Background and objectives: The World Cancer Research Fund/American Institute of Cancer Research (WCRF/AICR) provides lifestyle recommendations to reduce cancer risk. However, a limited number of studies has assessed whether following these recommendations leads to a reduction in breast cancer risk. We therefore examined the association between adherence to these recommendations and breast cancer incidence, overall, by menopausal status, and by receptor subtype in a real-world cohort, and explored potential biological mechanisms. Methods: We longitudinally analyzed 11,312 cancer-free women from the Moli-sani Study cohort in Italy. The 2018 WCRF/AICR Score is based on seven components, ranged from 0 to 7 points, and was categorized into population-specific tertiles, with the following ranges: T1, 0.75-3.0; T2, 3.25-3.75; and T3, 4.0-6.75. Hazard ratios (HRs) were estimated with multivariable Cox models. Potential mediators, including inflammatory and metabolic biomarkers, were analyzed based on change-in-estimate. Results: Over a median follow-up of 13.2 years, 290 breast cancer cases occurred. In multivariable-adjusted analyses, the highest versus lowest tertile of adherence to the 2018 WCRF/AICR Score was associated with a HR of 0.91 (95% CI: 0.68-1.21) for overall breast cancer incidence. Each 1-point increase in adherence was linked to a lower risk of estrogen receptor-positive (HR=0.85; 95%CI 0.72-1.00), progesterone receptor-negative (HR= 0.67; 95%CI 0.46-0.97), hormone receptor-positive (HR=0.84; 95%CI 0.71-0.99) and HER-2 negative breast cancer (HR=0.80; 95%CI 0.66-0.95). Lower levels of insulin and low-grade inflammation markers explained up to 25.2% of the association between the 2018 WCRF/AICR Score with risk of certain breast cancer types. Conclusion: Greater adherence to the 2018 WCRF/AICR lifestyle recommendations was associated with a lower incidence of specific breast cancer subtypes. Some of these associations may be explained by reduced insulin levels and lower systemic inflammation, suggesting potential underlying mechanisms.
Adherence to the 2018 WCRF/AICR Cancer Prevention Recommendations is associated with lower breast cancer incidence: A real-world prospective analysis from the Moli-sani Study and exploration of biological pathways
Iacoviello, Licia
;
2026-01-01
Abstract
Background and objectives: The World Cancer Research Fund/American Institute of Cancer Research (WCRF/AICR) provides lifestyle recommendations to reduce cancer risk. However, a limited number of studies has assessed whether following these recommendations leads to a reduction in breast cancer risk. We therefore examined the association between adherence to these recommendations and breast cancer incidence, overall, by menopausal status, and by receptor subtype in a real-world cohort, and explored potential biological mechanisms. Methods: We longitudinally analyzed 11,312 cancer-free women from the Moli-sani Study cohort in Italy. The 2018 WCRF/AICR Score is based on seven components, ranged from 0 to 7 points, and was categorized into population-specific tertiles, with the following ranges: T1, 0.75-3.0; T2, 3.25-3.75; and T3, 4.0-6.75. Hazard ratios (HRs) were estimated with multivariable Cox models. Potential mediators, including inflammatory and metabolic biomarkers, were analyzed based on change-in-estimate. Results: Over a median follow-up of 13.2 years, 290 breast cancer cases occurred. In multivariable-adjusted analyses, the highest versus lowest tertile of adherence to the 2018 WCRF/AICR Score was associated with a HR of 0.91 (95% CI: 0.68-1.21) for overall breast cancer incidence. Each 1-point increase in adherence was linked to a lower risk of estrogen receptor-positive (HR=0.85; 95%CI 0.72-1.00), progesterone receptor-negative (HR= 0.67; 95%CI 0.46-0.97), hormone receptor-positive (HR=0.84; 95%CI 0.71-0.99) and HER-2 negative breast cancer (HR=0.80; 95%CI 0.66-0.95). Lower levels of insulin and low-grade inflammation markers explained up to 25.2% of the association between the 2018 WCRF/AICR Score with risk of certain breast cancer types. Conclusion: Greater adherence to the 2018 WCRF/AICR lifestyle recommendations was associated with a lower incidence of specific breast cancer subtypes. Some of these associations may be explained by reduced insulin levels and lower systemic inflammation, suggesting potential underlying mechanisms.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
