ABSTRACT: Despite significant advances in cancer care, cancer remains the second leading cause of death in the USA. For a costeffective initiative to decrease cancer incidence, we argue in this review that an understanding of modifiable environmental factors in cancer and risk mitigation strategies should come first, as a population health approach to cancer. Additionally, this review also motivates the development of broad spectrum metabolic approaches to cancer, which may be effective over a broad array of cancers, instead of current antineoplastic agents, which are targeted against a small subset of cancers. By using a preventative approach, as well as utilizing low cost and broad spectrum therapeutic agents, it may be possible to improve cancer outcomes without a significant increase in cost. This review provides a roadmap for environmental risk mitigation as well as adjunctive, broad spectrum therapeutics.

Impact statement: This review assesses the feasibility of generalist approaches to cancer care, which may be helpful to a broad swathe of the population.

Key words: Cancer; metabolic therapy; environmental factors; warburg effect; ketogenic diet.