Comment on “Environment, Lifestyle, and Cancer in Women”

Recent research has shown that environmental and lifestyle factors play a significant role in the development of cancer, and can include carcinogenic agents in soil, water, air, and food. Modifiable factors such as these are imperative to understand and address to optimize cancer prevention. This article is a review focusing on the impact of environmental exposures and lifestyle behaviors on cancer in women and aiming to identify the role of risk factors in gynecologic cancer risk and progression. Environmental and lifestyle factors play a role in many gynecologic cancers. Ovarian cancer has one of the highest mortality rates of any gynecologic cancer and is influenced by factors including high body mass index (BMI) and dietary habits such as a lack of fruits and vegetables. Less modifiable risk factors include multiparity and long-term use of contraceptives, which can lower ovarian cancer risk, and air pollution that increases the risk. Uterine cancer is one of the most prevalent gynecologic cancers in high-income countries, and is associated with obesity, physical inactivity, and diets high in animal fat and low in fiber. Pesticides have also been implicated due to an association with hormonal disruption and systemic inflammation. Cervical cancer, on the other hand, is primarily related to sexual behaviors, as it is directly associated with HPV infection. Other risk factors include tobacco use, nutritional deficiencies such as folate and antioxidants, and an imbalance of the vaginal microbiome. Less common cancers, such as vulvar and vaginal cancers, are also strongly influenced by lifestyle and environmental factors, such as obesity, smoking, and exposure to carcinogens. Genetic and environmental factors interact in a nuanced way in the development of gynecologic cancer, and some risk factors are modifiable while some are not. Certain genetic mutations have been associated with an increased risk of several types of cancers, and this is outside of an individual’s control; however, the risk of gynecologic cancer can be reduced via a healthy diet and activity level and can mitigate some of the increased genetic risk. Polygenic risk scores (PRSs) have been developed as a tool to estimate individual risk of certain diseases, including gynecologic cancers, and calculate a score based on genetic factors that are present and their association with each disease based on genome-wide association studies (GWAS). Genetic factors with the highest relevance for gynecologic cancers include BRCA mutation carriers, aberrant DNA methylation, abnormal histone acetylation and methylation, and dysregulation of noncoding RNAs such as microRNAs. Evidence has shown that modifying risk factors even after diagnosis of gynecologic cancer can improve long-term outcomes; these can include smoking cessation, increased physical activity, diet, and body weight. These factors can improve both cancer survival and quality of life. Interplay between genetic and environmental factors is nuanced but imperative for understanding individualized gynecologic cancer risk. Some nuances of modifiable and nonmodifiable factors include cultural context and sociodemographic factors that can influence the ability of individuals to adhere to health recommendations, such as physical activity and dietary habits, as well as influence their access to health care and education. These disparities must be acknowledged when determining individual cancer risk. Future studies and interventions should include education and information dissemination, public health initiatives, regular cancer screenings, and supporting cancer survivors. (Summarized from Farina S, Sabatelli A, Boccia S, et al. Environment, lifestyle, and cancer in women. Int J Gynaecol Obstet. 2025;171 Suppl 1(Suppl 1):138-146. doi: https://doi.org/10.1002/ijgo.70156)