A new survey found that more than half of Americans understand the risk of cancer associated with consuming alcohol and processed meats.

More Americans reported that stress and other unfounded factors impacted cancer risk, rather than alcohol, processed meat, and lifestyle factors, according to the American Institute for Cancer Research (ACIR) Cancer Risk Awareness Survey.

These findings offer insight into what aspects of their lifestyle Americans believe affect cancer risk.

Less than half of participants reported that alcohol, processed meat, red meat, low intake of fruits and vegetables, and physical inactivity were all risk factors for developing cancer, according to the survey. Additionally, only half of participants knew that obesity is also linked to cancer.

However, individuals were more likely to report that unproven factors, such as stress, hormones in beef, and genetically-modified food, lead to cancer.

The investigators found that 44% believed that high-fat diets contribute more to cancer risk than physical inactivity. Many studies have demonstrated a strong link between exercise and cancer prevention, while few have shown a strong link between high-fat diets and cancer, according to the survey.

Less than 4 in 10 participants realized alcohol consumption is linked to cancer, despite growing evidence that it can cause colorectal, breast, liver, and esophageal cancers. In 2001, 42% of participants were aware of the risk, and only 39% were aware in the most recent survey.

Cured meats, such as hot dogs and bacon, are known to cause colorectal and stomach cancers. Only a slight increase in awareness of the association was found over the past 16 years, with 32% aware in 2001 to 40% in 2017.

Healthy weight is an effective way to reduce the risk of developing multiple cancers, such as breast, ovarian, colorectal, and esophageal cancers. However, only 50% of participants were aware of the risks associated with obesity. Despite knowledge gains in this category, more initiatives should focus on educating Americans about these risks.

Very few Americans were aware that drinking coffee may reduce the risk of developing certain cancers, according to the survey. Approximately 45% of participants knew that low vegetable and fruit intake increased cancer risk, while only 35% indicated high red meat consumption was also linked to cancer.

Interestingly, 28% of respondents said that high sugar consumption increases cancer risk, but it is only indirectly linked due to increased body fat.

Nearly all Americans understood that tobacco use and sun exposure were linked to cancer development, likely due to increased efforts to prevent smoking and unsafe sun behaviors.

“There is a clear crisis in cancer prevention awareness,” said Alice Bender, MS, RDN, AICR head of Nutrition Programs. “It’s troubling that people don’t recognize alcohol and processed meats increase cancer risk. This suggests the established factors that do affect cancer risk are getting muddled with headlines where the research is unclear or inconclusive.”

These findings suggest that more educational efforts should be put into place to ensure that Americans are receiving validated scientific evidence rather than unfounded studies.

The ACIR estimates that 1 in 3 cancers could be avoided due to healthy diet, weight management, and increased physical activity. When adding smoking cessation and avoiding sun damage, they estimate that nearly 50% of cancers could be avoided.

 “We know a lot of healthy people do get cancer and sometimes it’s easier to worry about genes or uncontrollable things rather than your everyday choices,” Bender concluded. “But the research says that being physically active, staying a healthy weight, and eating a plant-based diet has the potential to prevent hundreds of thousands of cancer cases each year. It’s a powerful message.”