Adherence to the 2018 World Cancer Research Fund/American Institute for Cancer Research Cancer Prevention Recommendations and survival in people with incident cancer in UK Biobank

BACKGROUND: The lifestyle-based World Cancer Research Fund (WCRF)/American Institute for Cancer Research (AICR) Cancer Prevention Recommendations aim to reduce cancer risk. People living with and beyond cancer are also encouraged to follow these recommendations, but evidence for their benefit in cancer survivors is limited. The authors investigated associations between adherence to the recommendations and survival among people with cancer within UK Biobank. METHODS: The UK Biobank recruited participants between 2006 and 2010. Lifestyle and sociodemographic data were collected at baseline. Adherence to the recommendations was assessed using an abbreviated 2018 WCRF/AICR score (range, 0-5 points). In the primary analysis, participants with a single incident cancer and who had a total abbreviated score were included (n = 28,550). Associations between score and all-cause mortality were investigated using multivariable Cox proportional hazards models. Analyses were conducted for all cancers combined and by site. RESULTS: Of the 28,550 individuals included in the primary analysis, 10,014 (35%) died over a 6-year median follow-up time. Abbreviated score was inversely associated with all-cause mortality (hazard ratio, per 1-point increment: 0.92; 95% confidence interval (CI), 0.90-0.94; p < .001). When considering individual cancer sites, significant inverse associations were observed for prostate, breast, lung, esophageal, and liver cancers, with risk reductions ranging from 5% to 14% per 1-point increment in abbreviated score. DISCUSSION: This is the first study to investigate associations between adherence to the Cancer Prevention Recommendations and cancer survival in a UK population. Each 1-point increment in score, equivalent to fully meeting one recommendation, reduced risk of death from any cause by 8%, providing evidence for development of interventions to support compliance in people with cancer.