Associations of the 2018 World Cancer Research Fund/American Institute of Cancer Research (WCRF/AICR) cancer prevention recommendations with stages of colorectal carcinogenesis

Ane Sørlie Kvaerner; Astrid Riseth Andersen; Hege Berg Henriksen; Markus Dines Knudsen; Anne Marte Wetting Johansen; Anette Hjartåker; Siv Kjølsrud Bøhn; Ingvild Paur; Gro Wiedswang; Sigbjørn Smeland; Trine B Rounge; Rune Blomhoff; Paula Berstad

doi:10.1002/cam4.6119

Associations of the 2018 World Cancer Research Fund/American Institute of Cancer Research (WCRF/AICR) cancer prevention recommendations with stages of colorectal carcinogenesis

Cancer Med. 2023 Jul;12(13):14806-14819. doi: 10.1002/cam4.6119. Epub 2023 May 22.

Authors

Ane Sørlie Kvaerner¹, Astrid Riseth Andersen², Hege Berg Henriksen², Markus Dines Knudsen^{2

3

4}, Anne Marte Wetting Johansen², Anette Hjartåker², Siv Kjølsrud Bøhn⁵, Ingvild Paur^{2

6

7}, Gro Wiedswang⁸, Sigbjørn Smeland^{9

10}, Trine B Rounge^{11

12}, Rune Blomhoff^{2

6}, Paula Berstad¹

Affiliations

¹ Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway.
² Department of Nutrition, University of Oslo, Oslo, Norway.
³ Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
⁴ Department of Transplantation, Division of Surgery, Inflammatory Medicine and Transplantation, Oslo University Hospital, Oslo, Norway.
⁵ Faculty of Chemistry, Biotechnology and Food Science, Norwegian University of Life Sciences (NMBU), Ås, Norway.
⁶ Department of Clinical Services, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway.
⁷ Norwegian Advisory Unit on Disease-related Undernutrition, Oslo University Hospital, Oslo, Norway.
⁸ Department of Gastrointestinal and Children Surgery, Division of Surgery, Inflammatory Medicine and Transplantation, Oslo University Hospital, Oslo, Norway.
⁹ Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway.
¹⁰ Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
¹¹ Department of Research, Cancer Registry of Norway, Oslo, Norway.
¹² Centre for Bioinformatics, Department of Pharmacy, University of Oslo, Oslo, Norway.

Abstract

Background: While 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 detection of colorectal lesions in a screening setting. As a secondary objective, we examined to what extent the recommendations were being followed in an external cohort of CRC patients.

Methods: Adherence to the seven-point 2018 WCRF/AICR Score was measured in screening participants receiving a positive fecal immunochemical test and in CRC patients participating 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 lesions.

Results: Of 1486 screening participants, 548 were free from adenomas, 524 had non-advanced adenomas, 349 had advanced lesions and 65 had CRC. Adherence to the 2018 WCRF/AICR Score was inversely associated with advanced lesions; OR 0.82 (95% CI 0.71, 0.94) per score point, but not with CRC. Of the seven individual components included in the score, alcohol, and BMI seemed to be the most influential. Of the 430 CRC patients included in the external cohort, the greatest potential for lifestyle improvement was seen for the recommendations concerning alcohol and red and processed meat, where 10% and 2% fully adhered, respectively.

Conclusions: Adherence to the 2018 WCRF/AICR Score was associated with lower probability of screen-detected advanced precancerous lesions, but not CRC. Although some components of the score seemed to be more influential than others (i.e., alcohol and BMI), taking a holistic approach to cancer prevention is likely the best way to prevent the occurrence of precancerous colorectal lesions.

Keywords: advanced colorectal lesions; cancer prevention recommendations; colorectal cancer; colorectal carcinogenesis; diet; lifestyle.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Carcinogenesis
Colorectal Neoplasms* / diagnosis
Colorectal Neoplasms* / epidemiology
Colorectal Neoplasms* / etiology
Diet
Exercise
Humans
Life Style
Patient Compliance*
Risk Factors
United States / epidemiology