Greater adherence to lifestyle-based recommendations reduced the risk of cancer in Britain

A recent one BMC medicine study assesses adherence to World Cancer Research Fund (WCRF)/American Institute for Cancer Research (AICR) recommendations and their impact on cancer incidence in the UK.

Study: Adherence to the 2018 World Cancer Research Fund (WCRF)/American Institute for Cancer Research (AICR) cancer prevention recommendations and risk of 14 lifestyle-related cancers in the UK Biobank prospective cohort study. Image credits: Jo Panuwat D / Shutterstock.com

Background

Several lifestyle factors, including physical activity, body composition and diet, have been linked to the incidence of several types of cancer. In Britain, around 40% of cancer cases are associated with modifiable risk factors, including obesity, tobacco smoking, alcohol consumption and inadequate dietary fiber intake.

WCRF/AICR published ten recommendations for cancer prevention, which were updated in 2018, based on healthy lifestyle patterns to reduce the risk of cancer and other non-communicable diseases. Although several studies have assessed whether adherence to WCRF/AICR recommendations for cancer prevention affected cancer incidence and survival rates, most of these studies did not consider the most recent recommendations.

The latest version removes the previous recommendation of less salt consumption and includes a limited intake of sugar-sweetened beverages. In addition, a previous recommendation from 2007 recommended a minimum consumption of 25 grams of dietary fiber per day, which was increased to a minimum of 30 grams per day in the 2018 version.

A meta-analysis and systematic review documented significant adherence to the 2007 Cancer Prevention Recommendations, which reduced the risk of colorectal cancer, lung cancer, and breast cancer. Greater adherence to recommendations also reduced overall cancer-specific mortality.

Importantly, different approaches were used to calculate compliance with the recommendations, resulting in different assessment results. Therefore, there is a need for a standardized assessment to provide consistency and comparability across studies.

In this context, Shams-White and colleagues developed a standardized scoring system in 2019 that operationalized seven of the ten recommendations. However, few studies have used this system to assess adherence to the 2018 cancer prevention recommendations.

About the study

The current UK Biobank prospective cohort study evaluated the association between adherence to the 2018 WCRF/AICR recommendations for cancer prevention using a standardized, fully operational score and the risk of multiple cancers. To do this, the researchers assessed how diet, nutrition and physical activity affected the risk of all types of invasive cancers, as well as fourteen specific cancers, including cancers affecting the uterus, bladder, gallbladder, colorectal, kidney, head and neck. chest, lungs, prostate, pancreas, esophagus, stomach, liver and ovaries.

The study cohort included more than 500,000 participants between 2006 and 2010, recruited from 22 centers in England, Wales and Scotland. The UK Biobank cohort included participants aged between 37 and 73 years, of whom approximately 56% were female.

Findings of the study

A total of 94,778 UK Biobank participants were selected for the current study. During a median follow-up of 7.9 years, 7,296 participants were diagnosed with cancer, of which prostate cancer was the most common, followed by breast and colorectal cancer.

A significant inverse correlation was observed between the total adherence score and the risk of all cancers. A 7% reduction in cancer risk was observed with each one-point increment in the score, which adjusted for age, ethnicity, gender, smoking status and hardship.

Individuals with a tertile score of 3.75-4.25 points and 4.5-7 points showed an 8% and 16% lower risk of developing all types of cancer, respectively. Similarly, a Swedish study indicated that the risk of cancer decreases by 3% for every one point increase in the score. These differential reduction values ​​indicate the need to determine associations based on global population.

The current study estimated a 10% reduction in breast cancer risk for every one-point increase in adherence score. Individuals with an adherence score between 5.75 and 7 points had the lowest risk of breast cancer incidence.

For every one point increase in the score, a 10% reduction in the incidence risk of colorectal cancer was observed. For this type of cancer, participants who belonged to the middle and highest score tertiles had a lower risk of cancer incidence.

Better adherence to the 2018 WCRF/AICR cancer prevention recommendations reduced the risk of esophageal, kidney, gallbladder, ovarian, and liver cancer. Consistent with the current study results, a previous EPIC study also indicated a 42% lower risk of esophageal, kidney, and liver cancer following the 2007 version of the WCRF/AICR Cancer Prevention Recommendations.

Conclusions

The current study shows that better adherence to the 2018 WCRF/AICR recommendations for cancer prevention reduces the risk of several types of cancer, including ovarian cancer, breast cancer, kidney cancer, gallbladder cancer, colorectal cancer, esophageal cancer and liver cancer. These findings strongly support the 2018 WCRF/AICR cancer prevention recommendations to prevent/reduce the incidence of cancer in the UK

In the future, similar studies should be conducted to assess the effectiveness of the recommendations for other world populations. However, these types of studies should include a standardized methodology to allow comparability between studies.