Lifestyle factors are known to influence health. According to the World Health Organization (WHO), approximately one third of deaths are due to unhealthy lifestyle habits. Among lifestyle-related risk factors for head and neck cancers (HNC), alcohol consumption and smoking play an undeniable role in the multifactorial etiology of the disease. In recent years, the promotion of healthy lifestyle choices has received significant attention, as it contributes to improved health and disease prevention.
Interventions to address these risk factors are vitally important in the prevention and progression of the disease. However, to effectively prevent disease and reduce risk factors, it is crucial to identify the initial reasons that lead to the adoption of these lifestyle-related risk factors in the first place. Stress, being a constant aspect of modern life, is known to contribute to alcohol and smoking practices. In this review article, the PubMed database was searched for relevant literature on stress, lifestyle factors, HNC and cancer to explore the role of stress and its associated biological pathways as a prior factor in the adoption of lifestyle risk factors that cause HNC.
It highlights the importance of stress pathways and the hypothalamus, pituitary and adrenal (HPA) axis as a site of interaction between stress, alcohol, smoking and cancer. Despite their widely accepted harmful effects, alcohol and smoking are still deeply embedded in contemporary life. A better understanding of the impact of stress on lifestyle choices and an exploration of the mechanisms that cause stress-related cancer, alcohol and smoking could highlight opportunities to improve prevention measures by modifying unhealthy lifestyle choices. Relevant literature was searched in the PubMed database on health, stress, lifestyle factors and HNC to explore the role of stress and its associated biological pathways as a prior factor in the adoption of lifestyle risk factors that cause HNC.
This section analyzes the underlying biological mechanisms that link previous stressful experiences to the adoption of risk factors for cancer related to an unhealthy lifestyle (alcohol and smoking). Evidence that relates temporary stressful exposure to subsequent unhealthy patterns of smoking and alcohol consumption, and the association of these factors with the etiology of HNC, require a greater understanding of the underlying mechanisms that relate stress, lifestyle factors and cancer. Prolonged exposure to stress can increase the glucocorticoid burden, increasing vulnerability to lifestyle risk factors (alcohol and smoking) (, which initially act as anxiolytics, but simultaneously as stress factors), which increases the activity of the HPA axis. Therefore, it is important to identify the role that stress plays in the adoption of lifestyle-related risk factors in order to effectively eradicate them and prevent associated diseases.
HNC has a recognized lifestyle etiology, in which alcohol and smoking are independent and synergistic risk factors for the onset and progression of cancer. Alcohol consumption, tobacco, betel quid and dietary deficiency are the most important lifestyle risk factors for HNC (Petti, 200). This may link childhood adversity as a risk factor for the development of anxiety disorders in adulthood and contribute to vulnerability to alcoholism in adulthood. These firmly established lifestyle habits often cannot be attributed to a single cause, since they have multiple purposes, such as facilitating social interactions, signifying joy and festivities, offering a means to relax, escape pain and as a mechanism for coping with stressful periods (Mann et al.
This could also mean that lifestyle factors are not only a risk factor due to their known carcinogenic mechanisms (Ogden, 201), but also because of their ability to keep stress pathways active, which in turn directly helps tumor progression by directly affecting cell proliferation, DNA damage and signaling pathways, and also increasing the chances of adopting risky lifestyle behaviors through underlying biological mechanisms (Boileau et al. However, lifestyles are social practices and ways of life adopted by people that reflect personal, group and socioeconomic identities. Modest but achievable adjustments to lifestyle-related behaviors are likely to have a significant impact at the individual and population levels. Lifestyle-related diseases share risk factors similar to long-term exposure to three modifiable lifestyle behaviors (smoking, unhealthy diet, and physical inactivity) and cause the development of chronic diseases, specifically heart disease, stroke, diabetes, obesity, metabolic syndrome, chronic obstructive pulmonary disease, and some types of cancer.
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