(P13-037-25) Adherence to the 2018 WCRF/AICR Cancer Prevention Recommendations and Risk of Lifestyle-Related Cancers in the PLCO Cancer Screening Trial

Objectives: The World Cancer Research Fund (WCRF)/ American Institute for Cancer Research (AICR) Cancer Prevention Recommendations aim to lower cancer incidence worldwide. Our study explored associations between adherence to these Recommendations, assessed using a standardized scoring system (‘2018 WCRF/AICR Score’), and the risk of first cancer incidence in a US cohort.

Methods: Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial Study participants who were cancer-free at baseline and who had complete data on 2018 WCRF/AICR Score components (n=69,061) were included in our analysis. Adherence to the Recommendations was assessed by operationalization of the standardized ‘2018 WCRF/AICR Score’, using data on BMI, diet and alcohol (collected using a Food Frequency Questionnaire), and physical activity (assessed using the Supplemental Questionnaire). Associations between Score and cancer endpoints, including incidence of any cancers, WCRF/AICR-reviewed lifestyle-related cancers, and individual cancer sites, were investigated using Cox proportional hazard models, adjusting for age, sex, trial arm, race, education, cigarette, cigar and pipe smoking. Pre-defined sub-group analyses were stratified according to sex and smoking status.

Results: Mean 2018 WCRF/AICR Score was 3.6 points (range 0-7). During a median follow-up time of 10 years, 11,109 participants developed cancer. The 2018 WCRF/AICR Score was inversely associated with risk of any cancer (HR: 0.97; 95% CI: 0.95-0.99; p=0.003), 17 WCRF/AICR-reviewed lifestyle-related cancers (HR: 0.97; 95% CI: 0.95-0.99; p=0.007), pancreatic cancer (HR: 0.86; 95% CI: 0.78-0.96; p=0.007), and breast cancer (HR:0.91; 95% CI: 0.87-0.96; p< 0.001). The observed protective associations were stronger in females and in participants who had never smoked.

Conclusions: Our findings support adherence to the 2018 WCRF/AICR Cancer Prevention Recommendations for reducing risk of cancer incidence, particularly breast and pancreatic cancer, in the US.

Funding Sources: This research was funded by the National Institute for Health and Care Research (NIHR) and Medical Research Council (MRC) Cancer Research Transatlantic Development and Skills Enhancement (DSE) Award.