SUMMARYTumor genomes are suffused with mutations, each caused by specific mutational processes that can leave tell-tale signatures revealing their aetiology. However, knowledge of these underlying mutational processes acting on our DNA does not on its own convey the causation of cancer: many mutations are “passenger” mutations that do not affect progression. One must determine which mutations are causative, which are not, and to what degree. Here we directly tie the cancer effect size—a metric of the proliferation and survival benefit conferred by molecular variants—to the mutational processes that generated molecular variation within individual tumors, quantifying the contribution of each mutagenic process to the formation of each whole-exome sequenced tumor. Furthermore, we extend this result at the individual level to demonstrate the specific mutational processes that are most responsible for tumors of 23 major cancer types. Melanomas and lung cancers are attributable to the actionable, preventable, exogenous mutational processes of ultraviolet light and tobacco exposure, whereas gliomas and prostate adenocarcinoma tumors are largely attributable to endogenous processes associated with aging. Other potentially actionable mutational processes, such as mutations associated with pathogen exposure and APOBEC activity, account for a large proportion of the cancer effect within head and neck, bladder, cervical, and breast cancers. These molecular attributions complement and expand longstanding epidemiological approaches that inform cancer prevention by revealing the burden of cancer caused by either endogenous or exogenous, non-actionable or actionable processes.