Associations of the 2018 World Cancer Research Fund/American Institute of Cancer Research (WCRF/AICR) Cancer Prevention Recommendations with Stages of Colorectal Carcinogenesis

Abstract

AbstractWhile adherence to cancer prevention recommendations is linked to lower risk of colorectal cancer (CRC), few have studied associations across the entire spectrum of colorectal carcinogenesis. Here, we studied the relationship of the standardized 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) Score for cancer prevention recommendations with colorectal carcinogenesis in a cross-sectional setting. Baseline data from two studies was combined to measure adherence to the seven-point 2018 WCRF/AICR Score in screening participants with a positive faecal immunochemical test and CRC patients in an intervention study. Dietary intake, body fatness and physical activity were assessed using self-administered questionnaires. Multinomial logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for screen-detected colorectal lesions and CRC. Of 1,914 participants, 548 were free from adenomas, 524 had non-advanced adenomas, 349 had advances lesions and 493 had CRC (63 screen-detected and 430 recruited from the intervention study). Adherence to the 2018 WCRF/AICR Score was inversely associated with advanced colorectal lesions; OR 0.82 (95% CI 0.71, 0.94,ptrend0.005) per score point, but not CRC. Adherence to the alcohol recommendation was the single factor most strongly inversely associated with CRC development, being significantly associated with advanced colorectal lesions and CRC. Adherence to the 2018 WCRF/AICR cancer prevention recommendations was associated with lower probability of screen-detected advanced colorectal lesions, but not CRC. Taking a holistic approach to cancer prevention is important to prevent the occurrence of precancerous colorectal lesions.What’s new?While several studies have documented an association between adherence to cancer prevention recommendations and risk colorectal cancer, data is sparse when it comes to the precancerous lesions. In this study, including participants representing the entire spectrum of colorectal carcinogenesis, strong inverse associations were observed between adherence to the 2018 World Cancer Research Fund/American Institute of Cancer Research (WCRF/AICR) and the two main precursor lesion types (advanced adenoma and advanced serrated lesion), highlighting the importance of adopting a healthy lifestyle early on to prevent the development of colorectal cancer.Trial RegistrationClinicalTrials.govIdentifier:NCT01538550(Bowel Cancer Screening in Norway (BCSN) trial) andNCT01570010(CRC-NORDIET).