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In 1981, British researchers Richard Doll and Richard Peto took on the task of estimating the percentage of cancer deaths in the United States that could be avoided by changing one's lifestyle. In a 119-page article in the Journal of the Na tional Cancer Institute that has since been cited thousands of times, they estimated that tobacco use and poor diet each accounted for about one-third of cancer deaths in the United States. When combined with alcohol consumption, certain infectious conditions, and environmental and occupational carcinogens , Doll and Peto estimated that about 75% – 80% of cancer deaths could, in principle, be prevented. Whereas Doll and Peto linked their conclusions about smoking to a large body of existing evidence, they had much less information on which to base their estimates about diet and nutrition, other than epidemiologic comparisons across countries or studies of immigrants who moved from one country to another. Still, Doll and Peto estimated that " diet, " which they defi ned not as caloric input but more as nutrition, could be responsible for up to 35% of cancer deaths — at least as much as tobacco use. Decades later, and with much more evidence available from large studies, there are still some doubts about which factors under the umbrella term " diet " actually do or do not affect cancer risk. For example, two recent studies from large prospective cohorts found no association between consumption of fruit and vegetables and cancer incidence (see News, Vol. 97, No. 7, p. 474). Doll himself said in a recent BBC interview that, " We know a lot about diet in relation to heart disease, but in relation to cancer, it's still very confused. I feel I know less about it now than I did 20 years ago. " One dietary factor that has biologic plausibility and some backing in epide-miologic data is the contribution of excess body weight to cancer development and death. With decades more data than Doll and Peto had, the International Agency for Research on Cancer estimated in a 2002 report that overweight and obesity may be responsible for about 10% of breast cancer and colorectal cancer cases and between 25% and 40% of kidney, esophageal, and endome-trial cancers. But even with obesity, there are still many unan-swered questions: the magnitude to which obesity may contribute to the risk of cancer and other adverse health effects, …

The Big Fat Question: What Is the Role of Excess Weight in Cancer Risk, Mortality?