmonton
Total
observed
PAR (%)
cases
North
Age at
Outcome
Total
observed
cases
43-52
53-62
63-72
73
Total
<5
19
15
24
< 63
28.3
28.9
26.4
26.5
10
45
58
90
203
28.3
27.2
24.3
23.5
6
18
22
40
86
29.5
28.6
26.3
23.8
15
38
68
79
200
28.5
27.9
25.9
24.2
6
19
14
27
66
29.2
28.8
27.3
24.1
43-52
53-62
63-72
73
Total
5
13
15
15
48
26.1
24.9
20.3
20.7
23.7
24
35
38
81
178
25.4
23.7
20.2
18.9
<5
11
17
47
< 80
26.7
24.4
20.3
19.7
6
34
40
98
178
26.7
24.0
20.4
17.8
5
12
15
24
56
25.9
24.7
20.0
18.8
43-52
53-62
< 10
32
26.5
27.3
34
80
26.2
25.7
< 11
29
28.8
27.0
21
72
28.0
26.0
11
31
27.7
27.2
55-64
63-72
30
65
73
39
Total
Total
< 111
23.4
24.3
26.0
96
171
381
22.6
21.3
39
87
< 168
23.7
21.6
108
177
23.9
20.6
29
51
23.5
21.6
PAR (%)
Total
observed
cases
PAR (%)
Men
35-44
45-54
55-64
65
Total
Women
35-44
45-54
55-64
65
Total
Total
35-44
45-54
378
122
242
Table 9.16
Observed colon cancer cases in Alberta (2012) and proportions attributable to suboptimal vitamin D supplement intake
Age at
Exposure
Age at
Outcome
Cancer
Site
Men
Observed
Cases
Men PAR (%)

(95% CI)
Women
Observed
Cases
Women PAR (%)

(95% CI)
Total
Observed
Cases
35-44
43-52
Colon
12
28.7 (6.2,44.8)
18
26.1 (6.1,41.3)
30
27.2
45-54
53-62
Colon
54
28.1 (5.7,44.2)
63
24.2 (5.8,38.7)
117
26
55-64
63-72
Colon
152
25.9 (5.8,41.1)
96
20.3 (4.3,32.7)
248
23.7
65
73
Colon
406
24.2 (4.9,38.8)
375
19.0 (4.0,30.9)
781
21.7
Total PAR (%)

Notes:
243
Table 9.17 Observed cancer cases in Alberta (2012) and proportions attributable to suboptimal vitamin D intake from diet and supplements
combined
Age at
Exposure
Age at
Outcome
Cancer Site
Rectum
Colon
Total
observed
cases
PAR (%)
EAC
Total
observed
cases
Breast
PAR (%)
EAC
Total
observed
cases
PAR (%)
EAC
Men
35-44
45-54
55-64
65
Total
43-52
53-62
63-72
73
Total
38
139
177
260
614
15.7
12.2
11.0
9.7
6
17
20
25
68
58
141
143
123
465
12.8
9.9
8.9
7.8
7
14
13
10
44
Women
35-44
45-54
55-64
65
Total
43-52
53-62
63-72
73
Total
42
105
125
265
537
11.9
10.8
7.8
6.9
5
11
10
18
44
39
76
77
91
283
9.7
8.7
6.3
5.5
4
7
5
5
20
463
584
559
522
2128
2.5
2.3
1.6
1.4
12
13
9
7
41
Total
35-44
43-52
80
13.7
11
45-54
53-62
244
11.6
28
55-64
63-72
302
9.7
29
65
73
525
8.2
43
Total
Total
1151
112
97
217
220
214
748
11.5
9.5
8.0
6.8
11
21
18
15
64
463
584
559
522
2128
2.5
2.3
1.6
1.4
12
13
9
7
41
Notes:
Cases represent the total number of site-specific cancer cases in 2012
PAR represents the proportion (%) of cancer cases attributable to suboptimal vitamin D intake from diet and supplements combined
Excess attributable cases represent the number of cases attributable to suboptimal vitamin D intake from diet and supplements combined
PAR estimates not available for colorectal cancer, as the relative risk was 1.00
244
Table 9.18 Observed cancer cases in the South Zone health region (2012) and proportions attributable to suboptimal vitamin D intake from diet
and supplements combined
Cancer Site
Age at
Exposure
Age at
Outcome
Colon
Total observed
PAR (%)
cases
Rectum
Total observed
PAR (%)
cases
Breast
Total observed
PAR (%)
cases
Men
35-44
45-54
55-64
65
Total
43-52
53-62
63-72
73
Total
<5
19
15
24
< 63
10.2
12.7
11.0
12.2
<5
13
12
7
< 37
8.2
10.3
8.9
9.9
Women
35-44
45-54
55-64
65
Total
43-52
53-62
63-72
73
Total
5
13
15
15
48
11.7
11.4
7.9
8.3
<5
7
12
8
< 32
9.5
9.2
6.3
6.7
37
47
56
43
183
2.5
2.4
1.6
1.7
< 10
32
30
39
< 111
11.5
12.2
9.5
10.7
6
20
24
15
65
8.9
9.9
7.6
8.2
37
47
56
43
183
2.5
2.4
1.6
1.7
Total
35-44
43-52
45-54
53-62
55-64
63-72
65
73
Total
Total
245
Table 9.19 Observed cancer cases in the Calgary Zone health region (2012) and proportions attributable to suboptimal vitamin D intake from
diet and supplements combined
Cancer Site
Age at
Exposure
Age at
Outcome
Colon
Total observed
PAR (%)
cases
Rectum
Total observed
PAR (%)
cases
Breast
Total observed
PAR (%)
cases
Men
35-44
45-54
55-64
65
Total
43-52
53-62
63-72
73
Total
10
45
58
90
203
11.9
11.9
9.9
9.0
19
46
37
37
139
9.6
9.6
8.0
7.3
Women
35-44
45-54
55-64
65
Total
43-52
53-62
63-72
73
Total
24
35
38
81
178
11.6
10.6
8.0
6.7
13
32
21
24
90
9.4
8.6
6.4
5.4
185
201
199
179
764
2.4
2.2
1.7
1.4
34
80
96
171
381
11.7
11.3
9.1
7.9
32
78
58
61
229
9.5
9.2
7.4
6.5
185
201
199
179
764
2.4
2.2
1.7
1.4
Total
35-44
43-52
45-54
53-62
55-64
63-72
65
73
Total
Total
246
Table 9.20 Observed cancer cases in the Central Zone health region (2012) and proportions attributable to suboptimal vitamin D intake from
Cancer Site
Age at
Exposure
Age at
Outcome
Colon
Total observed
PAR (%)
cases
Rectum
Total observed
PAR (%)
cases
Breast
Total observed
PAR (%)
cases
Men
35-44
45-54
55-64
65
Total
43-52
53-62
63-72
73
Total
6
18
22
40
86
11.7
12.3
11.2
9.4
11
17
29
17
74
9.5
10
9.1
7.6
Women
35-44
45-54
55-64
65
Total
43-52
53-62
63-72
73
Total
<5
11
17
47
< 80
11.9
10.7
7.8
7.4
<5
6
11
18
< 40
9.7
8.6
6.3
6.0
48
78
72
71
269
2.5
2.2
1.6
1.5
2.1
< 11
29
39
87
< 166
11.8
11.7
9.7
8.3
< 16
23
40
35
< 115
9.5
9.6
8.3
6.8
48
78
72
71
269
2.5
2.2
1.6
1.5
Total
35-44
43-52
45-54
53-62
55-64
63-72
65
73
Total
Total
247
Table 9.21 Observed cancer cases in the Edmonton Zone health region (2012) and proportions attributable to suboptimal vitamin D intake from
Cancer Site
Age at
Exposure
Age at
Outcome
Colon
Total observed
PAR (%)
cases
Rectum
Total observed
PAR (%)
cases
Breast
Total observed
PAR (%)
cases
Men
35-44
45-54
55-64
65
Total
43-52
53-62
63-72
73
Total
15
38
68
79
200
11.1
12.2
11.4
9.8
14
46
51
43
154
9
9.9
9.2
7.9
Women
35-44
45-54
55-64
65
Total
43-52
53-62
63-72
73
Total
6
34
40
98
178
12.5
10.6
8.1
5.9
18
20
23
35
96
10.2
8.5
6.5
4.8
152
210
185
189
736
2.6
2.2
1.7
1.2
21
72
108
177
378
11.5
11.4
10.1
7.7
32
66
74
78
250
9.6
9.5
8.4
6.5
152
210
185
189
736
2.6
2.2
1.7
1.2
Total
35-44
43-52
45-54
53-62
55-64
63-72
65
73
Total
Total
248
Table 9.22 Observed cancer cases in the North Zone health region (2012) and proportions attributable to suboptimal vitamin D intake from diet
and supplements combined
Cancer Site
Age at
Exposure
Age at
Outcome
Colon
Total observed
PAR (%)
cases
Rectum
Total observed
PAR (%)
cases
Breast
Total observed
PAR (%)
cases
Men
35-44
45-54
55-64
65
Total
43-52
53-62
63-72
73
Total
6
19
14
27
66
11.3
12.2
12.0
8.6
11
19
14
19
63
9.1
9.8
9.7
7.0
Women
35-44
45-54
55-64
65
Total
43-52
53-62
63-72
73
Total
5
12
15
24
56
11.8
11
7.2
6.4
<5
11
10
6
< 32
9.5
8.9
5.8
5.2
41
48
47
40
176
2.5
2.3
1.5
1.3
11
31
29
51
122
11.5
11.7
9.5
7.6
< 16
30
24
25
< 95
9.2
9.5
8.1
6.6
41
48
47
40
176
2.5
2.3
1.5
1.3
Total
35-44
43-52
45-54
53-62
55-64
63-72
65
73
Total
Total
249
Table 9.23
Observed cancer cases in Alberta (2012) and proportions attributable to suboptimal vitamin D intake from diet and supplements
combined
Age at
Exposure
Age at
Outcome
35-44
43-52
45-54
55-64
65
53-62
63-72
73
Cancer Site
Men
Observed
Cases
Men PAR (%)

(95% CI)
Breast
Women
Observed
Cases
Women PAR (%)

(95% CI)
Total
Observed
Cases
Total PAR
(%)
463
2.5 (0.1,5.0)
463
2.5
Colon
38
15.7 (4.8,24.9)
42
11.9 (3.7,19.1)
80
13.7
Rectum
58
12.8 (0,33.3)
39
9.7 (0,26.3)
97
11.5
584
2.3 (0.0,4.5)
584
2.3
Breast
Colon
139
12.2 (4.0,19.8)
105
10.8 (3.4,17.4)
244
11.6
Rectum
141
9.9 (0,27.1)
76
8.7 (0,24.1)
217
9.5
559
1.6 (0,3.2)
559
1.6
Breast
Colon
177
11.0 (3.4,18.0)
125
7.8 (2.4,12.8)
302
9.7
Rectum
143
8.9 (0,24.6)
77
6.3 (0,18.0)
220
522
1.4 (0.0,2.8)
522
1.4
Breast
Colon
260
9.7 (2.9,15.8)
265
6.9 (2.0,11.3)
525
8.2
Rectum
123
7.8 (0,21.7)
91
5.5 (0,15.6)
214
6.8

Notes:
250
Figure 9.1
Mean daily vitamin D intake from diet in Alberta (Alberta Tomorrow

Project)
251
Figure 9.2
Mean daily vitamin D intake from supplements in Alberta (Alberta

Tomorrow Project)
252
Figure 9.3
Mean daily vitamin D intake from diet and supplements combined in

Alberta (Alberta Tomorrow Project)
253
Figure 9.4
Mean daily vitamin D intake from diet in Alberta by health region (Alberta Tomorrow
Project)
254
Figure 9.5
Mean daily vitamin D intake from supplements in Alberta by health region (Alberta
Tomorrow Project)
255
Figure 9.6
Mean daily vitamin D intake from diet and supplements in Alberta by health region
(Alberta Tomorrow Project)
256
Figure 9.7
Cancer cases attributable to suboptimal vitamin D intake from diet and other
causes
257
Figure 9.8
Cancer cases attributable to suboptimal vitamin D intake from diet and

supplements combined and other causes
258
CHAPTER 10
Cancer Incidence Attributable to Insufficient Dietary

Calcium Intake in Alberta, Canada in 2012
259
SUMMARY
A cut-off of 1100 mg/day of dietary calcium based on guidelines from Health Canada was used
for the current analysis. Mean calcium consumption levels were 967 mg/day among men and 825
mg/day among women in Albertas Tomorrow Project (ATP) cohort. Approximately 4% of colorectal
cancers in men and 8% in women could be attributed to insufficient calcium intake. When examined
separately, approximately 7% of colon cancers and 5% of rectal cancers could be attributed to
insufficient calcium intake. Overall, approximately 8% of incident colorectal cancers in Alberta in 2012
could be attributed to excess salt consumption, equating to 1% of all incident cancers in Alberta in 2012
(Table 10.1).
METHODS OVERVIEW
Dietary calcium was chosen for inclusion in this study over milk consumption, since no public
health dietary guideline on sufficient milk consumption was available and the reduced cancer risk
associated with milk consumption is thought to occur through calcium. Relative risks associated with
dietary calcium intake for colorectal, colon and rectal cancer were obtained from the World Cancer
Research Funds Continuous Update Project on Colorectal Cancer (Table 10.2).
Data on mean dietary calcium consumption was obtained from the ATP cohort. ATP is a
population-based cohort study conducted in Alberta, Canada that includes a diet history questionnaire
(DHQ) as part of baseline data collection. Data used in this analysis were collected between 2000 and
2009, where data from the DHQ was used to estimate total dietary calcium intake in milligrams per day.
PARs were estimated using the method used for the analysis of vitamin D (described in Chapter 8). For
adults over 19 years of age, the recommended dietary intake per day by Health Canada for calcium
consumption is 1000 1200 milligrams. As such, the midpoint of this range (1100 mg/day) was used as
the cut-off for these analyses. The mean daily dietary calcium intake of Albertans is shown in Table 10.3
for Alberta (Figures 10.1) and AHS Zones (Figure 10.2).
A method similar to that used for vitamin D was used in the assessment of population
attributable risks (PARs) of colorectal, colon and rectal cancers attributable to insufficient dietary
calcium consumption. To estimate the relative risk of cancer at a specific level of intake, a modified
version of Formula 9.1 was used here:
10.1: =
exp( 200 1100

exp( 200 200 )
260
The excess number of cases of cancer attributable to insufficient dietary calcium intake was then
estimated using the following equation:
10.2: # =
PARs were then created by expressing the number of excess cases as a proportion of the total number
observed in each group. Estimates of PAR as well as the number of site-specific cancer cases attributable
to suboptimal calcium intake from diet are presented in Table 10.3 and by AHS Zone in Tables 10.4
10.8. The total number of cancer cases at each site attributable to suboptimal calcium intake from diet
and other causes is shown in Figures 10.3
261
Table 10.1
Summary of cases and proportions of cancer in Alberta in 2012 attributable to

insufficient calcium intakea
Colorectal
Cancer Siteb
Colon
Rectum
All Associated
Cancersf
All Cancersg
Men
Casesc
Excess Attributable Casesd
% Attributablee
1079
63
5.8
614
44
7.1
465
25
5.3
1079
69
6.4
8155
69
0.8
Women
Cases
% Attributable
820
73
8.9
537
56
10.5
283
24
8.6
820
81
9.8
7681
81
1.1
Total
Cases
% Attributable
1899
136
7.1
1151
100
8.7
748
49
6.6
1899
149
7.9
15836
149
0.9
a. Calcium intake prevalence from Albertas Tomorrow Project Cohort. Insufficient calcium intake
defined as less than 1100 mg/day of dietary calcium.
b. Cancer incidence data obtained from the Alberta Cancer Registry. Data from 2012 was used for
observed cancer cases for all cancer sites.
d. Number of cancer cases at individual cancer sites that can be attributed to insufficient calcium
intake.
e. Proportion of cancers at individual cancer sites attributable to insufficient calcium intake.
Calculated as excess attributable cases/observed cases.
f. Represents all cancers with a known association with insufficient calcium intake.
262
Table 10.2
Risk associations for risk associated with 200 mg/day of dietary calcium by cancer
sites of interest
Cancer site
Sex
RRa (95% CI)
ERR (1-RR)
Source
Colorectum
All
0.94 (0.93-0.96)
0.06
World Cancer Research Fund, 2011
Colon
All
0.93 (0.89-0.97)
0.07
Rectum
All
0.94 (0.86-1.02)
0.06
CI, confidence interval; ERR, excess relative risk; RR, relative risk
a
Protective effects associated with intake of 200 mg/day of calcium
263
Table 10.3
Mean daily dietary calcium intake in Alberta and Alberta health regions (Albertas
Tomorrow Project)
Age
(years)
Men
35-44
45-54
55-64
65
Total
1102 (11.4)
967 (8.9)
864 (9.7)
828 (15.2)
967 (5.5)
1146 (35.8)
974 (29.8)
897 (33.8)
784 (45.4)
981 (18.0)
1050 (18.9)
942 (15.5)
873 (18.3)
845 (33.2)
954 (9.8)
1118 (29.1)
983 (22.0)
854 (21.2)
826 (35.9)
965 (13.3)
1121 (24.1)
969 (17.5)
851 (17.9)
816 (24)
962 (10.8)
1126 (27.4)
985 (21.8)
861 (22.8)
871 (42.8)
990 (13.6)
Women
35-44
45-54
55-64
65
Total
879 (6.8)
824 (5.6)
787 (6.7)
751 (10.0)
825 (3.5)
867 (20.0)
810 (17.4)
776 (18.2)
743 (28.4)
811 (10.1)
868 (11.6)
810 (10.3)
773 (12.8)
766 (20.2)
817 (6.3)
914 (18.8)
846 (13.3)
787 (14.6)
735 (20.2)
835 (8.3)
880 (13.8)
831 (11.2)
791 (13.6)
763 (18.8)
829 (6.9)
872 (15.7)
827 (13.8)
809 (17.3)
741 (29.4)
829 (8.5)
Alberta
Mean daily dietary calcium intake (mg/day) (SE)

South
Calgary
Central
Edmonton
North
mg/day, milligrams/day; Se, standard error
264
Table 10.3
Observed cancer cases in Alberta (2012) and proportions attributable to insufficient dietary calcium intake
Cancer Site
Age at
Exposure
Age at
Outcome
Colorectum
Total
Observed
Cases
Colon
PAR (%)
EAC
Total
Observed
Cases
Rectum
PAR (%)
EAC
Total
Observed
Cases
PAR (%)
EAC
Men
35-44
45-54
55-64
65
Total
43-52
53-62
63-72
63
Total
96
280
320
683
1079
3.9
6.8
7.8
11
22
30
63
38
139
177
260
614
4.6
7.9
9.1
6
14
24
44
58
141
143
123
465
3.9
6.8
7.8
6
10
18
25
Women
35-44
45-54
55-64
65
Total
43-52
63-62
63-72
63
Total
81
181
202
356
820
6.4
7.9
9.0
9.9
5
14
18
35
73
42
105
125
265
537
7.4
9.2
10.4
11.5
3
10
13
30
56
39
76
77
91
283
6.4
7.9
9.0
9.9
2
6
7
9
24
43-52
63-62
63-72
177
461
522
2.9
5.5
7.7
5
25
40
80
244
302
3.9
6.6
8.9
3
16
27
97
217
220
2.5
5.3
7.6
2
12
17
65
63
739
8.8
65
Total
Total
1899
136
525
1151
10.3
54
100
214
748
8.7
19
49
Total
35-44
45-54
55-64
Notes for current and following tables:

Cases represent the total number of observed site-specific cancer cases in 2012
PAR represents the proportion (%) of cancer cases attributable to insufficient dietary calcium intake
Excess attributable cases represent the number of cases attributable to insufficient dietary calcium intake
265
Table 10.4
Observed cancer cases in the South zone health region (2012) and proportions attributable to insufficient dietary calcium intake
Cancer Site
Age at
Exposure
Men
35-44
45-54
55-64
65
Total
Age at Outcome
Colorectum
Total Observed
PAR (%)
Cases
Colon
Total Observed
PAR (%)
Cases
Rectum
Total Observed
PAR (%)
Cases
43-52
63-62
63-72
63
Total
<5
32
27
31
< 95
3.7
5.9
9.1
<5
19
15
24
< 63
4.3
6.9
10.5
<5
13
12
7
< 37
3.7
5.9
9.1
43-52
63-62
63-72
63
Total
8
20
27
23
78
6.8
8.3
9.3
10.2
5
13
15
15
48
7.8
9.6
10.7
11.7
<5
7
12
8
< 32
6.8
8.3
9.3
10.2
43-52
63-62
< 13
52
4.0
5.5
< 10
32
6.3
6.5
6
20
2.7
5.3
54
54
< 173
7.6
9.5
30
39
< 111
8.8
11.0
24
15
65
7.6
9.6
Women
35-44
45-54
55-64
65
Total
Total
35-44
45-54
55-64
63-72
65
63
Total
Total
266
Table 10.5
Observed cancer cases in the Calgary Zone health region (2012) and proportions attributable to insufficient dietary calcium intake
Cancer Site
Age at
Exposure
Men
35-44
45-54
55-64
65
Total
Age at Outcome
Colorectum
Total Observed
PAR (%)
Cases
Colon
Total Observed
PAR (%)
Cases
Rectum
Total Observed
PAR (%)
Cases
43-52
63-62
63-72
63
Total
29
91
95
127
342
1.5
4.6
6.6
7.4
10
45
58
90
203
1.7
5.4
7.6
8.6
19
46
37
37
139
1.5
4.6
6.6
7.4
43-52
63-62
63-72
63
Total
37
67
59
105
268
6.7
8.3
9.3
9.5
24
35
38
81
178
7.8
9.7
10.8
11.0
13
32
21
24
90
6.7
8.3
9.3
9.5
35-44
45-54
43-52
63-62
66
158
4.4
6.2
34
80
6.0
7.3
32
78
3.6
6.2
55-64
65
Total
63-72
63
Total
154
232
610
7.6
8.4
96
171
381
8.9
9.7
58
61
229
7.6
8.2
Women
35-44
45-54
55-64
65
Total
Total
267
Table 10.6
Observed cancer cases in the Central Zone health region (2012) and proportions attributable to insufficient dietary calcium intake
Cancer Site
Age at
Exposure
Men
35-44
45-54
55-64
65
Total
Age at Outcome
Colorectum
Total Observed
PAR (%)
Cases
Colon
Total Observed
PAR (%)
Cases
Rectum
Total Observed
PAR (%)
Cases
43-52
63-62
63-72
63
Total
17
35
51
57
160
3.5
7.1
7.9
6
18
22
40
86
4.0
8.3
9.1
11
17
29
17
74
3.5
7.1
7.9
35-44
45-54
55-64
65
Total
43-52
63-62
63-72
63
Total
5
17
28
65
115
5.4
7.3
9.0
10.4
<5
11
17
47
< 80
6.3
8.5
10.4
12.0
<5
6
11
18
< 40
5.4
7.3
9.0
10.4
Total
35-44
45-54
43-52
63-62
22
52
0.8
4.7
< 11
29
1.1
5.7
< 16
23
0.7
4.5
55-64
65
63-72
63
79
122
7.8
9.2
39
87
9.2
10.7
40
35
7.6
9.2
Total
Total
275
Women
< 166
< 114
268
Table 10.7 Observed cancer cases in the Edmonton Zone health region (2012) and proportions attributable to insufficient dietary calcium intake
Cancer Site
Age at
Exposure
Age at Outcome
Colorectum
Total Observed
PAR (%)
Cases
Colon
Total Observed
PAR (%)
Cases
Rectum
Total Observed
PAR (%)
Cases
Men
35-44
45-54
55-64
65
Total
43-52
63-62
63-72
63
Total
29
84
119
122
354
3.9
7.2
8.2
15
38
68
79
200
4.5
8.4
9.5
14
46
51
43
154
3.9
7.2
8.2
Women
35-44
45-54
55-64
65
Total
43-52
63-62
63-72
63
Total
24
54
63
133
274
6.4
7.8
8.8
9.6
6
34
40
98
178
7.4
9.0
10.2
11.1
18
20
23
35
96
6.4
7.8
8.8
9.6
53
138
182
255
628
2.5
5.4
7.8
8.9
21
72
108
177
378
1.6
6.6
9.1
10.4
32
66
74
78
250
3.3
5.0
7.7
8.8
Total
35-44
43-52
45-54
63-62
55-64
63-72
65
63
Total
Total
269
Table 10.8
Observed cancer cases in the North Zone health region (2012) and proportions attributable to insufficient dietary calcium intake
Cancer Site
Age at
Exposure
Age at Outcome
Colorectum
Total Observed
PAR (%)
Cases
Colon
Total Observed
PAR (%)
Cases
Rectum
Total Observed
PAR (%)
Cases
Men
35-44
45-54
55-64
65
Total
43-52
63-62
63-72
63
Total
17
38
28
46
129
3.4
6.9
6.6
6
19
14
27
66
3.9
8.0
7.7
11
19
14
19
63
3.4
6.9
6.6
Women
35-44
45-54
55-64
65
Total
43-52
63-62
63-72
63
Total
7
23
25
30
85
6.6
7.9
8.4
10.2
5
12
15
24
56
7.7
9.1
9.7
11.8
<5
11
10
6
< 32
6.6
7.9
8.4
10.2
Total
35-44
45-54
55-64
65
Total
43-52
63-62
63-72
63
Total
24
61
53
76
214
1.4
5.1
7.6
8.1
11
31
29
51
122
3.0
5.9
8.9
9.6
< 16
30
24
25
<95
0.4
5.0
7.5
7.5

270
Table 10.9
Observed cancer cases in Alberta (2012) and proportions attributable to insufficient dietary calcium intake
Age Group
Cancer Site
Men
Observed
Cases
Men PAR (%)

(95% CI)
Women
Observed
Cases
Women PAR (%)

(95% CI)
Total
Observed
Cases
Total
PAR (%)
35-44
Colorectum
96
81
6.4 (4.8,8.0)
177
2.9
Colon
38
42
7.4 (3.1,11.3)
80
3.9
Rectum
58
39
6.4 (0,14.1)
97
2.5
Colorectum
280
3.9 (2.8,5.0)
181
7.9 (6.0,9.8)
461
5.5
Colon
139
4.6 (1.9,7.1)
105
9.2 (3.8,14.0)
244
6.6
Rectum
141
3.9 (0,8.9)
76
7.9 (0,17.0)
217
5.3
Colorectum
320
6.8 (5.1,8.6)
202
9.0 (6.8,11.1)
522
7.7
Colon
177
7.9 (3.3,12.2)
125
10.4 (4.6,15.8)
302
8.9
Rectum
143
6.8 (0,15.1)
77
9.0 (0,19.3)
220
7.6
Colorectum
383
7.8 (5.8,9.9)
356
9.9 (7.5,12.3)
739
8.8
Colon
260
9.1 (3.9,13.9)
265
11.5 (5.0,17.3)
525
10.3
Rectum
123
7.8 (0,16.9)
91
9.9 (0,21.3)
214
8.7
45-54
55-64
65

Notes:
95% confidence intervals are not available for totals, as the data on calcium intake are stratified by sex. Therefore, prevalence
271
Figure 10.1
Mean daily dietary calcium intake in Alberta (Alberta Tomorrow Project)
Note: The dashed line represents the recommended dietary allowance per day by
Health Canada for calcium consumption (1100 mg/day)
272
Figure 10.2
Mean daily dietary calcium intake in Alberta by health region (Alberta

Tomorrow Project)
Note: The dashed line represents the recommended dietary allowance per day by Health
Canada for calcium consumption (1100 mg/day)
273
Figure 10.3
Cancer cases attributable to insufficient dietary calcium intake and other

known and unknown cancer causes
274
CHAPTER 11 Cancer Incidence Attributable to Oral Contraceptive Pills

and Hormone Replacement Therapy Use in Alberta,
Canada in 2012
275
SUMMARY
Based on the 2000-2009 Albertas Tomorrow Project (ATP) survey data, an estimated 65-90% of
women in Alberta aged 35 or older have used oral contraceptives (OCs) at some point in their
reproductive life. With a latency period of eight years, we estimated that 8% (136 cases) of breast
cancer diagnoses in Alberta in 2012 could be attributed to OC use and approximately 57% of
endometrial cancer and 29% of ovarian cancer, representing 329 cancer cases in total, could be
prevented with OC use (Table 11.1).
Hormone replacement therapy use was characterized among women aged 45 and older in order
to capture the relationships with cancer cases occurring among post-menopausal women in 2012 while
incorporating an eight-year latency between exposure and cancer diagnosis, where women aged 53 and
older in 2012 were considered postmenopausal at cancer diagnosis. Among these women, ATP data also
suggested approximately 25-60% used hormone replacement therapy (HRT). Overall in Alberta, 15.5% of
breast cancer and 8.9% ovarian cancer cases (271 cases in total) diagnosed in 2012 could be attributed
to ever use of HRT, whereas approximately 11.2% of endometrial cancer diagnoses (48 cases) could be
potentially prevented due to HRT use (Table 11.1).
METHODS OVERVIEW
The prevalence of OC use and HRT use in Alberta was estimated using data from Albertas
Tomorrow Project. Information on ever use of OCs and on ever and current use of HRT were collected
from the large population-based cohort studys 2000 - 2009 baseline health questionnaire.
Relative risks associated with OC use and HRT use for breast, endometrial and ovarian cancers
were obtained from a comprehensive literature review and are summarized in Table 11.2. ATP data did
not allow current OC users to be distinguished from former OC users; therefore, the risk estimates
comparing ever users with never users were included for OCs. For HRT, specific details concerning the
type of hormones used were not provided. Thus, RRs related to breast, endometrial and ovarian cancers
for estrogen-progestin combined hormone therapy were used, since this type of HRT was the most
commonly used formulation. The risk of breast cancer associated with HRT use has been shown to vary
by histological type, hence analyses for ductal, lobular and tubular breast cancers specifically were also
conducted. The RR estimates for different histological types of breast cancer associated with HRT ever
use were not available and therefore were not included. For endometrial cancer, RR associated with
continuous combined hormone therapy was used as ATP data did not provide details concerning the
sequential use of progestin.
276
The population attributable risks (PARs) associated with ever OC use, ever HRT use and current
HRT use for breast, endometrial and ovarian cancers were estimated using equation 11.1.
11.1: =
( 1)
1 + [ ( 1)]
Where Pe is the prevalence of OC or HRT use and RR is the relative risk of cancer associated with either
OC or HRT use.
PARs for each of OC and HRT use at individual cancer sites were combined with 2012 incidence
data from the Alberta Cancer Registry to estimate the number of cancer cases that could be attributed
to hormone use. Given that exposure data were collected between 2000 and 2009, a latency period of
eight years was estimated and age groups for cancer incidence data were lagged by 8 years (ex.
exposure data for 35 44 year olds corresponded to incidence data for 43 52 year olds) to reflect
cancers diagnosed in 2012 caused by previous hormone exposure.
277
Table 11.1
Cancer Site
Summary of cases and proportions of cancer in Alberta in 2012 attributable to oral contraceptive and hormone replacement therapy
use a
Oral Contraceptive
Ever Use
Ever Use
Excess
Excess
Observed
%
Observed
%
Attributable
Attributable
d
Casesb
Attributable
Cases
Attributable
Casesc
Cases
2128
136
6.4
1665
258
15.5
482
-277
-57.4
425
-48
-11.2
179
-52
-29.1
143
13
8.9

Current Use
Excess
Observed
%
Attributable
Cases
Attributable
Cases
1665
199
12.0
425
-23
-5.4
143
11
7.8
Breast
Endometrium
Ovary
All Attributable
2128
136
6.4
1808
271
15.0
1808
210
11.6
Cancerse
7681
136
1.8
7681
271
3.5
7681
210
2.7
All Cancersf
All Preventable
661
-329
-49.7
425
-48
-11.3
425
-23
-5.4
Cancersg
All Cancers
7681
-329
-4.3
7681
-48
-0.6
7681
-23
-0.3
a
Data on prevalence of oral contraceptive and hormone replacement therapy use are from the Albertas Tomorrow Project (ATP).
b
Number of observed cancer cases in Alberta in 2012 at individual cancer sites. Cancer incidence data obtained from the Alberta Cancer
Registry. For HRT, only post menopausal cancer cases (cancers diagnosed at age 53 or older) are included.
c
Number of cancer cases at individual cancer sites that can be attributed to OC ever use or HRT ever use or HRT current use. Negative values
represent preventable cancer cases due to the protective effect of OC ever use or HRT ever use or HRT current use.
d
Proportion of cancers at individual cancer sites attributable to OC ever use, HRT ever use or HRT current use. Calculated as excess attributable
e
Represents all cancers with a known association with OC ever use, HRT ever use or HRT current use, as listed in table.
f
g
Represents all preventable cancer cases associated with OC ever use, HRT ever use or HRT current use, as listed in table.
278
Table 11.2
Risk associations for risk associated with oral contraceptive and hormone replacement therapy by cancer sites of interest
Cancer Site
Detailed Exposure
Risk Estimate
95% CIa
Source (first author, year)
Breast
Ever Use
1.08
(1.00 1.17)
Gierisch, 2013
Endometrium
Ever Use
0.57
(0.43 0.77)
Gierisch, 2013
Ovary
Ever Use
0.73
(0.66 0.81)
Havrilesky, 2013
Exposure
Cancer Site
Detailed Exposure
Risk Estimate
95% CI
Source
Hormone
Breast
Ever Use
1.39
(1.12 1.72)
Shah, 2005
Replacement
Breast
Current Use
1.66
(1.58 1.75)
Beral, 2003
Therapyb
Breast Ductal
Current Use
1.76
(1.68 1.85)
Reeves, 2006
Breast Lobular
Current Use
2.51
(2.27 2.77)
Reeves, 2006
Breast Tubular
Current Use
3.57
(2.93 4.36)
Reeves, 2006
Endometrium
Ever Use
0.78
(0.72 0.86)
Brinton, 2014
Endometrium
Current Use
0.75
(0.58 0.97)
Beral, 2005
Ovary
Ever Use
1.2
(1.15 1.26)
CGESOCc, 2015
Ovary
Current Use
1.41
(1.32 1.50)
CGESOC, 2015
a
b
Continuous estrogen-progestin combined hormone therapy (progestins were included in the therapy for >25 days/month).
c
CGESOC, Collaborative Group on Epidemiological Studies of Ovarian Cancer.
Exposure
Oral
Contraceptives
279
Table 11.3
Prevalence of oral contraceptive and hormone replacement therapy use in Alberta (Albertas
Tomorrow Project, 2000-2009)
Age (years)
Oral Contraceptives Ever Use
35-44
45-54
55-64
65
Hormone Replacement Therapy Ever Use
Prevalence (95% CI)a

92.3 (91.7,93.0)
91.1 (90.4,91.8)
85.5 (84.5,86.6)
67.6 (65.3,69.9)
35-44
45-54
55-64
65
Hormone Replacement Therapy Current Use
4.4 (3.9,4.9)
25.2 (24.2,26.3)
60.3 (58.9,61.7)
60.5 (58.1,62.9)
35-44
45-54
55-64
65
a
2.8 (2.4,3.3)
15.5 (14.7,16.4)
27.2 (25.9,28.5)
19.6 (17.6,21.5)
280
Table 11.4
Prevalence of oral contraceptive and hormone replacement therapy use in Alberta by health region (zone) (Albertas Tomorrow
Project, 2000-2009)
Calgary Zone
Prevalence (95% CI)a

Central Zone
Edmonton Zone
North Zone
91.5 (90.3,92.8)
90.7 (89.3,92.0)
87.5 (85.6,89.4)
73.2 (68.9,77.6)
92.4 (90.8,94.0)
90.0 (88.3,91.7)
86.4 (84.2,88.6)
67.4 (62.6,72.1)
91.3 (89.9,92.7)
91.5 (90.1,92.9)
84.5 (82.4,86.7)
66.4 (61.8,71.0)
94.3 (92.9,95.6)
92.2 (90.7,93.7)
84.2 (81.5,86.8)
64.6 (58.7,70.6)
3.1 (2.3,3.9)
24.3 (22.3,26.3)
62.6 (59.8,65.4)
66.2 (61.5,70.8)
4.3 (3.0,5.5)
25.3 (22.8,27.8)
59.1 (55.9,62.2)
56.0 (51.1,61.0)
3.9 (2.9,4.9)
25.6 (23.5,27.8)
58.2 (55.3,61.1)
61.4 (56.6,66.2)
5.5 (4.1,6.8)
23.4 (21.0,25.8)
56.2 (52.5,59.8)
52.4 (46.2,58.7)
1.9 (1.3,2.6)
14.6 (12.9,16.2)
27.6 (25.0,30.2)
23.2 (19.1,27.4)
2.7 (1.7,3.7)
14.4 (12.3,16.4)
23.5 (20.8,26.2)
14.5 (10.9,18.0)
2.8 (1.9,3.6)
16.6 (14.8,18.4)
23.5 (20.8,26.2)
24.3 (20.1,28.5)
3.2 (2.1,4.2)
13.1 (11.2,15.0)
29.3 (26.6,31.9)
11.0 (7.1,14.9)
Age (years)
South Zone
35-44
93.4 (91.5,95.2)
45-54
91.2 (89.2,93.2)
55-64
83.7 (80.6,86.8)
65
62.6 (55.8,69.5)
35-44
7.4 (5.4,9.3)
45-54
29.4 (26.2,32.6)
55-64
67.2 (63.2,71.1)
65
65.8 (59.0,72.5)
35-44
5.0 (3.4,6.7)
45-54
21.3 (18.4,24.1)
55-64
35.4 (31.4,39.4)
65
23.2 (17.2,29.2)
a
281
Table 11.5
Observed cancer cases in Alberta (2012) and population attributable risks associated to oral contraceptive and hormone
replacement therapy use
Age at Exposure
Age at Outcome
Cancer Site
Observed Cases
35-44
43-52
Breast
Breast Ductal
Breast - Lobular
Breast - Tubular
Endometrium
Ovary
Breast
Breast Ductal
Breast - Lobular
Breast - Tubular
Endometrium
Ovary
Breast
Breast Ductal
Breast - Lobular
Breast - Tubular
Endometrium
Ovary
Breast
Breast Ductal
Breast - Lobular
Breast - Tubular
Endometrium
Ovary
463
418
25
4
57
36
584
499
47
8
183
46
559
458
62
6
152
46
522
401
69
7
90
51
45-54
55-64
65
53-62
63-72
73
Ever HRT Use

PAR (%) (95% CI)
Current HRT Use

PAR (%) (95% CI)
-64.8 (-111.5,-27.9)
-33.2 (-46.0,-21.4)
6.9 (0.2,13.1)
9.3 (8.2,10.5)
-63.4 (-108.2,-26.9)
-32.6 (-45.2,-21.5)
6.5 (0.2,12.4)
-4.0 (-7.0,-0.4)
6.0 (4.8,7.3)
15.2 (13.5,17.0)
-57.3 (-95.1,-24.6)
-30.0 (-41.1,-19.4)
5.2 (0.3,10.1)
-7.3 (-13.0,-0.7)
10.0 (8.1,12.2)
11.4 (9.8,13.1)
-40.4 (-62.8,-18.7)
-22.3 (-30.0,-14.9)
-5.1 (-9.0,-0.6)
7.4 (5.7,9.1)
9.0 (3.0,15.6)
16.1 (14.5,17.7)
27.6 (24.3,31.1)
39.3 (32.5,45.9)
-5.9 (-7.8,-3.9)
4.8 (3.6,6.1)
19.0 (6.9,30.2)
31.4 (28.9,33.9)
47.7 (43.4,51.7)
60.8 (53.9,66.8)
-15.3 (-20.9,-9.7)
10.8 (8.1,13.4)
19.1 (6.5,30.2)
31.5 (28.9,34.0)
47.7 (43.5,51.9)
60.8 (53.8,67.1)
-15.3 (-21.0,-9.8)
10.8 (8.1,13.4)
Ever OC Use
a
PAR (%) (95% CI)
7.0 (0.3,13.3)
PAR, population attributable risk (%). It represents the proportion (%) of cancer cases attributable to OC ever use or HRT ever use or HRT
current use. The negative values represent preventable proportions of cancer cases due to protective effect.
282
Table 11.6
Observed cancer cases in Alberta (2012) and proportions attributable to oral contraceptive and hormone replacement therapy
use
Breast
Obs.
PARb
c
EAC
a
Cases
(%)
35-44
43-52
463
7.0
32
45-54
53-62
584
6.9
40
55-64
63-72
559
6.5
36
65
73
522
5.2
27
Total
2128
135
35-44
43-52
45-54
53-62
584
9.0
52
55-64
63-72
559
19.0
106
65
73
522
19.1
100
Total
1665
258
35-44
43-52
45-54
53-62
584
9.3
54
55-64
63-72
559
15.2
85
65
73
522
11.4
60
Total
1665
199
Age at
Exposure
Age at
Outcome
Breast Ductal
Obs.
PAR
EAC
Cases (%)
499
458
401
1358
16.1
31.4
31.5
80
144
126
350
Breast - Lobular
Obs.
PAR
EAC
Cases (%)
47
62
69
178
27.6
47.7
47.7
13
30
33
76
Breast - Tubular
Obs.
PAR
EAC
Cases (%)
8
6
7
21
39.3
60.8
60.8
3
4
4
11
Endometrium
Obs.
PAR
Cases
(%)
EAC
Ovary
Obs.
Cases
PAR
(%)
EAC
57
183
152
90
482
-64.8
-63.4
-57.3
-40.4
-37
-116
-87
-36
-276
36
46
46
51
179
-33.2
-32.6
-30.0
-22.3
-12
-15
-14
-11
-52
183
152
90
425
-5.9
-15.3
-15.3
-11
-23
-14
-48
46
46
51
143
4.8
10.8
10.8
2
5
6
13
183
152
90
425
-4
-7.3
-5.1
-7
-11
-5
-23
46
46
51
143
6.0
10.0
7.4
3
5
4
12
Obs. Cases, observed cases. The values represent the total number of cases of each cancer type diagnosed in 2012. For HRT, only post
menopausal cancer cases (cancers diagnosed at age 53 or older) are included.
b
c
EAC, excess attributable risk. It represents the number of cases attributable to OC ever use or HRT ever use or HRT current use. The negative
values represent preventable cancer cases attributable to protective effect.
283
Table 11.7
Observed cancer cases in the South Zone health region (2012) and proportions attributable to oral contraceptive and hormone
Age at
Exposure
Age at
Outcome
Breast
Obs.
Casesa
PAR
(%)
Breast Ductal
Breast - Lobular
Breast - Tubular
Endometrium
Obs.
Cases
Obs.
Cases
Obs.
Cases
Obs.
Cases
PAR
(%)
Obs.
Cases
PAR
(%)
PAR
(%)
PAR
(%)
PAR
(%)
Ovary

35-44
43-52
37
<5
-66
<5
-33.7
45-54
53-62
47
6.9
16
-63.6
<5
-32.7
55-64
63-72
56
6.3
11
-55.4
<5
-29.2
65
73
43
4.8
14
-36.4
-20.4
Total
183
<46
18

35-44
43-52
45-54
53-62
47
10.3
16
-6.9
<5
5.5
55-64
63-72
56
20.8
11
-17.3
<5
11.8
65
73
43
20.4
14
-16.9
11.6
Total
146
41
16

35-44
43-52
45-54
53-62
47
12.3
36
18.3
30.7
<5
43
16
-5.6
<5
55-64
63-72
56
18.9
51
33.8
<5
50.3
<5
63.3
11
-9.7
<5
12.7
65
73
43
13.3
39
33.3
<5
49.8
<5
62.8
14
-6.1
8.7
Total
146
126
11
<5
41
16
menopausal cancer cases (cancers diagnosed at age 53 or older) were included.
b
current use. The negative values represent preventable proportions of cancer cases due to a protective effect.
284
Table 11.8
Age at
Exposure
Observed cancer cases in the Calgary Zone health region (2012) and proportions attributable to oral contraceptive and hormone
Age at
Outcome
Breast
Obs.
a
Cases
PAR
(%)
Breast Ductal
Breast - Lobular
Breast - Tubular
Endometrium
Obs.
Cases
Obs.
Cases
Obs.
Cases
Obs.
Cases
PAR
(%)
Obs.
Cases
PAR
(%)
PAR
(%)
PAR
(%)
PAR
(%)
Ovary

35-44
43-52
185
6.9
15
-63.9
12
-32.8
45-54
53-62
201
6.8
80
-62.9
19
-32.4
55-64
63-72
199
6.6
49
-59.4
18
-30.9
65
73
179
5.6
23
-45.3
15
-24.6
Total
764
167
64

35-44
43-52
45-54
53-62
201
8.7
80
-5.7
19
4.6
55-64
63-72
199
19.6
49
-16
18
11.1
65
73
179
20.5
23
-17
15
11.7
Total
579
152
52

35-44
43-52
45-54
53-62
201
8.8
172
15.6
17
26.9
<5
38.5
80
-3.8
19
5.6
55-64
63-72
199
15.4
169
32.2
22
48.6
<5
61.7
49
-7.4
18
10.2
65
73
179
13.3
146
33.5
22
50
<5
63
23
-6.2
15
8.7
Total
579
387
61
<5
152
52
b
285
Table 11.9 Observed cancer cases in the Central Zone health region (2012) and proportions attributable to oral contraceptive and hormone
Age at
Exposure
Age at
Outcome
Breast
Obs.
a
Cases
PAR
(%)
Breast Ductal
Breast - Lobular
Breast - Tubular
Endometrium
Obs.
Cases
Obs.
Cases
Obs.
Cases
Obs.
Cases
PAR
(%)
Obs.
Cases
PAR
(%)
PAR
(%)
PAR
(%)
PAR
(%)
Ovary

35-44
43-52
48
11
-64.9
<5
-33.2
45-54
53-62
78
6.8
24
-62.2
-32.1
55-64
63-72
72
6.5
18
-58.2
<5
-30.4
65
73
71
5.2
14
-40.3
10
-22.2
Total
269
67
<25

35-44
43-52
45-54
53-62
78
24
-5.9
4.8
55-64
63-72
72
18.7
18
-14.9
<5
10.6
65
73
71
17.9
14
-14.1
10
10.1
Total
221
56
<26

35-44
43-52
45-54
53-62
78
8.7
66
16.1
27.6
<5
39.4
24
-3.7
5.6
55-64
63-72
72
13.4
53
31
10
47.1
<5
60.3
18
-6.2
<5
8.8
65
73
71
8.7
53
29.9
13
45.8
59
14
-3.8
10
5.6
Total
221
172
28
56
<26
b
286
Table 11.10
Age at
Exposure
Observed cancer cases in the Edmonton Zone health region (2012) and proportions attributable to oral contraceptive and
hormone replacement therapy use
Age at
Outcome
Breast
Obs.
Casesa
PAR
(%)
Breast Ductal
Breast - Lobular
Breast - Tubular
Endometrium
Obs.
Cases
Obs.
Cases
Obs.
Cases
Obs.
Cases
PAR
(%)
Obs.
Cases
PAR
(%)
PAR
(%)
PAR
(%)
PAR
(%)
Ovary

35-44
43-52
152
6.9
18
-63.6
11
-32.7
45-54
53-62
210
6.9
45
-63.9
11
-32.8
55-64
63-72
185
6.4
58
-56.3
17
-29.6
65
73
189
5.1
34
-39.5
15
-21.9
Total
736
155
54

35-44
43-52
45-54
53-62
210
9.1
45
-6
11
4.9
55-64
63-72
185
18.5
58
-14.7
17
10.4
65
73
189
19.3
34
-15.6
15
10.9
Total
584
137
43

35-44
43-52
45-54
53-62
210
9.9
181
16.3
15
27.9
<5
39.7
45
-4.3
11
6.4
55-64
63-72
185
13.4
152
30.7
18
46.8
<5
59.9
58
-6.2
17
8.8
65
73
189
13.8
133
31.8
25
48.1
61.2
34
-6.5
15
9.1
Total
584
466
58
137
43
b
287
Table 11.11 Observed cancer cases in the North Zone health region (2012) and proportions attributable to oral contraceptive and hormone
Age at
Exposure
Age at
Outcome
Breast
Obs.
a
Cases
PAR
(%)
Breast Ductal
Breast - Lobular
Breast - Tubular
Endometrium
Obs.
Cases
Obs.
Cases
Obs.
Cases
Obs.
Cases
PAR
(%)
Obs.
Cases
PAR
(%)
PAR
(%)
PAR
(%)
PAR
(%)
Ovary

35-44
43-52
41
7.1
-67.1
-34.1
45-54
53-62
48
18
-64.7
-33.2
55-64
63-72
47
6.4
16
-55.9
<5
-29.4
65
73
40
-38
<5
-21.1
Total
176
48
19

35-44
43-52
45-54
53-62
48
8.4
18
-5.4
4.5
55-64
63-72
47
18
16
-14.1
<5
10.1
65
73
40
17
-13
<5
9.5
Total
135
39
12

35-44
43-52
45-54
53-62
48
44
15.1
<5
26.1
37.5
18
-3.4
5.1
55-64
63-72
47
16.2
33
29.9
10
45.9
59.1
16
-7.9
<5
10.7
65
73
40
6.8
30
28.5
44.2
57.4
-2.8
<5
4.3
Total
135
137
<22
39
12
b
288
Figure 11.1 Prevalence of oral contraceptive use in Alberta by age group (Albertas Tomorrow
Project, 2000-2009)
289
Figure 11.2 Prevalence of ever and current hormone replacement therapy use in Alberta by age
group (Albertas Tomorrow Project, 2000-2009)
290
Figure 11.3 Prevalence of oral contraceptive use in Alberta by age group and Alberta Health
Services region (Albertas Tomorrow Project, 2000-2009)
291
Figure 11.4 Prevalence of ever and current hormone replacement therapy use in Alberta by age
group and Alberta Health Services region (Albertas Tomorrow Project, 2000-2009)
292
Figure 11.5 Cancer cases attributable to ever use of hormone replacement therapy and
other known and unknown cancer causes
293
Figure 11.6 Cancer cases attributable to current use of hormone replacement therapy and
other known and unknown cancer causes
294
CHAPTER 12
Cancer Incidence Attributable to Infections in Alberta,

Canada in 2012
295
SUMMARY
No data on prevalence of infections were available for the province of Alberta. Based on
Canadian and other provincial estimates, the population prevalence of hepatitis B virus (HBV), hepatitis
C virus (HCV) and Helicobacter pylori (H. pylori) was assumed to be approximately 4.2%, 0.5% and 2538%, respectively. Due to the varying natures of the infectious agents as they relate to cancer (as a
sufficient vs. necessary cause of cancer) and the limited availability of prevalence data, a range of
population attributable risk (PAR) estimates was generated for some infectious agents and site-specific
cancers. Overall, 2.4-4.0% of all incident cancers and 35.7-57.8% of all cancers associated with infections
in Alberta in 2012 could be attributed to infectious agents (Table 12.1).
For HPV-associated cancers, PARs ranged from 8-16% for cancers of the oral cavity to 100% for
cervical cancer (Table 12.2) and thus, 43.1-56.4% of all cancers at sites related to HPV were attributable
to HPV infection. The PAR for Epstein-Barr Virus (EBV) ranged from 24.0-38.1% for Hodgkins lymphoma
and ranged from 33.3%-100% for nasopharyngeal cancers (Table 12.3). In total 39.0-49.0% of EBVassociated cancers were attributable to EBV infection. In addition, 8.7-45.0% and 10.0-21.1% of liver
cancers were attributable to HBV and HCV infection, respectively (Table 12.4), while 21.2-57.7% of all
non-cardia gastric cancers were attributable to H. pylori infection (Table 12.5).
METHODS OVERVIEW
Depending on the nature of the cancer and infectious agent relationship, and the availability of
prevalence data, one of three equations was used to estimate the PAR for infections.
12.1: =
( 1)
1 + [ ( 1)]
12.2: =
( 1)
12.3: =
In the above equations, Pe represents the population-level infection prevalence of the exposure while Pc
represents the prevalence of infections in cancer cases (tumours) and RR is the relative risk associated
between the exposure and site-specific cancer. Equation 12.3 is derived from Equation 12.2 as the
association between the presence of infection and cancer increases, such that the quantity (RR-1)/RR
approaches the limit of 1.0. Thus, Equation 12.3 was used in cases where there is evidence of a very
296
strong association between a given infectious agent and an associated cancer site such that the
infectious agent is believed to be a necessary cause of that cancer.
Very limited data on the prevalence of infections were available for Alberta and therefore, most
estimates were taken from either from the epidemiologic literature or from Canada-wide data from the
Canadian Health Measures Survey (CHMS). Both population prevalence and prevalence of infection in
cancer cases or tumours were used. Latency periods (the period from infection to cancer diagnosis)
were dependent on the available prevalence estimates, but were generally comparable to evidence
from the literature. Latency periods were only applicable when using Equations 12.1 and not a necessary
consideration when using prevalence of infection in cancer cases (Equations 12.2 and 12.3). Relative risk
estimates for site-specific cancers associated with different infectious agents were also obtained from
the literature (Table 12.6). Cancer incidence data were obtained for 2012 from the Alberta Cancer
Registry.
Human Papillomavirus
Since HPV is considered a necessary cause of cervical cancer since it is present in all cases, 100%
of cases were assumed to be attributable to HPV infection and no prevalence information was required.
For all other cancer sites, the prevalence of HPV infection in cases was extracted from the epidemiologic
literature (Table 12.7) and Equation 12.3 was used to estimate PAR (Table 12.8), on the assumption that
detection of HPV DNA in tumour cells is representative of the cancer being caused by HPV.
Epstein-Barr Virus
Because EBV infection is common in childhood and adolescence (90-95% prevalence) and
persists in B-lymphocytes throughout life, only those cases where EBV DNA is present in tumour cells
can truly be considered EBV-attributable cases. Thus, PAR estimates for EBV-related Hodgkins
Lymphoma were derived using EBV prevalence in cases (Table 12.9) and Equation 12.3 (Table 12.10). For
nasopharyngeal cancers, no EBV prevalence estimates were available for either the keratinizing or nonkeratinizing types. Therefore, to estimate the proportion of nasopharyngeal cancers attributable to EBV
infection, it was assumed that 100% of non-keratinizing nasopharyngeal cancers were attributable to
EBV infection, while 33% of keratinizing nasopharyngeal cancers contained EBV infection based on
methods used by de Martel et al.
Hepatitis B and C Virus
Both Canada-wide population prevalence of HBV and HCV infection from the CHMS and
prevalence in tumours from the literature were available (Table 12.11). Thus, Equations 12.1 and 12.2
297
respectively were used to estimate PARs (Table 12.12). RR estimates for HBV and HCV with liver cancer
were extracted from the literature. An approximate five- year latency was applied to estimates using
Equation 12.1 as population prevalence values were only available between 2007 and 2011.
Helicobacter pylori
As with HBV and HCV infection and liver cancer, both Equations 12.1 and 12.2 were used to
estimate PARs for H. pylori and non-cardia gastric cancers. Because no population prevalence estimates
of H. pylori infection exist in Alberta, prevalence estimates from Ontario and Nova Scotia (Table 12.13),
in combination with RR estimates from epidemiologic literature, were used to estimate PAR using
Equation 12.1 (Table 12.14). An approximate 13 to 20 year latency was applied to these estimates as
data from Ontario were collected between 1997 and 2000, while estimates from Nova Scotia were
obtained around 1993.
298
Table 12.1 Summary of proportion and number of cancers attributable to infectious agents in Alberta in 2012
Infectious Agent
Epstein-Barr virus
Hepatitis B virus
Hepatitis C virus
Helicobacter pylori
All Associated Cancersc
All Cancersd
Total Observed
Cases
635
100
218
218
137
1090
15836
Excess Attributable
Casesa
274-358
39-49
19-98
22-46
29-79
383-630
383-630
% Attributableb
43.1-56.4
39.0-49.0
8.7-45.0
10.1-21.1
21.2-57.7
35.1-57.8
2.4-4.0
Range of excess attributable cases presented represent different methods or prevalence values used to estimate
population attributable risks
b
Proportion of all associated cancers attributable to infection, calculated as excess attributable cases/observed cases
c
All associated cancers includes all cancers known to be associated with infections (as listed in the current table)
d
All cancers includes all incident cancer cases for Alberta for all ages in 2012
Table 12.2 Summary of proportion and number of cancers attributable to human papillomavirus (HPV) in
Alberta in 2012
Cancer Site
Anus
Cervix
Oral Cavity
Oropharynx
Penis
Vagina
Vulva
All Cancersd
Total Observed
Cases
47
136
233
137
13
16
53
635
15836
Excess Attributable
Casesa
38
136
19-38
32-96
5-6
11
33
274-358
274-358
% Attributableb
80.1
100.0
8.2-16.3
23.4-70.1
38.5-46.2
68.8
62.3
43.1-56.4
1.7-2.3
population attributable risks
b
Proportion of all associated cancers attributable to infection, calculated as excess attributable cases/observed cases
c
All associated cancers includes all cancers known to be associated with HPV infection (as listed in the current table)
d
299
Table 12.3 Summary of proportion and number of cancers attributable to Epstein-Barr virus (EBV) in Alberta in
2012
Cancer Site
Hodgkins lymphoma
Nasopharynx
All Cancersd
Total Observed
Cases
74
26
100
15836
Excess Attributable
Casesa
18-28
21
39-49
39-49
% Attributableb
24.3-37.8
80.8
39.0-49.0
0.2-0.3
Range of PARs presented represent different methods or prevalence values used to estimate PAR
Proportion of all associated cancers attributable to EBV infection, calculated as excess attributable cases/observed cases.
c
All associated cancers includes all cancers known to be associated with EBV infection (as listed in the current table)
d
b
Table 12.4 Summary of proportion and number of cancers attributable to hepatitis B and C virus (HBV and HCV)
in Alberta in 2012
Cancer Site
Hepatitis B Virus
Liver
All Cancersd
Hepatitis C Virus
Liver
All Cancersd
Total Observed
Cases
Excess Attributable
Casesa
% Attributableb
218
218
15836
19-98
19-98
19-98
8.7-45.0
8.7-45.0
0.1-0.6
218
218
15836
22-46
22-46
22-46
10.0-21.1
10.0-21.1
0.1-0.3
Range of PARs presented represent different methods or prevalence values used to estimate PAR
Proportion of all associated cancers attributable to EBV infection, calculated as excess attributable cases/observed cases.
c
All associated cancers includes all cancers known to be associated with HBV and HCV infection (as listed in the current
table)
d
b
Table 12.5 Summary of proportion and number of cancers attributable to Helicobacter pylori (H. pylori) in
Alberta in 2012
Cancer Site
Stomach Non-Cardia
All Cancersd
Total Observed
Cases
137
137
15836
Excess Attributable
Casesa
29-79
29-79
29-79
% Attributableb
21.2-57.7
21.2-57.7
0.2-0.5
population attributable risk
b
Proportion of cancers at individual cancer sites attributable to H.pylori infection, calculated as excess attributable
c
All associated cancers includes all cancers known to be associated with H. pylori infection (as listed in the current table)
d
300
Table 12.6 Relative risk estimates of cancer for infections used for population attributable risk calculations
Infectious Agent
HBV
HCV
H. pylori
Cancer Site
Liver
Liver
Stomach- Non-cardia
Source
Cho (2011)[11]
Cho (2011)[11]
Cavaleiro-Pinto (2011)[14]
Risk Estimate (RR/OR)

20.30
23.80
2.56
301
Table 12.7 Prevalence estimates of cancer-related human papillomavirus infections used for population attributable risk calculations
Cancer Site
Prevalence Source
Geographic Region
Anus
Oral Cavity
Oropharynx
Penis
Vagina
Vulva
Calgary
North Americac
United Kingdomd
United Statese
North Americaf
North Americac
North Americag
North Americah
United Kingdomd
North Americai
North Americai
Prevalence
typea
Cases
Cases
Cases
Cases
Cases
Cases
Cases
Cases
Cases
Cases
Cases
Age
(Years)
All
All
All
All
All
All
All
All
All
All
All
Prevalence Estimates (%)

All
80.0
16.1
8.0
70.0
56.0
47.0
23.5
Men
48.7
40.0
Prevalence in cases denotes estimates were derived from the prevalence of HPV infection in site-specific cancer cases
Prevalence estimate obtained from Urgoiti et al. (2014)
c
Prevalence estimate obtained from Kreimer et al. (2005)
d
Prevalence estimate obtained from Parkin et al. (2010)
e
Prevalence estimate obtained from Chaturvedi et al. (2011)
f
Prevalence estimate obtained from de Martel et al. (2012)
g
Prevalence estimate obtained using methods by Parkin et al. (2010) applied to prevalence data from Kreimer et al. (2005)
h
Prevalence estimate obtained from Backes et al. (2009)
i
Prevalence estimate obtained from De Vuyst et al. (2009)
Women
70.3
63.2
302
Table 12.8 Cases and proportions of cancer in Alberta in 2012 attributable to Human Papillomavirus (HPV) infection
Cancer Site
Anus
Cervix
Oral Cavity
Oropharynx
Penis
Vagina
Vulva
a
Prevalence Source
Geographic Region
Prevalence
a
type
Calgarye
NAf
North Americag
United Kingdomh
United Statesi
North Americaj
North Americag
North Americak
North Americal
United Kingdomh
North Americam
North Americam
Cases
NA
Cases
Cases
Cases
Cases
Cases
Cases
Cases
Cases
Cases
Cases
Age
(Years)
All
All
All
All
All
All
All
All
All
All
All
All
Total
Observed
b
Cases
PARc
47
80.0
233
233
137
137
137
137
16.1
8.0
70.0
56.0
47.0
23.5
Men
Excess
Attributable
d
Cases
Observed
Cases
PAR
38
38
19
96
77
64
32
13
13
48.7
40.0
Women
Excess
Attributable
Cases
6
5
Observed
Cases
PAR
Excess
Attributable
Cases
136
100.0
136
16
53
70.3
63.2
11
33
Number of observed cancer cases in Alberta in 2012 at individual cancer sites
c
d
Number of cancer cases at individual cancer sites that can be attributed to HPV infection
e
Prevalence estimate obtained from Urgoiti et al. (2014)
f
HPV is considered a necessary cause of cervical cancer and thus, 100% of cases are attributable to HPV infection and prevalence estimates were not obtained
g
Prevalence estimate obtained from Kreimer et al. (2005)
h
Prevalence estimate obtained from Parkin et al. (2010)
i
Prevalence estimate obtained from Chaturvedi et al. (2011)
j
Prevalence estimate obtained from de Martel et al. (2012)
k
Prevalence estimate obtained using methods by Parkin et al. (2010) applied to prevalence data from Kreimer et al. (2005)
l
Prevalence estimate obtained from Backes et al. (2009)
m
Prevalence estimate obtained from De Vuyst et al. (2009)
b
303
Table 12.9 Prevalence estimates of cancer-related Epstein-Barr virus infections used for population attributable risk calculations
Cancer Site
Hodgkins lymphoma
a
Prevalence Source
Geographic Region
North Americab
North Americac
Prevalence
typea
Cases
Cases
Age
(Years)
All
All
38.1
24.0
Prevalence estimate obtained from Lee et al. (2014) using data published prior to 2000
c
Prevalence estimate obtained from Lee et al. (2014) using data published in and after 2000
b
Table 12.10 Summary of cases and proportions of cancer in Alberta in 2012 attributable to Epstein-Barr Virus
Cancer Site
Hodgkins lymphoma
Keratinizing nasopharynx
Non-keratinizing nasopharynx
Prevalence Source
Geographic Region
Prevalence type
North Americae
North Americaf
NAg
NAg
Cases
Cases
NA
NA
Age
(Years)
All
All
All
All
Observed
Casesb
74
74
7
19
Total
PAR
38.1
24.0
33.3
100.0
Excess Attributable
Casesd
28
18
2
19
c
d
Number of cancer cases at individual cancer sites that can be attributed to EBV infection
e
Prevalence estimate obtained from Lee et al. (2014) using data published prior to 2000
f
Prevalence estimate obtained from Lee et al. (2014) using data published after 2000
g
Prevalence values were not obtained as it was assumed that one third of all keratinizing and 100% of non-keratinizing nasopharyngeal cancers were
attributed to EBV infection
b
304
Table 12.11 Prevalence estimates of cancer-related hepatitis B and C infections used for population attributable risk calculations
Cancer Site
Prevalence Source
Geographic Region
Hepatitis B Virus
Liver
Canada
North Americac
Hepatitis C Virus
Liver
Canadab
North Americac
Prevalence
typea
Population
Cases
Population
Cases
Age
(Years)
All
Men
Women
All
14-49
50-79
All
4.2
3.2
5.8
9.0
4.5
2.9
7.3
3.8
3.5
4.5
All
14-49
50-79
All
0.5
0.4
0.8
22.0
0.4
1.4
0.8
2.1
Prevalence in cases denotes estimates were derived from the prevalence of HBV or HCV infection in site-specific cancer cases. Prevalence in population refers
to estimates derived from population-based data.
b
Prevalence estimate obtained from Rotermann et al. (2013) using data from the Canadian Health Measures Survey
c
Prevalence estimate obtained from Raza et al. (2007)
305
Table 12.12 Summary of cases and proportions of cancer in Alberta in 2012 attributable to Hepatitis B and C Virus
Cancer
Site
Prevalence Source
Geographic
Region
Prevalence
typea
Canadae
Population
North Americaf
Cases
Canadae
Population
North Americaf
Cases
Hepatitis B Virus
Liver
Hepatitis C Virus
Liver
Age
(Years)
Total
Men
Observed
Casesb
PARc
Excess
Attributable
Casesd
Observed
Cases
PAR
Excess
Attributable
Cases
Observed
Cases
All
14-49
50-79
All
218
31
179
218
44.8
38.2
52.8
8.6
98
12
95
19
149
23
123
42.3
35.9
58.5
69
8
72
All
14-49
50-79
All
218
31
179
218
10.2
8.4
15.4
21.1
22
3
28
46
149
8.4
12
Women
PAR
Excess
Attributable
Cases
69
8
56
42.3
40.3
46.5
29
3
26
69
24.2
17
Prevalence in cases denotes estimates were derived from the prevalence of HBV or HCV infection in site-specific cancer cases. Prevalence in population refers
to estimates derived from population-based data.
b
c
d
Number of cancer cases at individual cancer sites that can be attributed to HBV or HCV infection
e
Prevalence estimate obtained from Rotermann et al. (2013) using data from the Canadian Health Measures Survey
f
Prevalence estimate obtained from Raza et al. (2007)
306
Table 12.13 Prevalence estimates of cancer-related Helicobacter pylori infections used for population attributable risk calculations
Cancer Site
Prevalence Source
All
Population
18-72
20-29
30-39
40-49
50-59
60-69
70-79
38.0
21.0
28.0
39.0
41.0
47.0
50.0
Ontarioc
Population
USA (California)d
Australiae
Cases
Cases
50-80
50-59
60-70
71-80
All
All
Geographic Region
Stomach Non-Cardia
Age
(Years)
Nova Scotia
Prevalence
typea
88.7
94.7
Men
Women
33.0
29.4
32.1
38.7
24.8
17.3
24.3
36.0
USA, United States of America

a
Prevalence in cases denotes estimates were derived from the prevalence of H. pylori infection in site-specific cancer cases. Prevalence in population refers to
estimates derived from population-based data.
b
Prevalence estimate obtained from Veldhuyzen van Zanten et al. (1994)
c
Prevalence estimate obtained from Naja et al. (2007)
d
Prevalence estimate obtained from the Helicobacter and Cancer Collaborative Group (2001)
e
Prevalence estimate obtained from Plummer et al. (2015)
307
Table 12.14 Summary of cases and proportions of cancer in Alberta in 2012 attributable to Helicobacter pylori
Cancer Site
Prevalence Source
Geographic
Region
Stomach
Non-Cardia
Prevalence
typea
Age
(Years)
Nova Scotiae
Population
18-72
20-29
30-39
40-49
50-59
60-69
70-79
Ontariof
Population
50-80
50-59
60-70
71-80
All
All
USA (California)g
Australiah
Cases
Cases
Total
c
Observed
Casesb
PAR
129
11
20
30
33
31
5
37.2
24.7
30.4
37.8
39.0
42.3
43.8
137
137
54.1
57.7
Men
Excess
Attributable
d
Cases
PAR
Excess
Attributable
Cases
Observed
Cases
PAR
Excess
Attributable
Cases
60
25
23
12
34.0
31.4
33.4
37.6
20
8
8
5
31
12
9
10
27.9
21.3
27.5
36.0
9
3
2
4
48
3
6
11
13
13
2
74
79
Women
Observed
Cases
USA, United States of America

a
Prevalence in cases denotes estimates were derived from the prevalence of H. pylori infection in site-specific cancer cases. Prevalence in population refers to
estimates derived from population-based data.
b
c
d
Number of cancer cases at individual cancer sites that can be attributed to H.pylori infection
e
Prevalence estimate obtained from Veldhuyzen van Zanten et al. (1994)
f
Prevalence estimate obtained from Naja et al. (2007)
g
Prevalence estimate obtained from the Helicobacter and Cancer Collaborative Group (2001)
h
Prevalence estimate obtained from Plummer et al. (2015)
308
CHAPTER 13
Cancer Incidence Attributable to Ultraviolet Light

Exposure in Alberta, Canada in 2012
309
SUMMARY
The prevalence of Albertans exposed to both artificial and natural ultraviolet (UV) light was
estimated using the 2006 National Sun Survey. As of the year 2006, 23% of Albertans over the age of 16
had experienced at least one sunburn in their lifetime. In addition, approximately 11% of Albertans had
been exposed to artificial UV by using tanning equipment in the last 12 months. Approximately 1% (3
cases) of malignant melanoma in men and 3% (5 cases) in women in 2012 could be attributed to using
tanning equipment in the past year. Approximately 14% of malignant melanoma in men and 11% in
women could be attributed to having one or more sunburns in lifetime. A sensitivity analysis comparing
cases of malignant melanoma on skin exposed and unexposed to UV from the sun was also completed.
Based on this analysis, between 76% and 94% of malignant melanoma was attributable to UV exposure
from the sun (Table 13.1).
METHODS OVERVIEW
To estimate the population attributable risk (PAR) of UV exposure in Alberta, both natural and
artificial sources of UV exposure were considered. Natural UV exposure occurs from sunlight outside,
whereas artificial UV exposure occurs in tanning beds or other forms of tanning equipment. Data on the
prevalence of sun-protective behaviours and frequency of tanning bed use available from the 2006
Second National Sun Survey were used. The survey was completed by participants across Canada, with
Alberta representing 14.8% (1,054 participants) of the sample. Computer Assisted Telephone
Interviewing was used to collect data. Information on time spent in the sun, sun protection behaviours,
tan seeking behaviours, sunburns and artificial tanning were collected. For the purposes of the current
analyses, those who had at least one sunburn in their lifetime were considered exposed to natural UV
and those who had used tanning equipment in the last year were considered exposed to artificial UV.
Risk estimates for the association between UV exposure and malignant melanoma required for the PAR
310
estimation came from comprehensive meta-analyses and are presented in Table 13.2. To estimate the
proportion of malignant melanoma in Alberta in 2012 attributable to both natural and artificial UV
exposure, Formula 1 was used:
13.1: () =
( 1)
1 + [ ( 1)]
Where Pe represents the prevalence of exposure to UV (Table 13.3) and RR represents the relative risk
(RR) of malignant melanoma associated with the specific forms of UV exposure (Table 13.2). PARs were
then multiplied by the number of incident malignant melanoma cases in 2012, as reported by the
Alberta Cancer Registry to estimate the number of malignant melanoma cases in 2012 attributable to
UV exposure (Table13.4-13.5).
As a sensitivity analysis, we compared incident malignant melanoma cases on body parts
exposed to natural UV and not exposed. We estimated that between 20-80% of malignant melanoma on
the trunk were on areas not exposed to UV from the sun. To calculate the PAR, Forumla 13.2 was used:
13.2: =
Where the population incidence is the incidence of malignant melanoma in Alberta in 2012 and the
unexposed incidence is the incidence of malignant melanoma on skin areas assumed to be unexposed to
UV from the sun.
Assuming that 60% of cases of malignant melanoma on the trunk are on unexposed areas of
skin, we estimated that 82.1% of incident cases in 2012 were attributable to natural UV exposure. The
PAR estimates ranged from 76.1% to 94.0% when we assumed that 80% to 20% of the cases on the
trunk of the body were on skin areas unexposed to UV, respectively (Table 13.6).
311
Table 13.1
Summary of cases and proportions of malignant melanoma in Alberta in 2012 attributable to

ultraviolet light exposurea
Natural UV
( 1 sunburn in lifetime)
Malignant
All
Melanomae
Cancersf
Artificial UV
(tanning equipment use)
Malignant
All
Melanomae
Cancersf
Exposed vs. unexposed sking

Malignant
Melanomae
All Cancersf
Men
Casesb
% Attributabled
329
45
13.7
8155
45
0.6
226
3
1.1
8155
3
0
329
256
78.7
8155
256
3.1
Women
Cases
% Attributable
270
30
11.1
7681
30
0.4
199
5
2.7
7681
5
0.1
270
232
86.0
7681
232
3.0
Total
599
15836
425
15836
599
15836
Cases
75
75
8
8
492
492
12.5
0.5
1.9
0
82.1
3.1
% Attributable
UV, ultra violet light
a. Prevalence of population exposed to artificial and natural UV from the Second National Sun
Survey (2006). Natural UV exposure defined as those who have experienced 1 sunburn in their
lifetime. Artificial UV exposure defined as those who have used artificial tanning equipment (e.g.
tanning beds) in the last year.
b. Number of malignant melanoma cancer cases in Alberta in 2012.
c. Number of cancer cases at individual cancer sites that can be attributed to UV exposure.
d. Proportion of malignant melanoma attributable to UV exposure. Calculated as excess
attributable cases/observed cases.
observed cancer cases for all cancer sites (only malignant melanoma in this case).
f. Represents all incident cancers in Alberta in 2012 in all age groups.
g. Based on the assumption that 60% of malignant melanomas on the trunk not exposed to UV
from the sun.
312
Table 13.2
Risk Estimates for the associations between natural and artificial ultraviolet light
exposure and malignant melanoma
Exposure
Referent Group
Risk Estimate (95%

CI)
Source
Never exposed
1.23 (1.03, 1.47)
Colantonio,
2014
Never
sunburned
2.03 (1.73, 2.37)
Gandini, 2005
Artificial
Ever exposed to indoor tanning
Natural
1 sunburn in lifetime
313
Table 13.3
Prevalence of Albertans in 2006 who have experienced 1 sunburn in their lifetime or have
used tanning equipment in the last year
Age
1 Sunburn in Lifetime (%)
Used Tanning Equipment (%)
Men
16-24
25-44
45-64
65
29
27
15
9
8
7
4
Women
16-24
25-44
45-64
65
29
21
10
4
27
15
8
All
16
23
*Prevalence data from the Second National Sun Survey (2006)
11
314
Table 13.4
Age
Cases and proportions of malignant melanoma in Alberta in 2012 attributable to

experiencing 1 sunburn in lifetime
Excess Attributable
Cases of Melanoma
Latency Age
Melanoma Cases
PAR (%) (95% CI)
Men
16-24
25-44
45-64
65
Total
22-30
31-50
51-70
71
Total
9
63
154
103
329
23.0 (17.4,28.9)
21.8 (16.3,27.5)
13.4 (9.6,17.5)
8.5 (5.8,11.5)
2
14
21
9
45
Women
16-24
25-44
45-64
65
Total
22-30
31-50
51-70
71
Total
10
85
104
71
270
23.0 (17.5,29.0)
17.8 (13.1,22.9)
9.3 (6.5,12.7)
4.0 (2.5,5.7)
2
15
10
3
30
23.0
19.5
11.8
6.6
4
29
30
12
75
Total
22-30
19
16-24
31-50
148
25-44
51-70
258
45-64
71
174
65
Total
599
Total
*Confidence intervals not available for totals as prevalence data was not available age-sex specific totals
315
Table 13.5
Age
Cases and proportions of malignant melanoma in Alberta in 2012 attributable to using

tanning equipment in the past year
Excess Attributable
Cases of Melanoma
Latency Age
Melanoma Cases
PAR (%) (95% CI)
Men
16-24
25-44
45-64
Total
22-30
31-50
51-70
Total
9
63
154
226
1.8 (0.2,3.7)
1.6 (0.2,3.3)
0.9 (0.1,1.9)
0
1
1
3
Women
16-24
25-44
45-64
Total
22-30
31-50
51-70
Total
10
85
104
199
5.8 (0.8,11.3)
3.3 (0.5,6.6)
1.8 (0.3,3.7)
1
3
2
5
3.9
2.6
1.3
1
4
3
8
Total
19
22-30
16-24
148
31-50
25-44
258
51-70
45-64
425
Total
Total
*Confidence intervals not available for totals as prevalence data was not available age-sex specific totals
316
Table 13.6
Cases and proportions of malignant melanoma in Alberta in 2012 attributable to UV

exposure from the sun
Assumed % of trunk not

exposed to UV from sun
Men
20%
30%
40%
50%
60%
70%
80%
Women
20%
30%
40%
50%
60%
70%
80%
Total
20%
30%
40%
50%
60%
70%
80%
Population
cases
Cases with
melanoma on
trunk of body
Cases on unexposed
skin
PAR (%)
329
329
329
329
329
329
329
117
117
117
117
117
117
117
23.4
35.1
46.8
58.5
70.2
81.9
93.6
92.9
89.3
85.8
82.2
78.7
75.1
71.6
270
270
270
270
270
270
270
63
63
63
63
63
63
63
12.6
18.9
25.2
31.5
37.8
44.1
50.4
95.3
93.0
90.7
88.3
86.0
83.7
81.3
599
599
599
599
599
599
599
180
180
180
180
180
180
180
36
54
72
90
107
125
143
94.0
91.0
88.0
85.0
82.1
79.1
76.1
317
CHAPTER 14
Cancer Incidence Attributable to PM2.5 Air Pollution in

318
SUMMARY
Average concentrations of fine particulate matter (<2.5 m in diameter; PM2.5) for 27
communities in Alberta were extracted for the year 2011 from the Clean Air Strategic Alliance (CASA)
Data Warehouse. Population-weighted PM2.5 concentrations were estimated for Alberta and each
Alberta Health Services (AHS) Zone. In Alberta, the population-weighted concentration of PM2.5 in 2011
was 10.3 g/m3. Approximately 2% (36 cases) of incident lung cancer in Alberta in 2012 could be
attributed to PM2.5 exposure (Table 14.1).
METHODS OVERVIEW
PM2.5 concentrations recorded in the CASA database are collected by 48 stations that measure
air pollutants hourly. Annual averages from the 48 stations were population-weighted based on the
census population estimates for the year 2011. Population-weighted concentrations for PM2.5 were
then averaged across each AHS health region (zone) and for Alberta as a whole (Table 14.2).
The following equation (Adapted from Norman et al., 2007) was then used to determine the
relative risks (RRs) for lung cancer incidence associated with PM2.5 exposure for Alberta:
3
Formula 14.1: RR = e[ x (C 7.5 g/m )]

Where RR is the risk of lung cancer associated with PM2.5 exposure and C is the populationweighted mean concentration of PM2.5 in each health Zone and Alberta as a whole. is the slope of the
linear concentration-response function for PM2.5 exposure and lung cancer (= 0.00789, SE=0.003447)
and the value of 7.5 g/m3 represents the theoretical minimum annual average concentration
associated with lung cancer risk, established in the global burden of disease study (Cohen et al., 2005).
The RRs estimated from Formula 14.1 (Table 14.3) were then used in the following formula to
calculate the PARs by AHS health region and for Alberta as a whole:
319
(1)
Formula 14.2: = (1)+1

Where P is the prevalence of the population exposed to an annual average PM2.5 concentration
above 7.5 g/m3 in 2011 (Table 14.4) and RR as calculated above in Formula 14.1. The PARs for each AHS
health region and Alberta as a whole were then multiplied by the lung cancer incidence for the year
2012, acquired from the Alberta Cancer Registry to determine the number of excess lung cancer cases
attributable to PM2.5 exposure.
320
Table 14.1 Summary of cases and proportions of lung cancer in Alberta in 2012 attributable to PM2.5
exposurea
1952
All Associated
Cancersf
1952
36
36
36
% Attributable
1.8
1.8
0.2
Lung Cancere
Cases
All Cancersg
15836
a.
b.
c.
d.
PM2.5 exposure estimated from the Clean Air Strategic Alliance Data Warehouse.
Number of observed lung cancer cases in Alberta in 2012.
Number of lung cancers cases that can be attributed to PM2.5 exposure.
Proportion of lung cancers attributable to PM2.5 exposure. Calculated as excess attributable
observed cancer cases for all cancer sites (only lung cancer in this case).
f. Represents all cancers with a known association with radon exposure (only lung cancer in this
case).
321
Table 14.2
Population-weighted mean PM2.5 concentrations in each Alberta Health Services Zone and
Alberta in 2011
Geographic Location
Population*
PM2.5 concentration (g/m3)
South
178,806
7.20
Calgary
1,214,839
10.82
Central
103,206
12.86
Edmonton
1,178,920
9.70
North
156, 046
8.53
Alberta
2,831,752
10.03
*Sum of community populations in each zone with complete air quality data and 2011 Census data
322
Table 14.3
Estimates of relative risk of lung cancer incidence related to PM2.5 exposure for Alberta
health Services Zones and Alberta
Geographic Location
RR
South
1.00
Calgary
1.03
Central
1.04
Edmonton
1.02
North
1.01
Alberta
1.02
323
Table 14.4
Prevalence of population with an average annual concentration of PM2.5 above 7.5g/m3

in each Alberta Health Services Zone and Alberta in 2011
Geographic Location
Prevalence (%)
South
40.7
Calgary
100.0
Central
88.9
Edmonton
98.4
North
42.7
Alberta
94.2
324
Table 14.5
Observed lung cancer cases in Alberta (2012) and proportions attributable to PM2.5
exposurea
Geographic Location
Observed Casesb
Population Attributable Riskc (%)

(95% CI)
Excess Attributable Casesd

(95% CI)
South
187
-0.10 (-0.40,-0.03)
0 (-1,0)
Calgary
559
2.59 (0.23,4.34)
14 (1,24)
Central
278
3.70 (0.41,7.00)
10 (1,20)
Edmonton
680
1.69 (0.20,2.91)
11 (1,20)
North
248
0.35 (0.03,0.49)
1 (0,1)
Alberta
1952
1.87 (0.22,3.36)
36 (4,66)

a. PM2.5 concentrations from the Clean Air Strategic Alliance (CASA) Data Warehouse.
b. Number of observed lung cancer cases in Alberta in 2012. Cancer incidence data obtained from the
Alberta Cancer Registry.
c. Proportion of lung cancer attributable to PM2.5 exposure.
d. Number of lung cancer cases that can be attributed to PM2.5 exposure.
325
CHAPTER 15
Lung Cancer Incidence Attributable to Radon Exposure

in Alberta, Canada in 2012
326
SUMMARY
The average radon concentration in Alberta in 2009 - 2011, as measured in Health Canadas
Cross-Canada Survey of Radon Concentrations in Homes, was 71.04 Bq/m3. There was some variation in
radon levels across Alberta with the lowest radon values observed in the Calgary Zone (geometric mean
= 64.89 Bq/m3) and the highest values in the Central Zone (geometric mean = 78.52 Bq/m3). Population
attributable risks (PARs) of lung cancer due to radon were estimated for men, women and both genders
combined unadjusted for smoking history, as well as adjusted for smoking history (ever or never
smoker). Without accounting for smoking status, 16.7% of lung cancers in men and women combined
were attributable to radon exposure, which is equivalent to an excess 323 lung cancer cases in Alberta in
2012. When smoking status was considered, the PAR was consistently higher for never (PAR = 24.2%)
compared with ever (PAR = 15.7%) smokers. However, given that 90% of lung cancers are expected to
occur among ever smokers, the total number of excess attributable lung cancer cases (EAC) due to
radon exposure was higher for ever smokers (EAC = 276) than never smokers (EAC = 47). Similar
patterns were observed for men and women. While there were slight variations in radon levels across
Alberta Health Services Zones, these did not have a major impact on measured PARs, which were similar
across the province. Overall, with a PAR for lung cancer of 16.7%, the 323 lung cancer cases attributable
to radon exposure represent 2.0% of all cancers diagnosed in Alberta in 2012 (Table 15.1).
METHODS
The population attributable risk (PAR) of lung cancer in Alberta due to radon was estimated
using the method of Brand et al. (2005), which has previously been used for similar analysis in Ontario.
This method is based on the exposure-age-concentration model described by the 1999 report from the
Committee on Health Risks of Exposure to Radon (BEIR VI) at the National Research Council in the
United States. Briefly, the procedure uses estimates of Excess Lifetime Relative Risk (ELRR) and life-years
lost (LYL) to estimate the PAR% of lung cancer mortality attributable to radon exposure. It was assumed
that the fraction of lung cancers that were caused by radon was equivalent to the number of lung cancer
deaths, thus these PAR% estimates were applied to 2012 lung cancer incidence data from the Alberta
Cancer Registry.
Data Sources
The excess risk ratio was estimated using data on radon exposure in Alberta and an estimate of
the proportion of Albertans living in apartments in 2011. Radon exposure levels in Alberta were
estimated using data from the Cross-Canada Survey of Radon Concentrations in Homes (CCSRH). This
327
survey was conducted by Health Canada over the course of the 2009/2010 and 2010/2011 fall/winter
periods. Eligible participants were the heads of households over 18 years of age who were homeowners,
did not live on first nations reserves or on military bases, whose homes were not high rise condos or
built on stilts and who did not plan to move or be away during the proposed time of the study (October
to March). Participating households were asked to place an alpha track detector (measures alpha
particles from radon gas) on the lowest lived-in level in their home for at least three months. A total of
1,131 tests were completed in Alberta and the overall study response rate was approximately 21%. Of
the 1,131 tests from Alberta, 55 (4.9%) were missing values and were excluded, leaving a total of 1,076
tests from which mean radon exposure levels for Alberta were estimated (Table 15.2). As described by
Brand et al. (2005), individuals living in apartments above the second floor typically have negligible
exposure to radon and thus the proportion of the Alberta population residing in apartment buildings
was estimated from Statistics Canada 2011 census data (http://www12.statcan.gc.ca/censusrecensement/2011/as-sa/fogs-spg/Facts-pr-eng.cfm?Lang=eng&GC=48) at 20%. Thus, a value of zero
radon exposure was assigned to 20% of the Alberta population, where data from the CCSRH was used to
estimate radon exposure in the remaining 80% of the population.
Data on the prevalence of ever smokers in Alberta were obtained from the Canadian
Community Health Survey (CCHS). Prevalence values were estimated in 5-year age groups using data
from 2000/2001, 2003, 2005 and 2007/2008. The mean prevalence value across these survey years was
used in each age-sex group in the analysis to enhance the stability of the estimates, similar to the
method used by Peterson et al. (2013). Ever smokers were individuals who reported being either current
or former daily or occasional smokers, while never smokers were individuals who reported that they had
never smoked. All-cause mortality data for the years 2008 2012 were obtained from Statistics Canada
and lung cancer mortality data for the same time period were obtained from the Alberta Cancer
Registry.
Statistical Analysis
The method described by Brand et al. (2005) was used to apply the age-exposure-concentration
model from the BIER-VI methods to estimate PARs of lung cancer mortality due to radon exposure.
Similar to the approach previously used by Parkin and Darby (2011), the PAR associated with lung cancer
mortality was considered to approximate the PAR that would be associated with lung cancer incidence,
which assumes that the risk of lung cancer death is the same for cases that were and were not caused
by radon.
328
Specifically, excess relative risks (ERR) of lung cancer mortality were estimated using the
equations described by Brand et al. (2005). The geometric mean of radon exposure levels for Alberta
from the CCSRH measured in Bq/m3 was converted to a measure of working level months per year
(WLM/y) for analysis using an equilibrium fraction of 0.0039 WLM/y per Bq/m3 as described in the Brand
et al. analysis (2005). A Monte Carlo simulation, as described by Brand et al. (2005), was used to
estimate uncertainty in the ERR estimates with 150 x 900 x 900 iterations to estimate hyperparameter
uncertainty, exposure uncertainty and inter-individual variability of ERR estimates, as done by Peterson
et al. (2013) in their Ontario analysis.
Abridged life table calculations, as described by Brand et al. (2005), were then performed to
estimate the lifetime risk of lung cancer mortality, performed for ever smokers, never smokers and
combined (ever and never smokers) groups. These calculations were performed using age and genderspecific all-cause and lung cancer mortality rates, along with age and gender specific data on the
prevalence of ever smokers in Alberta. Life-table calculations were then combined with previously
estimated values of ERR to produce estimates of the lifetime risk (LRE) of lung cancer mortality among
exposed individuals.
Estimates of lifetime risk (LR) of lung cancer among exposed and unexposed were used to
estimate the excess lifetime risk ratio (ELRR), as ELRR = LRE/(LR -1). These values were then used to
estimate the population attributable risk of lung cancer due to radon as PAR = (LRE LR)/(LRE) = 1/(ELRR
+ 1). To estimate the number of lung cancers in Alberta in 2012 that could be attributed to radon
exposure, these PAR estimates were applied to lung cancer incidence data from the Alberta Cancer
Registry. For the purposes of this analysis it was assumed that 10% of lung cancers in Alberta occurred
in never smokers and this proportion was applied to lung cancer incidence values for Alberta to estimate
the number of lung cancers in ever and never smokers attributable to radon (Sun et al., 2007). PARs
were estimated for ever and never smokers, as well as estimates unconditional on smoking status, for
Alberta and each Alberta Health Services Zone (Table 15.3-15.4). Estimates are presented stratified by
gender, as well as for men and women combined.
329
Table 15.1 Summary of cases and proportions of lung cancer in Alberta in 2012 attributable to radon
exposurea
a.
b.
c.
d.
e.
f.
g.
Lung Cancere
All Associated
Cancersf
All Cancersg
Men
Casesb
% Attributabled
953
164
17.2
953
164
17.2
8155
164
2.0
Women
Cases
% Attributable
999
155
15.5
999
155
15.5
7681
155
2.0
Total
1952
1952
15836
Cases
323
323
323
16.5
16.5
2.0
% Attributable
Radon exposure estimated from the Cross-Canada Survey of Radon in Homes.
Number of observed lung cancer cases in Alberta in 2012.
Number of lung cancers cases that can be attributed to radon exposure.
Proportion of lung cancers attributable to radon exposure. Calculated as excess attributable
Cancer incidence data obtained from the Alberta Cancer Registry. Data from 2012 was used for
observed cancer cases for all cancer sites (only lung cancer in this case).
Represents all cancers with a known association with radon exposure (only lung cancer in this
case).
330
Table 15.2 Mean Radon Concentrations in Alberta and by Alberta Health Services Zone as measured
from the 2009 2011 Cross-Canada Survey on Radon in Homes
Region
Alberta
South Zone
Calgary Zone
Central Zone
Edmonton Zone
North Zone
Geometric Mean
(Bq/m3)
71.04
72.4
64.89
78.52
70.22
69.03
Geometric Standard
Error
1.65
3.86
5.72
4.18
5.1
2.35
Geometric Mean
(WLM/y)
0.28
0.28
0.25
0.31
0.27
0.27
331
Table 15.3 Population Attributable Risks and Total Number of Cancers Attributable to Radon in Alberta
in 2012
Excess
Gender
# Observed Cases
Attributable
Casesc
All
Combined
16.7
1952
323
Ever
15.7
1757
276
Never
24.2
195
47
Men
Combined
17.2
953
164
Ever
15.7
856
134
Never
26.6
95
25
Women
Combined
15.5
999
155
Ever
15.5
900
140
Never
24.2
100
24
a. Data on the proportion of ever and never smokers in Alberta obtained from combined data from
the 2000/2001, 2003, 2005 and 2007/2008 cycles of the Canadian Community Health Survey.
b. Number of observed lung cancer cases in Alberta in 2012. Cancer incidence data obtained from
the Alberta Cancer Registry. Values for Combined smoking status represent observed number
of incident cases. The observed number in ever and never smokers is estimated by assuming
that 90% of lung cancer cases occur in ever smokers. Values of this variable for ever and never
smokers thus represent estimates applying these proportions and are not true incidence counts.
c. Number of lung cancers that are attributable to radon exposure. Calculated as # observed cases
x Population Attributable Risk %.
Smoking
Statusa
Population
Attributable Risk (%)
332
Table 15.4: Population Attributable Risks and Total Number of Cancers Attributable to Radon in Alberta
Health Services Zones in 2012
Population
Excess
# Observed
Attributable Risk
Attributable
b
Cases
(%)
Casesc
South Zone
All
Combined
16.3
187
30
Ever
15.2
168
26
Never
24.8
19
5
Men
Combined
17.0
99
17
Ever
16.1
89
14
Never
26.5
10
3
Women
Combined
16.4
88
14
Ever
15.4
79
12
Never
25.2
9
2
Calgary Zone
All
Combined
16.2
559
91
Ever
15.2
503
76
Never
23.8
56
13
Men
Combined
16.4
274
45
Ever
15.4
247
38
Never
25.4
27
7
Women
Combined
15.0
285
43
Ever
14.8
257
38
Never
22.6
29
7
Central Zone
All
Combined
16.7
278
46
Ever
15.9
250
40
Never
25.0
28
7
Men
Combined
17.1
126
22
Ever
16.9
113
19
Never
27.4
13
4
Women
Combined
16.3
152
25
Ever
16.0
137
22
Never
25.4
15
4
Edmonton Zone
All
Combined
16.5
680
112
Ever
15.1
612
92
Never
24.3
68
17
Men
Combined
17.0
328
56
Ever
15.6
295
46
Never
25.5
33
8
Women
Combined
15.9
352
56
Ever
15.2
317
48
Never
24.6
2
0.5
North Zone
All
Combined
16.2
248
40
Ever
15.7
223
35
Never
24.4
25
6
Men
Combined
16.4
126
21
Ever
15.7
113
18
Never
25.4
13
3
Women
Combined
15.8
122
19
Ever
15.2
110
17
Never
23.7
12
3
a. Data on the proportion of ever and never smokers in Alberta obtained from combined data from the 2000/2001,
2003, 2005 and 2007/2008 cycles of the Canadian Community Health Survey.
b. Number of observed lung cancer cases in Alberta in 2012. Cancer incidence data obtained from the Alberta Cancer
Registry. Values for Combined smoking status represent observed number of incident cases. Values for
Combined smoking status represent observed number of incident cases. The observed number in ever and never
smokers is estimated by assuming that 90% of lung cancer cases occur in ever smokers. Values of this variable for
ever and never smokers thus represent estimates applying these proportions and are not true incidence counts.
c. Number of lung cancers that are attributable to radon exposure. Calculated as # observed cases x Population
Attributable Risk %.
Alberta Health
Services Zone
Gender
Smoking
Statusa
333
CHAPTER 16 Bladder Cancer Incidence Attributable to Disinfection ByProducts in Drinking Water in Alberta, Canada in 2012
334
SUMMARY
Disinfection by-products refer to compounds produced by the reaction between chlorine added
as a disinfectant to the water supply with organic material present in the water. This reaction process
leads to a number of by-products, the most common of which are trihalomethanes. Trihalomethanes
are composed primarily of four compounds (chloroform, bromodichloromethane,
dichlorobromomethane and bromoform), which have been classified as possible carcinogens (King et al.,
1996). In the current analysis, levels of trihalomethanes in drinking water above 50 g/L were
considered elevated (positive test). Approximately 6% of the water tests conducted in Alberta were
positive (Table 16.1). The proportion of positive tests across the Alberta Health Services (AHS) regions
ranged from 0.1% to 36%. In Alberta in 2012, there were 354 incident cases of bladder cancer and 2.5%
(9 cases) of those cases could be attributed to disinfection by-product exposure (Table 16.1).
METHODS OVERVIEW
The population attributable risk (PAR) related to exposure to disinfection by-products was
estimated for bladder cancer. Follow-up times from cohort studies in the existing peer-reviewed
literature were examined to determine the most appropriate latency period between disinfection byproduct exposure and bladder cancer. Following this review, it was determined that cumulative
exposure to disinfection by-products was the most relevant exposure and as such, exposure data from
the longest period of time available was used to characterize exposure levels. Further, because
cumulative exposure was considered the most relevant, no latency period between exposure and
bladder cancer development was applied.
Data on disinfection by-product exposure were obtained from Alberta Environment and
Sustainable Resource Development. Measures of the concentration of trihalomethanes in units of g/L
from routine water quality measurements at public water treatment stations across Alberta were
obtained for the years 2000 2012. Measurements where the trihalomethane concentration was
greater than 50 g/L were considered to have levels associated with elevated risk. The number of
trihalomethane measurements was not evenly distributed throughout the province. As such, the
proportion of positive tests, calculated as the number of positive tests divided by the total number of
observations was estimated for each AHS Zone. This proportion was then weighted by the proportion of
the Alberta population living in each AHS Zone to generate an overall estimate of the prevalence of
exposure to elevated levels of trihalomethanes in drinking water in Alberta. Individual measures for
each AHS zone were also estimated. Levels of trihalomethanes in private well water were assumed to be
335
<50 g/L. The proportion of positive tests for each zone, as well as the overall weighted average
proportion for Alberta are shown in Table 16.2.
The relative risk linking disinfection by-product exposure with bladder cancer risk was obtained
from the peer reviewed literature. In a 2003 meta-analysis, Villanueva et al. estimated that ever being
exposed to chlorinated drinking water was associated with an increased RR of bladder cancer of 1.2
(95% Confidence Interval = 1.1 1.4). The value for ever exposure was used as only 12 years of exposure
data were available and these observations were unevenly distributed through time throughout the
province. Thus, the ever exposure characterization was considered to be the most appropriate.
Population attributable risks (PARs) due to exposure to disinfection by-products, specifically
trihalomethanes, were estimated using equation 16.1.
16.1: () =
( 1)
1 + [ ( 1)]
where Pe represents the prevalence of exposure to elevated trihalomethanes and RR is the relative risk
of bladder cancer with ever exposure to chlorinated drinking water. PARs for Alberta overall and for
each AHS zone were estimated (Table 16.3). The number of excess attributable bladder cancer cases
was estimated by multiplying the total number of incident bladder cancer cases in 2012 by the
estimated PAR. Data on bladder cancer incidence in Alberta and by AHS Zone in 2012 were obtained
from the Alberta Cancer Registry.
336
Table 16.1 Summary of cases and proportions of bladder cancer in Alberta in 2012 attributable to
disinfection by-product (trihalomethane) exposurea
354
All Associated
Cancersf
354
36
2.5
2.5
0.06
Bladder Cancere
Cases
% Attributable
All Cancersg
15836
a. Trihalomethanes exposure estimated from Alberta Environment and Sustainable Resource

Development data.
b. Number of observed bladder cancer cases in Alberta in 2012.
c. Number of bladder cancers cases that can be attributed to trihalomethane exposure.
d. Proportion of bladder cancers attributable to trihalomethane exposure. Calculated as excess
attributable cases/observed cases.
observed cancer cases for all cancer sites (only bladder cancer in this case).
f. Represents all cancers with a known association with trihalomethane exposure (only bladder
cancer in this case).
337
Table 16.2:
The proportion of water tests with trihalomethane concentrations 50 g/L in Alberta

and by AHS Zone
Region
Number Positive
Tests
Total Number of
Observations
Total Population
Percentage
Positive Tests
Alberta
883
14,890
3,645,250
5.93%a
South Zone
118
454
273,990
25.99%
Calgary Zone
102
1,004
1,360,705
10.16%
Central Zone
214
894
433,560
23.94%
Edmonton Zone
14
11,340
1,159,925
0.12%
North Zone
435
1,198
417,070
36.31%
a. Proportion of all positive tests weighted by population in each AHS Zone.
338
Table 16.3
Proportion and number of bladder cancer cases in 2012 attributable to exposure to

disinfection by-products (trihalomethanes) in Alberta
Region
Observed Cases
PAR (%)
EAC
South Zone
33
4.9 (1.5,8.6)
2 (0,3)
Calgary Zone
119
2.0 (0.6,3.6)
2 (1,4)
Central Zone
46
4.6 (1.4,7.8)
2 (1,4)
Edmonton Zone
122
0.0 (0.0,0.1)
0 (0,0)
North Zone
34
6.8 (2.2,11.3)
2 (1,4)
Alberta
354
2.5 (0.8,4.3)
9 (3,15)
EAC, excess attributable cases; PAR, population attributable risk
339
CHAPTER 17
Justification for Risk Factor Removal or Omission from

ACPLF PAR-Alberta Project
340
There are additional modifiable lifestyle and factors that are related to altered cancer risk that
were considered for these analyses. We omitted medical radiation, arsenic exposure and dietary
supplement intake due a lack of exposure data as well as a suspected low impact on primary cancer risk
in Alberta. The detailed reasons for the omissions are outlined below.
Medical Radiation
When discussing potential cancer risk due to medical radiation exposure, there are three
components of that warrant consideration: diagnostic x-rays, nuclear medicine and radiotherapy from
cancer treatment.
To estimate the true total proportion of cancers in Alberta attributable to medical radiation,
accurate estimates of the proportions attributable to diagnostic x-rays and nuclear medicine treatment
are also required. No comprehensive database exists for use of diagnostic x-rays and nuclear medicine
treatment currently exists in Alberta. While some data on the number of x-rays and nuclear medicine
procedures is available from Data Integration, Management and Reporting (DIMR) at Alberta Health
Services, these counts cover only about half of procedures completed in Alberta. Further, since the
available data is primarily collected for billing purposes, the details provided in the description of the
procedures are inconsistent, making the anatomic location of some procedures difficult to determine.
Specific details of the type of nuclear medicine or diagnostic x-ray procedure performed and the
anatomic location targeted by these procedures is necessary since radiation is thought to have a fieldspecific effect where the location of the body targeted by the x-ray or nuclear medicine is at risk (e.g.
elevated lung cancer risk from chest x-rays). Because of the incomplete coverage and radiation site
ambiguity the quality of diagnostic x-ray and nuclear medicine exposure data in Alberta is not sufficient
to allow accurate estimates of population attributable risks.
341
Therefore, the population attributable risk of cancer associated with medical radiation exposure
was not estimated since in the absence of estimates from diagnostic x-rays and nuclear medicine overall
estimates would be incomplete and difficult to interpret.
Radiotherapy in cancer treatment is particularly relevant to the risk of second primary cancers,
where a de novo cancer diagnosis in an individual is thought to have been caused by radiotherapy used
to treat the first cancer diagnosis. In Alberta, data on radiotherapy use in cancer treatment is collected
in the Alberta Cancer Registry, such that the estimates of the proportion of second cancers attributable
to radiotherapy are theoretically possible.
Dietary Supplements
While some randomized controlled trials (RCTs) have demonstrated that high-doses of dietary
supplements may be related to risks of some cancers (ex. beta-carotene increases lung cancer risk,
calcium protects against colorectal cancer), the cancer prevention guidelines produced by the World
Cancer Research Fund in 2007 do not recommend the use of dietary supplements for cancer prevention.
[1] Specifically, the report cites that evidence shows that high-dose nutrient supplements can be
protective or can cause cancer. The studies that demonstrate such effects do not relate to widespread
use among the general population, in whom the balance of risks and benefits cannot confidently be
predicted. [1] Thus, while some data on supplement use was available in Alberta from participants in
Albertas Tomorrow Project (ATP), in the absence of clear cancer prevention guidelines associated with
supplement use in the general population, public health messages associated with any PAR estimates
produced using this data would be difficult to interpret. As such, estimates of PAR for dietary
supplements were not calculated for Alberta.
Arsenic (Drinking water well water)
Several studies have been conducted to examine the association between exposure to arsenic in
well water and cancers of the lungs, bladder and skin. The International Agency for Research on Cancer
342
(IARC) has classified ingested arsenic as a Group 1 carcinogen and cause of lung, bladder and skin
cancer. When observing lifetime exposure to arsenic in drinking water in Northern Chile, Steinmaus et
al. (2013) found a positive association for lung and bladder cancers at arsenic concentrations above 91
g/L.[2] In 2010, a Taiwanese study concluded that there was no apparent increased risk for lung cancer
at arsenic concentrations between 10 and 100 g/L. However, at concentrations between 100 and 300
g/L, evidence of an excess risk for lung cancer was observed.[3] Finally, a case-control study of
participants residing in Nevada and California examined the association between exposure to arsenic in
drinking water 40 years before enrollment in the study and lung cancer. Compared to those exposed to
arsenic levels below 10 g/L, no significant association between exposure to arsenic concentrations 85
g/L and lung cancer was observed.[4]
A comprehensive review of the data available on arsenic concentrations in drinking water in
Alberta was conducted for the PAR-Alberta project. Average levels of arsenic were around 1 g/L for all
communities sampled. Based on the studies described above and additional literature on this topic,
available prevalence data in Alberta suggest that there are no tested sites with levels near the threshold
for increased risk. We have therefore concluded that there is no cancer burden attributable to arsenic
in Alberta. Therefore, we will not be including arsenic as an exposure in our population attributable risk
analyses for Alberta.
343
REFERENCES
1.
World Cancer Research Fund/American Intitute for Cancer Research. Food, Nutrition,
Physical Activity, and the Prevention of Cancer: a Global Perspective. Washington, DC:
AICR; 2007.
2.
Steinmaus CM, Ferreccio C, Romo JA, Yuan Y, Cortes S, Marshall G, Moore LE, Balmes JR,
Liaw J, Golden T et al: Drinking water arsenic in northern Chile: high cancer risks 40
years after exposure cessation. Cancer epidemiology, biomarkers & prevention : a
publication of the American Association for Cancer Research, cosponsored by the
American Society of Preventive Oncology 2013, 22(4):10.1158/1055-9965.EPI-11121190.
3.
Chen CL, Chiou HY, Hsu LI, Hsueh YM, Wu MM, Chen CJ: Ingested arsenic, characteristics
of well water consumption and risk of different histological types of lung cancer in
northeastern Taiwan. Environmental research 2010, 110(5):455-462.
4.
Dauphin DC, Smith AH, Yuan Y, Balmes JR, Bates MN, Steinmaus C: Case-Control Study
of Arsenic in Drinking Water and Lung Cancer in California and Nevada. International
Journal of Environmental Research and Public Health 2013, 10(8):3310-3324.
344
CHAPTER 18
Summary
345
BACKGROUND FOR SUMMARY OF POPULATION ATTRIBUTABLE RISKS

Population attributable risk (PAR) data can inform cancer prevention activities by identifying
exposures that have the largest impact on disease incidence. When multiple population attributable risk
estimates are considered together, the proportion of all cancers that can be attributed to groups of
known risk factors can be evaluated. Parkin and colleagues have previously estimated that 42.7% of
cancers diagnosed in the United Kingdom were attributable to modifiable cancer risk factors. However,
to our knowledge no similar estimates exist for Canada or more specifically Alberta. Estimates of the
total cancer burden attributable to modifiable lifestyle and environmental risk factors are needed to
inform cancer prevention activities.
To estimate the proportion of cancers in Alberta in 2012 that were attributable to past exposure
to the 24 modifiable lifestyle and environmental risk factors described in the preceding chapters in this
report, the analysis described below was used. As some factors were considered protective for cancer
and others were cancer risk factors, Table 18.1 summarizes what we considered to be the theoretical
minimum risk level of exposure for each lifestyle and environmental risk factor. In this chapter, our
objective was to combine the information from the individual population attributable risk estimates for
each of the 24 risk factors to estimate the total proportion of cancer in Alberta that could be attributed
to modifiable lifestyle and environmental risk factors.
METHODS
In Table 18.2, the proportion of incident cancer cases at individual sites attributable to each
exposure is presented. However, some cancers are caused by multiple risk factors and thus, summing
the percentages for each cancer site in Table 18.2 would overestimate the total burden of cancer
attributable to the 24 exposures. Therefore, to estimate the proportion of all incident cancers in Alberta
in 2012 attributable to any of the exposures, the method proposed and implemented by Parkin et al.
was employed.[1] Briefly, this method accounts for overlap between various exposures so that the
attributable fraction for a specific cancer for all risk factors combined is less than the sum of the
individual population attributable risks for each exposure and associated cancer site. The proportion of
incident cases due to all exposures for each cancer (final row of Table 18.2) was estimated by
subtracting the population attributable risk for the first exposure (e.g. active tobacco smoking) from
100% and then sequentially applying the population attributable risk for subsequent exposures to the
remaining percentage of unexplained cancers. The same sequential process was used to estimate the
346
proportion of cancer attributable to relevant exposures for each individual cancer site, as shown in Table
18.2. Separate analyses for men and women are shown in Tables 18.3 and 18.4. The total number of
excess cancers attributable to all risk factors by cancer site and overall are shown in Table 18.5.
Table 18.1
Theoretical minimum risk levels of exposures
Exposure
Theoretical minimum risk exposure level
Active Smoking
None
Passive Smoking
None
Energy Imbalance
Overweight and Obesity
BMI < 25 kg/m2
Inadequate physical activity
> 2.9 kcal/kg/day
Diet
Inadequate fruit and vegetable consumption
5 servings/day
Inadequate fibre intake
23g/day
Red meat
None
Processed meat
None
Salt
5.75 g/day
Inadequate calcium intake
1100 mg/day
Inadequate vitamin D intake
600 IU/day
Alcohol
None
Hormones
Oral contraceptive
None*
Hormone replacement therapy
None*
Infections
Epstein-Barr virus
None
Hepatitis B virus
None
Hepatitis C virus
None
None
Helicobacter pylori
None
Environment
Air pollution
< 7.5 g/m3 annual average exposure
Natural ultra-violet radiation
No sunburn in lifetime
Artificial ultra-violet radiation
No use of tanning equipment in past year
Water disinfection by-products
< 50 g/L
(trihalomethanes)
Radon
None
*Ever use of oral contraceptives and ever/current use of hormone replacement therapy are protective
for endometrial and ovarian cancer
347
Table 18.2
Percentage of incident cancer cases in Alberta in 2012 attributable to lifestyle and environmental factors
Exposure
Lung Breast Larynx
Active smoking
75.6
Physical inactivity 20.7

Excess body fat
Occupation
Low Vitamin D
Radon
Fruits and Veg
74.3
17.4
16.1
12.2
1.9
9.2
16.7
3.3
Alcohol
30.9
11.4
5.5
4.1
6.7
40
24.7
11.3
16.6
17.3
30.3
12.5
2.9
7.2
20.3
4.3
4
1.4
2.1
1.8
18.6
1.7
15.5
12
-11.2
-5.4
8.9
7.8
-57.4
-29.1
1.7
1.3
0.9
1
0.9
0.8
2.0
7.1
6.4
9.5
25.4
Low fibre
Processed meat
Sunburn
H. pylori
Hepatitis B Virus
Epstein Barr Virus
Air pollution
Excess salt
Hepatitis C Virus
20.4
18.2
3
Ever HRT use

Current HRT use
Calcium
Medical radiation
OCP use
Red meat
HPV
Oral
ColoEsophEndoGallLeuk- Mela- Hodgkins
Liver
Cavity & Pancreas Kidney
Bladder Stomach Ovary Prostate Cervix
All
rectum
agus
metrium bladder
emia noma* lymphoma
Pharynx
11.4 26.4 45.4
42.6
19.3
19.7
41.6
20.9
3.6
25.9 12.3
15.7
100
0.7
2.9
82.1
22.6
26.7
31.1
1.9
11.7
15.7
DBP
Passive smoking
Artificial tan
2.5
2.4
All of the Above
85.1
0.1
0
0
1.9
49.7
81.4
57.0
56.4
79.9
73.1
24.7
33.6
80.1
20.3
43.1
56.0
49.8
2.9
100
12.3
0.6
3.1
0.4
0.4
0.3
0.2
0.2
0.2
82.4
*Malignant melanoma
Abbreviations: DBP, disinfection by-products; EBV, Epstein-Barr virus; H. pylori, Helicobacter pylori; HPV, human papillomavirus; HRT, hormone replacement
therapy; OCP, oral contraceptive
Note: Cancers of the anus, penis, vagina, vulva and nasopharync were also included in the summary analysis but are not displayed in Table 2.
348
31.1
42.3
Table 18.3: Percentage of incident cancer cases in Alberta in 2012 attributable to lifestyle and environmental factors among men
Exposure
Lung Breast Larynx
Active smoking
77.5
76.5
Oral
Liver
All
rectum
agus
metrium bladder
emia noma* lymphoma
Pharynx
12.7
15.8
Excess body fat

Occupation
Low Vitamin D
Radon
Fruits and Veg
Alcohol
Ever HRT use
17.2
48.1
45.0
20.9
21.1
44.7
23.0
13.8
17.7
2.9
31.4
5.5
16.5
5.4
6.5
3.6
4
1.4
2.0
2.9
2.1
0
10.4
17.2
4.1
19.2
12.8
Current HRT use

Calcium
Medical radiation
OCP use
7.5
5.1
41.9
12.6
30.4
19.9
22.5
0
0.8
0.9
0
5.8
Red meat
HPV
Low fibre
Processed meat
Sunburn
H. pylori
Hepatitis B Virus
Epstein Barr Virus
Air pollution
Excess salt
Hepatitis C Virus
DBP
28.6
15.4
1.2
0.1
0.9
0.8
25.4
6.6
3.8
78.7
12.9
46.5
31.1
1.9
16.4
8.4
2.5
Passive smoking
Artificial tan
2.3
All of the Above
86.3
0
0
1.1
0
83.4
63.9
66.8
81.9
77.1
25.3
34.1
6.5
46.1
56.5
2.9
13.8
3.2
0.3
0.8
0.3
0.2
0.3
0.2
0.1
78.9
*Malignant melanoma
349
31.1
40.2
Table 18.4:
Percentage of incident cancer cases in Alberta in 2012 attributable to lifestyle and environmental factors among women
Exposure
Lung Breast Larynx
Active smoking
73.4

Excess body fat
Occupation
Low Vitamin D
Radon
Fruits and Veg
Alcohol
Ever HRT use
70.8
17.4
8.0
16.4
5.7
1.9
15.5
2.5
3.0
15.5
Current HRT use

Calcium
26.8
7.7
18.8
20.4
30.3
12.5
9.1
5.0
30.9
4.0
1.4
2.0
0.7
1.4
3.5
7.8
12.8
4.4
2.9
2.0
30.9
5.3
8.9
7.6
12.1
12.0
-11.2
8.9
-5.4
7.8
2.7
1.1
8.9
Medical radiation
OCP use
6.4
-57.4
Red meat
HPV
Low fibre
Processed meat
Sunburn
H. pylori
Hepatitis B Virus
Epstein Barr Virus
Air pollution
Excess salt
Hepatitis C Virus
DBP
Oral
Liver
All
rectum
agus
metrium bladder
emia noma* lymphoma
Pharynx
10.1 24.1 42.8
38.7
17.7
18.0
37..8
18.9
3.6
25.9 10.8
13.7
1.2
1.8
-29.1
1.8
25.4
0.5
2.4
0.5
0.4
100
5.2
1.6
86.0
9.0
42.3
31.1
1.9
3.4
24.2
2.5
Passive smoking
Artificial tan
2.4
All of the Above
83.4
0
0.1
2.7
49.7
75.7
47.1
67.5
72.6
61.5
24.0
33.4
80.1
30.9
39.4
37.3
49.8
100
10.8
3.0
0.1
0.4
0.3
0.2
0
0.2
0.1
86.4
*Malignant melanoma
350
31.1
43.9
Table 18.5 Number of cancer cases attributable to modifiable lifestyle and environmental factors by cancer site
Total Number of Cancer Casesa
Total
Men
Lung
1661
822
Breast
1160
Larynx
62
53
Colorectum
1118
710
Liver
123
99
Esophagus
146
124
273
210
Pancreas
94
44
Kidney
163
112
Endometrium
404
Gall Bladder
11
2
Bladder
153
129
Stomach
143
90
Ovarian
98
Prostate
68
68
Cervix
136
Myeloid Leukemia
23
14
Melanomab
494
260
Hodgkins Lymphoma
23
Penis
6
6
Anus
38
Vagina
11
Vulva
33
Nasopharynx
21
a. Cancer incidence data for the year 2012 from the Alberta Cancer Registry
b. Malignant melanoma only
Cancer Site
Women
833
1160
9
400
47
23
62
50
53
404
10
29
36
98
136
9
233
11
33
-
OVERALL DISCUSSION
Summary of Study Findings
Overall, 42.3% of cancers diagnosed in Alberta in 2012 (40.2% in men, 43.9% in women) were
attributable to modifiable lifestyle and environmental risk factors. This percentage translated to a total 6,699
excess cases of cancer. When men and women were examined separately, we estimated a total of 3,278 excess
cases in men and 3,372 excess cases in women. Active tobacco smoking was responsible for the greatest cancer
burden, accounting for 15.7% of all incident cancers (2,485 cases). The next most important risk factors for
cancer in Alberta after smoking were physical inactivity and excess body weight, as they accounted for 7.2% and
4.3% of incident cancers, respectively. All other exposures were each responsible for less than 4% of all incident
cancer cases.
351
The 24 modifiable lifestyle and environmental risk factors were responsible for the largest proportions
of cervix (100%), lung (85.1%), larynx (81.4%), endometrial (80.1%) and esophageal (79.9%) cancers. As HPV is
considered a necessary cause of cervical cancer, such that an oncogenic strain of the virus must be present for
the cancer to develop, all cases of cervical cancer can, to an extent, be considered attributable to HPV. For lung
and larynx cancers, the largest contributing risk factor was active smoking, where physical inactivity and radon
were other major contributors for lung cancer and excess alcohol and insufficient fruit and vegetable
consumption were secondary risk factors for larynx cancer. Causes of esophageal cancer were more balanced,
where active smoking accounted for the largest proportion of this type of cancer but excess body weight,
insufficient fruit and vegetable consumption and excess alcohol consumption were also contributors. The
situation with endometrial cancer is somewhat unique, in that the two major negative risk factors are physical
inactivity (20.4%) and excess body weight (30.3%). However, ever (-11.2%) or current (-5.4%) use of hormone
replacement therapy and ever use of oral contraceptives (-57.4%) are protective for endometrial cancer risk,
and the proportions cited here represent the proportions of endometrial cancer theoretically prevented by
these exposures. Therefore, the 80.1% of endometrial cancers explained by the 24 modifiable risk factors
include estimates of cases both caused and prevented by these exposures. For all other cancer sites, the
proportion of cancers attributable to the 24 risk factors was under 75%.
In addition to lung cancer, the other most commonly diagnosed cancer types in Alberta in 2012 were
breast, prostate and colorectal cancers. The set of 24 modifiable lifestyle and environmental risk factors
included in this report accounted for 49.7% of incident breast cancer cases, 57.0% of colorectal cancer cases and
2.9% of prostate cancer cases. For breast cancer, physical inactivity, hormone use and excess body weight are
the risk factors for which population attributable risk estimates are highest. Physical inactivity and excess body
weight, along with a number of dietary characteristics, are the risk factors that were identified as responsible for
the greatest proportions of colorectal cancers. In contrast, among the modifiable lifestyle and environmental
risk factors included in our study, only physical inactivity met the threshold for inclusion in this project with
respect to prostate cancer and as such, the proportion of cases that can be attributed to the 24 risk factors is
quite low. Particularly for breast and colorectal cancers, despite the fact that compared to some cancer sites like
larynx and esophagus the proportion of cancers attributable to modifiable risk factors is lower, changes in the
population prevalence of risk factors to which many cases of these cancers can be attributed has the potential to
substantially reduce Albertas cancer burden.
When the proportion of cancers attributable to modifiable lifestyle and environmental risk factors in
men and women were examined separately, results were generally quite similar to those for the full population.
The largest proportion of cancers in both men and women were attributable to active tobacco smoking (17.7%
352
men, 13.7% women), followed by physical inactivity (5.4% men, 9.1% women) and excess body weight (3.6%,
5.0% women). Among men, the 24 modifiable cancer risk factors were responsible for 86.3% of lung cancers,
83.4% of larynx cancers and 81.9% of esophageal cancers, with proportions for all other cancers under 75%.
Among women cancers where over 75% of incident cases were attributable to the 24 modifiable risk factors
were cervix (100%), lung (83.4%), endometrium (80.1%) and larynx (75.7%).
The results of this project indicate that in Alberta, the exposures responsible for the greatest proportion
of the provincial cancer burden are active tobacco smoking, physical inactivity and excess body weight. As such,
these risk factors represent ideal targets for cancer prevention programs, as changes in their risk factor profile in
the Alberta population have the potential to have the greatest impact on cancer incidence. From the perspective
of specific cancer sites, the observation that 100% of cervical cancers can be attributed to HPV infection
highlights the importance of HPV vaccination as a mechanism for cancer prevention. Further, in addition to
active tobacco smoking, physical inactivity and excess body weight, dietary factors are the most important with
respect to colorectal cancer incidence. Given that colorectal cancer is one of the most commonly diagnosed
cancer types in Alberta, improving the risk profile of dietary characteristics associated with colorectal cancer risk
has the potential to further reduce the number of cases diagnosed in Alberta.
Limitations
The use of a systematic method to estimate the population attributable risk associated with 24
modifiable lifestyle and environmental risk factors for cancer for the first time in Alberta is a strength of this
project. However, there are limitations that should be considered when interpreting these results. While we did
make an effort to control for the fact that some cancers are caused by multiple risk factors, a formal analysis of
potential interactions between risk factors was not included. In order to fully consider interactions between risk
factors when generating estimates of the total proportion of cancers attributable to the 24 modifiable risk
factors included here, exposure prevalence data that includes the joint distributions of all risk factors being
considered in the interaction analysis would be required and these types of data are not available for Alberta. As
such, if some cancer cases are caused by interactions between risk factors that are not captured in the current
summary estimates, some cases could be counted in reference to multiple risk factors and the summary
estimates of population attributable risk would overestimate the true values.
In addition, the validity of the individual population attributable risk estimates that have been presented
in this report is dependent upon the representativeness of the prevalence data used in our estimations.
Specifically, for some risk factors such as infectious diseases, Alberta-specific data were not available and the
353
prevalence was approximated based on values from other regions. For other risk factors, data from populationbased cohort studies (specifically Albertas Tomorrow Project) were used to approximate prevalence in the
general population. Any differences in risk factor prevalence between these sources and the general Alberta
population would produce errors in the exposure-specific population attributable risk estimates and these errors
would be compounded when individual population attributable risk estimates are combined to create summary
measures. However, given that the summary population attributable risk estimates for Alberta are similar to
those produced in similar Western populations, it seems unlikely that this had a major impact on the observed
burden of cancer due to modifiable lifestyle and environmental risk factors in Alberta.
Conclusions
We estimate that 42.3% of cancers in Alberta in 2012 were attributable to modifiable lifestyle and
environmental risk factors. Among these risk factors, the largest contributors to the cancer burden were active
tobacco smoking, physical inactivity and excess body weight, marking them as important targets for future
cancer prevention activities. For specific cancer sites, the 24 modifiable lifestyle and environmental risk factors
evaluated here explained the greatest proportion of cervix, lung, larynx, endometrial and esophageal cancers. As
all the risk factors that were included in this project are considered modifiable, changes in the distribution of
these risk factors in the Alberta population to increase the proportion of the population at the theoretical
minimum risk level of exposure has the potential to substantially reduce the provincial cancer burden.
354
APPENDIX A
Additional Tables for Cancer Incidence Attributable to Alcohol

Consumption in Alberta, Canada in 2012
355
Table A1
Proportion of Alberta Adults (%) in each alcohol consumption category by sex and age, 2000/2001(Canadian Community Health Survey)
Prevalence (95% CI)
Men by age (years)
Women by age (years)
20-34
35-49
50-64
65
20-34
35-49
1. Drank during past week: average 1
34.4 (31.3,37.5) 37.8 (34.9,40.8) 34.6 (30.7,38.5) 32.4 (28.2,36.6) 30.6 (27.5,33.6) 33.9 (31.1,36.7)
drink/day
2. Drank during past week: average 1 - 2
14.3 (12.0,16.6) 13.8 (11.4,16.1) 9.1 (6.9,11.3)
7.3 (4.8,9.8)
5.8 (4.3,7.4)
5.7 (4.3,7.1)
drinks/day
5.3 (4.0,6.7)
3.4 (2.2,4.5)
4.3 (2.5,6.1)
1.7 (0.7,2.7)
1.2 (0.5,2.0)
1.1 (0.5,1.8)
drinks/day
3.5 (2.3,4.7)
1.4 (0.7,2.2)
1.3 (0.6,2.0)
0.3 (0,0.8)
0.5 (0.1,0.9)
0.7 (0.2,1.2)
drinks/day
5. Drank during past week: average 4
3.5 (2.3,4.7)
1.9 (1.1,2.6)
0.7 (0,1.4)
1.0 (0,2.1)
0.4 (0,0.8)
0.4 (0,0.8)
drinks/day
6. No drinking past week but drank during past
10.8 (8.5,13.0) 10.8 (8.8,12.8) 14.4 (11.3,17.5) 17.2 (13.4,21.0) 22.8 (19.8,25.8) 20.2 (17.7,22.6)
year 1 time/month
5.3 (3.8,6.7)
5.8 (4.4,7.1)
4.6 (3.1,6.0)
3.8 (2.2,5.5)
8.5 (6.8,10.3)
6.2 (4.7,7.7)
year 1 time/month
5.3 (4.0,6.6)
5.2 (3.9,6.5)
5.4 (3.5,7.4)
2.0 (0.8,3.3)
6.2 (4.7,7.8)
5.2 (3.8,6.5)
year 2 - 3 times/month
3.5 (2.4,4.5)
3.0 (2.0,4.0)
2.3 (1.3,3.8)
2.2 (1.1,3.3)
3.1 (2.0,4.2)
2.7 (1.8,3.6)
year 1 time/week
2.3 (1.2,3.3)
1.7 (1.0,4.0)
1.5 (0.6,2.4)
1.4 (0.2,2.6)
1.3 (0.7,2.0)
0.8 (0.3,1.2)
year 2 - 3 times/week
0 (0,0.1)
0.1 (0,0.3)
0.1 (0,0.3)
0.6 (0,1.4)
0 (0,0)
0 (0,0.1)
year 4 - 6 times/week
0.2 (0,0.4)
0.2 (0,0.4)
0.4 (0,1.0)
0.6 (0,1.3)
0.1 (0,0.1)
0.1 (0,0.1)
year everyday
13. Has had 1 drink in lifetime: used to
1.4 (0.7,2.1)
4.4 (3.1,5.6)
6.5 (4.7,8.2)
6.5 (4.5,8.5)
0.8 (0.3,1.3)
1.7 (0.9,2.5)
regularly drink >12 drinks/week
14. Has had 1 drink in lifetime: did not
3.2 (2.1,4.3)
4.0 (2.9,5.1)
6.6 (4.8,8.5) 14.0 (10.9,17.0) 7.8 (6.2,9.4) 12.3 (10.3,14.3)
regularly drink 12 drinks/week
4.3 (2.8,5.9)
3.8 (2.4,5.2)
4.8 (2.0,7.6)
5.8 (3.6,8.0)
9.0 (6.5,11.6)
7.6 (5.6,9.6)
50-64
65
32.0 (28.3,35.6) 21.5 (18.3,24.8)

3.8 (2.1,5.4)
1.5 (0.6,2.3)
0.9 (0.2,1.7)
0 (0,0.1)
0.1 (0,0.3)
0.3 (0,0.8)
0.2 (0,0.4)
0 (0,0)
20.6 (17.2,24.0) 23.0 (19.7,26.4)

4.9 (2.9,6.8)
3.5 (2.3,4.8)
3.4 (2.1,4.6)
3.0 (1.6,4.5)
2.0 (1.0,3.0)
1.3 (0.4,2.2)
1.7 (0.5,2.9)
0.6 (0.1,1.2)
0 (0,0)
0.2 (0,0.5)
0.8 (0,1.7)
0.1 (0,0.2)
1.8 (0.9,2.7)
1.6 (0.6,2.7)
15.9 (13.2,18.7) 28.2 (24.6,31.7)

10.2 (6.8,13.6) 13.5 (11.0,16.1)
356
Table A2
Proportion of Adults in the South Zone health region (%) in each alcohol consumption category by sex and age, 2000/2001(Canadian
Community Health Survey)
Prevalence by Age (years)
20-34
32.7 (26.1,39.3)
35-49
24.9 (19.1,30.7)
50-64
24.2 (18.2,30.2)
65
18.3 (13.6,23.0)
9.8 (6.1,13.5)
8.3 (4.8,12.0)
6.7 (3.7,9.7)
2.7 (0.9,4.4)
4.2 (1.8,6.6)
1.5 (0,3.1)
3.1 (0,6.3)
2.3 (0.6,4.1)
2.2 (0.3,4.1)
0.8 (0,1.7)
0.8 (0,1.7)
0.4 (0,1.2)
1.8 (0.5,3.1)
3.6 (0,7.7)
0.6 (0,1.5)
0.2 (0,0.6)
11.2 (7.4,15.1)
12.3 (7.4,17.1)
14.8 (10.1,19.6)
17.0 (12.7,21.2)
5.3 (2.6,8.0)
8.2 (3.8,12.6)
9.9 (4.2,15.7)
5.2 (2.7,7.7)
7.3 (4.3,10.2)
7.0 (2.4,11.7)
3.0 (1.0,5.0)
5.8 (1.4,10.2)
2.3 (0.6,3.9)
3.8 (1.7,5.9)
1.5 (0.2,2.8)
2.8 (0.8,4.7)
1.0 (0.1,2.0)
1.5 (0.2,2.8)
1.3 (0.2,2.3)
2.0 (0,4.1)
0 (0,0.1)
0 (0,0)
0 (0,0)
0 (0,0)
0.3 (0,0.9)
0.7 (0,2.1)
0 (0,0)
0.4 (0,1.1)
1.4 (0.1,2.8)
3.6 (0.1,7.1)
3.5 (1.5,5.5)
3.5 (1.1,6.0)
8.7 (4.7,12.7)
7.6 (3.7,11.6)
15.8 (9.6,22.0)
20.2 (15.6,24.9)
7.3 (3.1,11.5)
11.0 (4.9,17.1)
6.1 (3.1,9.1)
12.9 (8.9,16.8)
357
Table A3
Proportion of Adults in the Calgary Zone health region (%) in each alcohol consumption category by sex and age,
2000/2001(Canadian Community Health Survey)
20-34
36.2 (31.6,40.8)
35-49
36.6 (31.9,41.3)
50-64
40.7 (34.8,46.6)
65
31.0 (25.4,36.5)
12.2 (9.0,15.4)
9.7 (7.0,12.5)
11.0 (6.8,15.2)
5.6 (2.9,8.3)
2.6 (1.4,3.7)
3.3 (1.6,4.9)
4.5 (2.1,7.0)
3.7 (0.9,6.5)
1.1 (0,2.0)
1.3 (0.4,2.2)
0.6 (0.1,1.1)
0.1 (0,0.2)
2.9 (1.1,4.6)
0.5 (0,1.0)
0.2 (0,0.6)
0.1 (0,0.3)
10.7 (7.9,13.5)
11.6 (8.8,14.5)
10.4 (7.2,13.5)
14.1 (10.3,17.9)
7.2 (4.6,9.7)
5.9 (3.6,8.1)
4.4 (2.4,6.3)
5.0 (1.9,8.1)
6.6 (4.1,9.1)
5.8 (3.1,8.4)
3.5 (1.0,6.0)
2.4 (0.6,4.1)
3.4 (1.9,5.0)
2.9 (1.0,4.7)
1.1 (0.2,1.9)
0.9 (0,1.7)
2.8 (1.0,4.6)
1.3 (0.3,2.3)
2.4 (0,5.0)
1.2 (0.2,2.2)
0.1 (0,0.2)
0.1 (0,0.3)
0.3 (0,0.8)
0.3 (0,0.8)
0.2 (0,0.5)
0.2 (0,0.5)
0.2 (0,0.6)
0.4 (0,1.0)
0.8 (0.2,1.3)
2.8 (1.3,4.2)
3.0 (1.1,5.0)
2.2 (0.8,3.5)
4.9 (3.0,6.9)
10.1 (6.5,13.9)
7.2 (4.5,9.8)
17.7 (12.8,22.7)
6.8 (4.3,9.2)
4.0 (2.0,5.9)
5.0 (2.0,7.9)
8.3 (5.1,11.6)

358
Table A4
Proportion of Adults in the Central Zone health region (%) in each alcohol consumption category by sex and age,
2000/2001(Canadian Community Health Survey)
20-34
36.6 (31.3,42.0)
35-49
36.4 (31.2,41.8)
50-64
34.6 (29.5,39.7)
65
22.7 (18.6,26.7)
6.8 (3.9,9.7)
10.2 (7.0,13.3)
5.0 (2.6,7.4)
4.1 (1.7,6.4)
3.8 (2.1,5.4)
3.9 (1.8,5.9)
2.8 (0.7,4.9)
1.7 (0.5,3.0)
1.1 (0.1,2.1)
0.1 (0,0.2)
0.6 (0,1.3)
0 (0,0)
2.0 (0.6,3.4)
0.8 (0.1,1.5)
0.3 (0,0.6)
0.1 (0,0.3)
16.0 (12.2,19.7)
14.8 (10.6,19.0)
14.7 (11.4,17.9)
16.0 (12.5,19.5)
6.0 (3.7,8.2)
8.6 (5.2,11.9)
5.7 (3.3,8.1)
4.9 (2.7,7.1)
6.0 (3.5,8.4)
4.0 (2.0,6.0)
5.0 (2.9,7.1)
1.9 (0.7,3.1)
3.9 (1.6,6.3)
3.4 (1.5,5.4)
2.8 (0.8,4.9)
2.6 (1.1,4.1)
0.5 (0,1.0)
0.4 (0,0.8)
1.2 (0.2,2.1)
2.1 (0.3,3.9)
0.3 (0,0.9)
0 (0,0)
0.2 (0,0.5)
0.2 (0,0.7)
0 (0,0)
0.1 (0,0.4)
0.7 (0,1.6)
0.5 (0,1.3)
1.9 (0.6,3.3)
2.9 (1.2,4.5)
6.9 (3.1,10.7)
3.9 (1.9,6.0)
9.0 (5.6,12.3)
8.4 (5.5,11.3)
11.9 (9.0,14.8)
23.8 (19.6,28.1)
2.8 (1.3,4.3)
3.2 (1.2,5.2)
2.6 (1.1,4.1)
9.8 (6.9,12.7)
359
Table A5
Proportion of Adults in the Edmonton Zone health region (%) in each alcohol consumption category by sex and age, 2000/2001
20-34
32.0 (27.2,36.8)
35-49
36.9 (31.1,42.7)
50-64
36.9 (31.2,42.6)
65
24.2 (19.1,29.4)
8.4 (5.4,11.3)
6.8 (4.5,9.0)
6.2 (3.7,8.7)
5.6 (2.3,8.9)
3.2 (1.7,4.7)
2.1 (0.7,3.4)
1.9 (0.7,3.2)
0.1 (0,0.2)
2.1 (0.2,4.1)
1.1 (0,2.5)
1.3 (0.3,2.3)
0.5 (0,1.2)
3.0 (0.1,5.9)
0.6 (0,1.3)
0.6 (0,1.2)
0.1 (0,0.2)
11.3 (8.3,14.5)
11.4 (7.6,15.2)
12.5 (9.0,16.0)
18.9 (13.5,24.2)
7.5 (4.3,10.7)
8.1 (4.8,11.3)
4.9 (2.5,7.3)
6.0 (3.3,8.6)
5.4 (3.3,7.5)
5.0 (3.1,6.9)
4.3 (2.0,6.3)
3.3 (1.2,5.4)
4.5 (2.1,6.9)
2.7 (1.0,4.4)
1.5 (0.5,2.6)
2.9 (0.9,4.7)
4.3 (1.3,7.3)
2.5 (0.8,4.2)
0.9 (0,1.7)
2.6 (0.8,4.4)
0.1 (0,0.2)
0.1 (0,0.4)
0.4 (0,1.0)
0.5 (0,1.4)
0.2 (0,0.4)
0 (0,0)
1.6 (0,3.8)
0.4 (0,1.1)
1.9 (0,4.3)
1.5 (0.6,2.5)
3.9 (1.6,6.2)
4.1 (1.7,6.6)
8.0 (5.0,10.9)
9.7 (6.6,12.7)
12.1 (8.1,16.2)
16.7 (12.5,20.8)
4.1 (2.0,6.1)
8.1 (4.3,11.8)
7.0 (3.1,10.9)
7.8 (4.3,11.3)
360
Table A6
Proportion of Adults in the North Zone health region (%) in each alcohol consumption category by sex and age, 2000/2001(Canadian Community
Health Survey)
20-34
30.5 (26.1,34.8)
35-49
37.3 (32.8,41.8)
50-64
28.3 (24.1,32.5)
65
20.4 (15.5,25.2)
8.7 (5.9,11.6)
9.3 (6.6,12.1)
6.7 (4.4,9.1)
0.5 (0,1.2)
3.5 (1.5,5.4)
2.1 (0.5,3.7)
2.4 (0.9,3.8)
1.0 (0,2.3)
1.5 (0.6,2.5)
0.8 (0.2,1.4)
0 (0,0.1)
0.1 (0,0.3)
2.7 (1.3,4.1)
0.5 (0.1,0.9)
0 (0,0.1)
0.1 (0,0.3)
14.8 (12.0,17.6)
15.1 (12.0,18.3)
15.5 (11.8,19.3)
19.7 (14.7,24.7)
7.9 (5.2,10.6)
6.2 (3.7,8.6)
5.4 (3.0,7.8)
6.0 (3.4,8.7)
4.1 (2.6,5.7)
3.0 (1.9,4.2)
6.1 (3.2,8.9)
1.8 (0.5,3.2)
3.7 (2.2,5.2)
6.2 (3.7,8.7)
3.0 (1.3,4.7)
1.1 (0.2,2.0)
3.2 (1.3,5.2)
2.1 (0.7,3.4)
0.9 (0.1,1.7)
1.7 (0.1,3.2)
0.4 (0,1.1)
0.2 (0,0.6)
0 (0,0.1)
0 (0,0.2)
0.1 (0,0.3)
0.5 (0,1.1)
1.3 (0,2.6)
0.2 (0,0.7)
1.7 (0.4,2.9)
3.6 (2.0,5.3)
4.2 (2.5,6.0)
2.8 (1.3,4.4)
8.4 (5.7,11.1)
8.2 (5.8,10.5)
16.5 (13.0,20)
29.4 (23.5,35.3)
3.9 (2.0,5.8)
2.7 (0.9,4.5)
4.7 (2.4,7.1)
7.8 (5.3,10.4)
361
Table A7
Age at
Exposure
(years)
Observed cancer cases in Alberta (2012) and proportions attributable to alcohol consumption, adjusted for recorded consumption
Age at
Outcome
(years)
Larynx
<5
41
69
37
<152
42.1
31.7
27.8
24.9
<5
13
19
9
<46
24
119
96
34
273
62.8
48.2
42.8
40.4
15
57
41
14
127
35
9.1
3
<5
5.3
0
<5
<5
12
0
193
9.1
18
17
4.8
1
9
6
11.6
1
292
6.8
20
32
4.7
1
15
5
7.6
0
326
4.1
13
18
3
1
7
<16
1
846
54
<72
3
<36
EAC, excess attributable risk; PAR, population attributable risk; Tot Obs. Cases, total observed cases
15.8
16.3
11.5
6.9
0
1
2
0
4
12
22
34
32
100
25.1
27.2
17.6
10.5
3
6
6
3
18
Women
20-34
35-49
50-64
65
Total
30-44
45-59
60-74
75
Total
<5
18
37
7
<67
44.4
29.5
28.1
19.2
<5
5
10
1
<21
37
276
454
338
1105
PAR
(%)
24.4
18.6
16.3
14
EAC
Total
Obs.
Cases
9
51
74
47
182
<5
58
54
34
<151
Oral Cavity and

Pharynx
Total
PAR
Obs.
EAC
(%)
Cases
0
7
6
3
16
30-44
45-59
60-74
75
Total
Total
Obs.
Cases
Esophagus
Total
Obs.
Cases
PAR
(%)
EAC
Liver
EAC
Men
20-34
35-49
50-64
65
Total
Total
Obs.
Cases
Colon-rectum
PAR
(%)
17.3
11.9
11.7
7.7
PAR
(%)
EAC
Breast
Total
Obs.
Cases
257
798
840
427
2322
PAR
(%)
EAC
8
8
6
3.6
21
64
50
15
150
362
Table A8
Age at
Exposure
(years)
Observed cancer cases in Alberta (2012) and proportions attributable to alcohol consumption, adjusted for recorded and unrecorded consumption
Age at
Outcome
(years)
Larynx
<5
41
69
37
<152
51.5
39
34.3
31.4
<5
16
24
12
<57
24
119
96
34
273
74.5
59.2
53.3
52
18
70
51
18
157
35
11.1
4
<5
6.4
0
<5
<5
14.9
0
193
11.3 22
17
5.8
1
9
6
14.3
1
292
8.3
24
32
5.6
2
15
5
9.5
0
326
4.9
16
18
3.6
1
7
<16
1
846
66
<72
4
<36
EAC, excess attributable risk; PAR, population attributable risk; Total Obs. Cases, total observed cases
19.8
20.8
14.2
8.5
0
2
2
1
5
12
22
34
32
100
32.4
36.3
22
13.1
4
8
7
4
24
Women
20-34
35-49
50-64
65
Total
30-44
45-59
60-74
75
Total
<5
18
37
7
<67
54.2
36.1
34
23.5
<5
7
13
2
<27
37
276
454
338
1105
PAR
(%)
29.9
22.6
19.9
17.2
EAC
Total
Obs.
Cases
11
63
90
58
222
<5
58
54
34
<151
Oral Cavity and

Pharynx
Total
PAR
Obs.
EAC
(%)
Cases
0
8
8
3
19
30-44
45-59
60-74
75
Total
Total
Obs.
Cases
Esophagus
Total
Obs.
Cases
PAR
(%)
EAC
Liver
EAC
Men
20-34
35-49
50-64
65
Total
Total
Obs.
Cases
Colon-rectum
PAR
(%)
21.1
14.3
14.1
9.3
PAR
(%)
EAC
Breast
Total
Obs.
Cases
257
798
840
427
2322
PAR
(%)
EAC
9.7
9.8
7.3
4.3
25
78
61
19
183
363
APPENDIX B
Additional Tables for Cancer Incidence Attributable to

Insufficient Fruit and Vegetable Consumption in
364
Table B1
Sex
CCHS 2003
Men
Women
CCHS 2004
Men
Women
CCHS 2005
Men
Women
CCHS
2007/2008
Men
Women
Prevalence (%) of Albertans in each category of fruit and vegetable consumption for CCHS data for all
survey years used in analysis
Age
Prevalence (%)
<3 servings <4 servings
0 servings
<1 serving
<2 servings
<5 servings
5 servings
20 - 34
35 - 49
50 64
65
0.3
0.2
0.2
0.1
1.5
1.6
0.8
0.9
13.6
8.8
4.5
3.7
26.7
25.3
20.5
16.4
25.3
24.6
29.8
26
12.9
18.1
19.5
20.9
19.7
21.4
24.8
32
20 - 34
35 - 49
50 64
65
0.03
0
0.02
0
1.2
1.6
0.7
0.6
6.2
3.5
3.2
3.3
15
11.7
10.8
12
21.9
20.7
18.9
19
16.2
18.1
18.2
19.6
39.5
44.4
48
45.5
19 35
36 - 50
51 - 65
66
0.3
0.2
0
1.4
5.3
0.7
2.9
18.3
15.4
7.9
5.2
9.6
24.8
22.5
23
21.2
22.3
31.6
35.2
11.7
17.8
16.8
11.9
25.7
14.1
20.3
21.9
12.2
19 35
36 - 50
51 - 65
66
0
0
0
0.7
2.2
0.2
0.4
4.1
11.8
5
3.1
4.9
20.8
20.8
17.8
10
32.4
24.7
31.3
23.3
11.7
25.1
21.2
22.9
21
24.2
26.3
34.1
20 - 34
35 - 49
50 64
65
0.1
0.04
0.2
0
1.9
1.7
0.7
2
13
7.4
8.7
7.1
27.4
24.8
22.3
16
22.7
24.8
25.6
26.3
14.7
15.5
19.3
21.2
20.2
25.8
23.3
27.4
20 - 34
35 - 49
50 64
65
0.01
0.09
0.2
0.02
0.5
0.7
0.9
0.5
6.2
5.3
4
2.4
14.4
14.3
11.1
10.6
20.5
21.6
18
23.2
18.1
16.5
16.7
23.3
40.3
41.5
49.1
40
20 - 34
35 - 49
50 64
65
0.3
0.2
0.4
0
0.9
1.9
1.9
0.4
9.9
9.9
7.7
7.4
22.6
18.6
19.4
17.4
21.6
26
22.7
23.9
15.9
17.5
17.5
22.4
28.8
25.9
30.4
28.4
20 - 34
35 - 49
50 64
65
0.1
0.02
0.04
0
1.2
0.6
1.7
1.2
5.8
4.5
3.8
3.2
11.1
12.1
9.9
10
15.9
18.2
16.7
22.7
15.3
17.1
16.3
16.1
50.6
47.4
51.5
46.8
365
ACKNOWLEDGEMENTS
This project was funded by the Alberta Cancer Prevention Legacy Fund. Dr Christine Friedenreich is
supported by an Alberta Innovates-Health Solutions Health Senior Scholar Award and the Alberta Cancer
Foundation Weekend to End Womens Cancers Breast Cancer Chair at the University of Calgary. We
thank Bethany Kaposhi and Lorraine Shack from the Alberta Cancer Registry for providing cancer
incidence data, the department of Data Integration, Measurement and Reporting at Alberta Health
Services for access to Canadian Community Health Survey data. This research was supported by funds to
the Canadian Research Data Centre Network (CRDCN) from the Social Science and Humanities research
Council (SSHRC), the Canadian Institute for Health Research (CIHR), the Canadian Foundation for
Innovation (CFI) and Statistics Canada.
366

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Cancer Incidence Attributable to Modifiable Risk Factors in

Alberta, Canada in 2012

Produced by the Department of Cancer Epidemiology and Prevention Research

Dr. Anne Grundy, Postdoctoral Fellow (Epidemiology)

July 10, 2015

Cancer Incidence Attributable to Active Tobacco Smoking in Alberta, Canada in 2012

Cancer Incidence Attributable to Passive Tobacco Exposure in Alberta, Canada in

Cancer Incidence Attributable to Inadequate Physical in Alberta, Canada in 2012 ............ 92

Cancer Incidence Attributable to Insufficient Fruit and Vegetable Consumption in Alberta,

Cancer Incidence Attributable to Red and Processed Meat Consumption in Alberta,

Cancer Incidence Attributable to Insufficient Fibre Consumption in Alberta, Canada in

Cancer Incidence Attributable to Suboptimal Vitamin D Intake in Alberta, Canada in 2012

Cancer Incidence Attributable to Insufficient Dietary Calcium Intake in Alberta, Canada in

Among environmental exposures, natural UV exposure in relation to malignant melanoma and

Statistics Canada surveys; 2) publically available government databases; 3) published peer-reviewed

Estimation of Population Attributable Risks

Cancer types consistently associated with

Tobacco Consumption and Exposure

Hormone Replacement Therapy

Low fruit intake

High Alcohol Intake

High red meat intake

Oral cavity and pharynx

Risk Estimates from International Collaborative Panels

quantitatively combine results from individual high quality** cohort and

Alberta Health Services

Figure I.2. The hierarchy for selection of exposure prevalence estimates

Cancer Incidence Attributable to Active and Passive

All Associated Cancers

All Associated Cancers

Corresponding CCHS cycle (year)

Gandini et al., 2008

Gandini et al., 2008

Kim et al., 2014

Cancer Incidence Attributable to Active Tobacco Smoking in Alberta,

Prevalence (95% CI)

CI, confidence interval

Cancer cases and proportions attributable to active smoking in Alberta (2012)

Oral cavity and pharynx

Obs. Cases, observed cases; PAR, population attributable risk (%)

Obs. Cases, observed cases; PAR, population attributable risk (%)

Obs. Cases, observed cases; PAR, population attributable risk (%)

Obs. Cases, observed cases; PAR, population attributable risk (%)

Obs. Cases, observed cases; PAR, population attributable risk (%)

Obs. Cases, observed cases; PAR, population attributable risk (%)

Obs. Cases, observed cases; PAR, population attributable risk (%)

Obs. Cases, observed cases; PAR, population attributable risk (%)

Obs. Cases, observed cases; PAR, population attributable risk (%)

Obs. Cases, observed cases; PAR, population attributable risk (%)

Oral cavity and pharynx

Obs. Cases, observed cases; PAR, population attributable risk (%)

Obs. Cases, observed cases; PAR, population attributable risk (%)

Oral cavity and pharynx

CI, confidence interval; PAR, population attributable risk

PAR (95% CI)

EAC (95% CI)

Cases represent the total number of cases of lung cancer in 2012

Proportions and cases of lung cancer attributable to active smoking in the

PAR (95% CI)

EAC (95% CI)

PAR (95% CI)

EAC (95% CI)

PAR (95% CI)

EAC (95% CI)