Adherence to the World Cancer Research Fund/American Institute for Cancer Research cancer prevention guidelines and colorectal cancer incidence among African Americans and whites: The Atherosclerosis Risk in Communities study

• Published in: Cancer 2020-03, Vol.126 (5), p.1041-1050
• Main Authors: Onyeaghala, Guillaume, Lintelmann, Anna K., Joshu, Corrine E., Lutsey, Pamela L., Folsom, Aaron R., Robien, Kimberly, Platz, Elizabeth A., Prizment, Anna E.
• Format: Article
• Language: English
• Subjects: African Americans; Arteriosclerosis; Aspirin; Atherosclerosis; Black or African American - statistics & numerical data; Calcium; Calories; cancer prevention; Cancer research; Colon; Colon cancer; Colorectal cancer; Colorectal carcinoma; Colorectal Neoplasms - epidemiology; Colorectal Neoplasms - prevention & control; Confidence intervals; Diabetes mellitus; Diet; Disease prevention; Exercise; Female; Follow-Up Studies; Guidelines; Guidelines as Topic - standards; Health risk assessment; Health risks; Hormone replacement therapy; Humans; Incidence; Life Style; Male; Medical research; Men; Middle Aged; Minority & ethnic groups; obesity; Oncology; Patient Compliance - statistics & numerical data; physical activity; Prevention; Prognosis; prospective cohort; Prospective Studies; Race; Rectum; Risk; Risk Factors; Statistical analysis; Surveys and Questionnaires; United States - epidemiology; White People - statistics & numerical data; Women
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.32616

Background Adherence to the World Cancer Research Fund (WCRF)/American Institute for Cancer Research (AICR) cancer prevention recommendations is associated with colorectal cancer (CRC) risk in whites, but only 1 previous study has reported on this link in African Americans. This study assessed the association between the 2018 WCRF/AICR guidelines and CRC incidence in African Americans (26.5%) and whites (73.5%) in the Atherosclerosis Risk in Communities prospective cohort (n = 13,822). Methods A total of 368 incident CRC cases (268 among whites and 100 among African Americans) were identified between the baseline (1987) and 2012. A baseline adherence score was created for 7 WCRF/AICR guidelines (each contributing 0, 0.5, or 1 point to the score, with higher scores corresponding to greater adherence). Adherence scores were also categorized as tertiles (0.0‐3.0, 3.5‐4.0, and 4.5‐7.0). Cox proportional hazards regression was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for the total cohort and with stratification by race. Results After adjustments for age, sex, race, center, smoking, education, intake of aspirin, calcium, total calories, diabetes status, and, in women, hormone replacement therapy, greater adherence was associated with decreased CRC risk. The HRs per 1‐unit increment in score were 0.88 (95% CI, 0.80‐0.97) for the whole cohort, 0.89 (95% CI, 0.73‐1.09) for African Americans, and 0.88 (95% CI, 0.77‐0.99) for whites. Similar associations between higher adherence scores and decreased cancer risk were observed for men and women and for colon cancer but not for rectal cancer. Conclusions Greater adherence to the cancer prevention recommendations appears to be associated with decreased CRC risk for both African Americans and whites. In the Atherosclerosis Risk in Communities cohort, African American and white men and women with greater adherence to WCRF/AICR expert recommendations on modifiable risk factors for cancer prevention have a lower risk of colorectal and colon cancer, but not rectal cancer. These associations indicate that effective public health initiatives to promote healthy lifestyle behaviors indicated in the WCRF/AICR recommendations would be beneficial for colorectal cancer prevention in these groups.