In the field of cancer control, most messages about prevention emphasize “lifestyle” as the appropriate focus of attention. A watershed moment was the publication of a report by Sirs Richard Doll and Richard Peto in 1981 that provided quantitative estimates of cancer risks. That landmark report, still widely cited, attributed large proportions of cancer deaths to lifestyle factors, primarily tobacco and diet. Over time, the meaning of lifestyle in the context of cancer control has shifted from broad environmental and cultural factors to a specific set of factors (most often smoking, obesity and physical activity). The contemporary use of lifestyle in our popular culture influences our perception that lifestyle is largely a function of personal choice. Paradoxically, lifestyle now encompasses undesirable risk factors that few would intentionally choose, such smoking (an addiction) and obesity (a chronic condition). Smoking and obesity are themselves the result of a complex array of genetic, individual, social, and environmental influences. Industries that market harmful products such as tobacco have promoted the concept of personal responsibility and a limited role of government. The labeling of behavioral risk factors as lifestyle is consistent with this emphasis on personal responsibility and narrows the focus for intervention. At the population level, framing risk factors within the concept of lifestyle shifts attention and resources to personal behaviors and away from environmental and policy approaches. Vulnerable populations, however, often have limited choices over their living circumstances. Interventions can occur at different levels of the socio-ecologic framework. Interventions that focus on counseling and education are generally expected to have a smaller impact at the population level than approaches that address socioeconomic factors or the environmental context in which decisions are made. Comprehensive tobacco control programs, for example, operate at multiple levels and include context-changing interventions such as tobacco taxes, smoke-free environments and the elimination of advertising. In addition, the importance of environmental pollution as a cause of cancer can be overlooked, as well as the complex interaction of multiple risk factors across a lifespan. Environmental and social problems call for environmental and social solutions.