Adherence to the World Cancer Research Fund/American Institute for Cancer Research Recommendations and the Risk of Breast Cancer.

Federica Turati, Michela Dalmartello, Francesca Bravi, Diego Serraino, Livia Augustin, Attilio Giacosa, Eva Negri, Fabio Levi, Carlo La Vecchia

Research output: Contribution to journalArticlepeer-review


The World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) introduced in 2007, and updated in 2018, nutrition-related recommendations for cancer prevention. Previous studies generally reported inverse associations of breast cancer with the 2007 recommendations, while no study has yet evaluated the association with the 2018 guidelines. We investigated the association between adherence to the 2018 WCRF/AICR recommendations and breast cancer risk in a case-control study from Italy and Switzerland (1991-2008) including 3034 incident histologically-confirmed breast cancer cases and 3392 hospital controls. Adherence to the 2018 guidelines was summarized through a score incorporating eight recommendations (body fatness, physical activity, consumption of wholegrains/vegetables/fruit/beans, "fast foods" and other processed foods high in fat, starches, or sugars, red/processed meat, sugar-sweetened drinks, alcohol, breastfeeding), with higher scores indicating higher adherence. Odds ratios (OR) were estimated using multiple logistic regression models. We also conducted a meta-analysis including 15 additional studies using random-effects models. In our case-control study, adherence to the 2018 WCRF/AICR guidelines was inversely associated with breast cancer, with ORs of 0.60 (95CI), 0.51-0.70) for a score ≥5.5 vs. ≤4.25, and of 0.83 (95 0.79-0.88) for a 1-point increment. In our study, 25to-moderate guideline adherence. In the meta-analysis, the pooled relative risks (RRs) were 0.73 (95 0.65-0.82, p heterogeneity among studiestextless 0.001) for the highest vs. the lowest WCRF/AICR score category, and 0.91 (95 0.88-0.94, p heterogeneity textless 0.001) for a 1-point increment. This work provides quantitative evidence that higher adherence to the WCRF/AICR recommendations reduces the risk of breast cancer, thus opening perspectives for prevention.
Original languageEnglish
Issue number3
Publication statusPublished - Feb 1 2020


  • Adult
  • Female
  • Humans
  • Middle Aged
  • Risk Factors
  • breast cancer
  • lifestyle
  • prevention
  • nutrition
  • Aged
  • United States
  • diet
  • Case-Control Studies
  • Odds Ratio
  • Confidence Intervals
  • Italy/epidemiology
  • guideline adherence
  • *Academies and Institutes
  • *Biomedical Research
  • *Guideline Adherence
  • Breast Neoplasms/*epidemiology
  • Meta-Analysis as Topic
  • Switzerland/epidemiology


Dive into the research topics of 'Adherence to the World Cancer Research Fund/American Institute for Cancer Research Recommendations and the Risk of Breast Cancer.'. Together they form a unique fingerprint.

Cite this