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Ontario Cancer Facts

Following cancer prevention recommendations could reduce the risk of developing cancer

Mar 2021

Highlights

 

  • A study found that compared with not following WCRF/AICR recommendations, increased vegetable and fruit consumption, decreased alcohol consumption, and lower body fatness without being underweight were each associated with reduced risk of developing cancer.
  • Following all 4 cancer prevention recommendations was associated with a reduction in cancer risk by approximately 30% when compared with not following any of the recommendations.
  • These preliminary findings support public health messages to reduce the risk of developing cancer.

 

A study undertaken by Ontario Health (Cancer Care Ontario) found that following international cancer prevention recommendations on body fatness, physical activity, plant foods and alcoholic drinks may substantially reduce cancer risk in Ontario.

The study used data from the Canadian Community Health Survey (CCHS), which asks about dietary and lifestyle factors. Over 111,000 people in Ontario who completed the CCHS from 2000 to 2008 were linked to the Ontario Cancer Registry to track whether they were diagnosed with cancer. This data was used to retrospectively assess whether survey participants had a reduced risk of developing cancer if they followed 4 (out of a total of 8) specific World Cancer Research Fund (WCRF)/American Institute for Cancer Research (AICR) recommendations released in 2007. The CCHS questions related to these recommendations were on body mass index, physical activity, vegetable and fruit consumption (used as a proxy for plant foods), and alcohol consumption. The analysis found that approximately 9,000 cases of cancer were diagnosed in the survey participants from 2000 to the end of 2016.

Compared with not following WCRF/AICR recommendations, increased vegetable and fruit consumption, decreased alcohol consumption, and lower body fatness without being underweight were each found to be associated with a reduced risk of developing cancer. In addition, a WCRF/AICR recommendation composite score was developed to indicate how well someone followed the 4 recommendations that were the focus of the study. Preliminary findings showed that following all 4 WCRF/AICR cancer prevention recommendations reduced cancer risk by approximately 30% when compared with not following any of the recommendations that were reviewed (see Figure).

*The WCRF/AICR Recommendation Composite Score is the sum of the individual scores assigned to the four WCRF/AICR cancer prevention recommendations looked at in this study: body fatness, physical activity, vegetable and fruit consumption (used as a proxy for plant foods), and alcoholic drinks. Each individual score was quantified as 0 (not following), 0.5 (partially following) or 1 (fully following) based on survey responses. The composite score in this study ranges from 0 (not following any of the 4 recommendations) to 4 (fully following all of the 4 recommendations).

Source:

  1. Ontario Cancer Registry (Ontario Health [Cancer Care Ontario]), 1964–2014.
  2. Canadian Community Health Survey (CCHS), 2000–2008.

Notes:

  1. Cox proportional hazard models were used to estimate hazard ratios and 95% confidence intervals (as the vertical whiskers show) for the association of meeting guideline with cancer risk.
  2. Hazard ratio is the ratio of the hazard rates corresponding to the conditions described by 9 levels of a composite adherence score (a ratio of 1 suggests no effect, and a ratio of less than 1 suggests less risk of cancer), and score 0 (not following any of the 4 recommendations) is the reference group.
  3. Four WCRF/AICR cancer prevention recommendations (body fatness, physical activity, plant foods and alcoholic drinks) are operationalized as the adherence score. It measures least (0) to most (4) in accordance with the recommendations based on responses in CCHS questionnaire.
Association between following WCRF/AICR recommendations (score*) and the risk of developing cancer
WCRF/AICR recommendation composite score Hazard ratio Lower 95% confidence limit Upper 95% confidence limit
0 (ref) 1.00 1.00 1.00
0.5 0.82 0.62 1.13
1.0 0.83 0.63 1.10
1.5 0.82 0.62 1.07
2.0 0.79 0.60 1.03
2.5 0.78 0.60 1.02
3.0 0.73 0.56 0.96
3.5 0.71 0.54 0.93
4.0 0.69 0.51 0.92

*The WCRF/AICR Recommendation Composite Score is the sum of the individual scores assigned to the four WCRF/AICR cancer prevention recommendations looked at in this study: body fatness, physical activity, vegetable and fruit consumption (used as a proxy for plant foods), and alcoholic drinks. Each individual score was quantified as 0 (not following), 0.5 (partially following) or 1 (fully following) based on survey responses. The composite score in this study ranges from 0 (not following any of the 4 recommendations) to 4 (fully following all of the 4 recommendations).

Source:

  1. Ontario Cancer Registry (Ontario Health [Cancer Care Ontario]), 1964–2014.
  2. Canadian Community Health Survey (CCHS), 2000–2008.

Notes:

  1. Cox proportional hazard models were used to estimate hazard ratios and 95% confidence intervals (as the vertical whiskers show) for the association of meeting guideline with cancer risk.
  2. Hazard ratio is the ratio of the hazard rates corresponding to the conditions described by 9 levels of a composite adherence score (a ratio of 1 suggests no effect, and a ratio of less than 1 suggests less risk of cancer), and score 0 (not following any of the 4 recommendations) is the reference group.
  3. Four WCRF/AICR cancer prevention recommendations (body fatness, physical activity, plant foods and alcoholic drinks) are operationalized as the adherence score. It measures least (0) to most (4) in accordance with the recommendations based on responses in CCHS questionnaire.

Several studies conducted in the United States and Europe have examined whether following the WCRF/AICR cancer prevention recommendations is associated with reduced cancer risk.,, Less research in this area has been done in Canada,, and to the best of our knowledge, this is the first study conducted in Ontario examining the association between WCRF/AICR recommendations and all cancers.

These preliminary findings support public health messages to promote cancer prevention, such as including physical activity and healthy eating as part of daily living. Ontario Health (Cancer Care Ontario) supports people living in Ontario to make healthy lifestyle choices, such as through MyCancerIQ.ca, which allows people to assess their risk of developing 6 different types of cancer and receive a personalized report with cancer prevention suggestions.

Four WCRF/AICR cancer prevention recommendations (2007) used in the study:

  • Body fatness: Be as lean as possible within the normal range of body weight.
  • Physical activity: Be as physically active as possible as part of everyday life.
  • Plant foods: Eat mostly foods of plant origin.
  • Alcoholic drinks: Limit alcoholic drinks.

The remaining 4 WCRF/AICR cancer prevention recommendations (2007) not used due to limited CCHS survey data:

  • Foods and drinks that promote weight gain: Limit consumption of energy-dense foods and avoid sugary drinks.
  • Animal foods: Limit intake of red meat and avoid processed meat.
  • Preservation, processing, preparation: Limit consumption of salt and avoid moldy cereals (grains) or pulses (legumes).
  • Dietary supplements: Aim to meet nutritional needs through diet alone.

References

  1. Wang Y, Haque MZ, Young SW, Cotterchio M, Truscott R. Association between Cancer Risk and Behaviors Adherent to Cancer Prevention Recommendations in Ontario, Canada. Journal of Registry Management. 2021; 48(3):92-103. Available at: www.ncra-usa.org/Portals/68/Journal%20of%20Registry%20Management/JRM%20F....
  2. World Cancer Research Fund/American Institute for Cancer Research. Food, nutrition, physical activity, and the prevention of cancer: a global perspective. Washington, D.C.: American Institute for Cancer Research; 2007.
  3. Lavalette C, Adjibade M, Srour B, et al. Cancer-Specific and General Nutritional Scores and Cancer Risk: Results from the Prospective NutriNet-Sante Cohort. Cancer research. 2018;78(15):4427–35.
  4. Jankovic N, Geelen A, Winkels RM, et al. Adherence to the WCRF/AICR Dietary Recommendations for Cancer Prevention and Risk of Cancer in Elderly from Europe and the United States: A Meta-Analysis within the CHANCES Project. Cancer Epidemiol Biomarkers Prev. 2017;26(1):136–44.
  5. Romaguera D, Vergnaud AC, Peeters PH, et al. Is concordance with World Cancer Research Fund/American Institute for Cancer Research guidelines for cancer prevention related to subsequent risk of cancer? Results from the EPIC study. Am J Clin Nutr. 2012;96(1):150–63.
  6. Xu JY, Vena JE, Whelan HK, Robson PJ. Impact of adherence to cancer-specific prevention recommendations on subsequent risk of cancer in participants in Alberta's Tomorrow Project. Public Health Nutr. 2019;22(2):235–45.
  7. Catsberg C, Miller AB, Rohan TE. Adherence of cancer prevention guidelines and risk of breast cancer. Int J Cancer. 2014;135:2444–52.