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Epidemiology

Different operationalizations of the 2018 WCRF/AICR cancer prevention recommendations and risk of cancer

British Journal of Cancer volume 129, pages 982–992 (2023)Cite this article

Subjects

Abstract

Background

The standardized scoring system assessing adherence to the 2018 World Cancer Research Fund (WCRF)/American Institute for Cancer Research (AICR) cancer prevention recommendations assigns equal weight for each recommendation, thereby giving higher weight to dietary factors collectively (5 points) than adiposity (1 point) and physical activity (1 point). An alternative score assigning equal weights to the adiposity, physical activity, alcohol, and other dietary (composite) recommendations may better predict cancer associations.

Methods

We examined associations between standardized and alternative scores with cancer risk in two US prospective cohorts. Multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox regression.

Results

During 28 years of follow-up, 16,342 incident cancer cases in women and 8729 cases in men occurred. Individuals in the highest versus lowest quintile of the standardized score had a reduced overall cancer risk (women: HR = 0.89, 95% CI: 0.85, 0.94; men: HR = 0.87, 95% CI: 0.81, 0.94). Results were slightly stronger for the alternative score (women: HR = 0.83, 95% CI: 0.79, 0.87; men: HR = 0.81, 95% CI: 0.75, 0.86). Similar patterns were observed for obesity-related, alcohol-related, smoking-related, and digestive system cancers.

Conclusions

Greater adherence to the WCRF/AICR cancer prevention recommendations was associated with lower cancer risk. A score assigning equal weights to the adiposity, physical activity, alcohol, and all remaining diet components yielded stronger associations than the standardized score.

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Fig. 1: HRs and 95% CIs between WCRF/AICR lifestyle scores with risk of total, obesity-related, alcohol-related, smoking-related, and digestive system cancer in NHS (women)a and HPFS (men)b per interquartile-rangec increase in score.
Fig. 2: HRs and 95% CIs between standardized WCRF/AICR score with risk of total, obesity-related, alcohol-related, smoking-related, and digestive system cancer by smoking status in NHS (women)a and HPFS (men)b per interquartile-rangec increase in score.
Fig. 3: HRs and 95% CIs between WCRF/AICR lifestyle scores with risk of cancer by sites in NHS (women)a and HPFS (men)b per interquartile-rangec increase in the score.

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Data availability

The data and code that support the findings of this study are available from the authors upon reasonable request and with permission of the Harvard T.H. Chan School of Public Health and Channing Division of Network Medicine at Brigham and Women’s Hospital.

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Acknowledgements

The authors would like to acknowledge the contribution to this study from central cancer registries supported through the Centers for Disease Control and Prevention’s National Program of Cancer Registries (NPCR) and/or the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program. Central registries may also be supported by state agencies, universities, and cancer centers. Participating central cancer registries include the following: Alabama, Alaska, Arizona, Arkansas, California, Delaware, Colorado, Connecticut, Florida, Georgia, Hawaii, Idaho, Indiana, Iowa, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Mississippi, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Puerto Rico, Rhode Island, Seattle SEER Registry, South Carolina, Tennessee, Texas, Utah, Virginia, West Virginia, Wyoming.

Funding

The Nurses’ Health Study and Health Professionals Follow-up Study are supported by funding from the National Cancer Institute at the National Institute of Health under the award numbers UM1 CA186107, P01 CA87969, and U01 CA167552. Emily Riseberg is supported by funding from the National Research Service Award T32 DK 007703. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Author notes

  1. These authors contributed equally: Edward L. Giovannucci, Stephanie A. Smith-Warner.

Authors and Affiliations

  1. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Rui Song, Emily Riseberg, Kana Wu, Xuehong Zhang, Walter C. Willett, Edward L. Giovannucci & Stephanie A. Smith-Warner

  2. Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, MA, USA

    Joshua Petimar

  3. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Joshua Petimar, Molin Wang, Lorelei A. Mucci, Walter C. Willett, Edward L. Giovannucci & Stephanie A. Smith-Warner

  4. Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Molin Wang

  5. Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Lorelei A. Mucci & Xuehong Zhang

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Contributions

Conceptualization: E.L.G., S.A.S.-W., and J.P.; Formal analysis and investigation: R.S.; Original draft preparation: R.S.; Review and editing: E.R., J.P., M.W., L.A.M., K.W., X.Z., W.C.W., E.L.G., S.A.S.-W.; Funding acquisition: W.C.W., E.L.G., L.A.M.; Resources: E.L.G., S.A.S.-W.; Supervision: S.A.S.-W.

Corresponding author

Correspondence to Stephanie A. Smith-Warner.

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Song, R., Riseberg, E., Petimar, J. et al. Different operationalizations of the 2018 WCRF/AICR cancer prevention recommendations and risk of cancer. Br J Cancer 129, 982–992 (2023). https://doi.org/10.1038/s41416-023-02314-x

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