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Original Article Adherence to the World Cancer Research Fund/American Institute for Cancer Research and Korean Cancer Prevention Guidelines and cancer risk: a prospective cohort study from the Health Examinees-Gem study
Jeeyoo Lee1orcid , Aesun Shin1,2,3,4,5orcid , Woo-Kyoung Shin1,4orcid , Ji-Yeob Choi2,6,7orcid , Daehee Kang1,2,4orcid , Jong-Koo Lee8orcid
Epidemiol Health 2023;45e2023070-0
DOI: https://doi.org/10.4178/epih.e2023070
Published online: August 1, 2023
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1Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
2Cancer Research Institute, Seoul National University, Seoul, Korea
3Interdisciplinary Program in Cancer Biology Major, Seoul National University College of Medicine, Seoul, Korea
4Integrated Major in Innovative Medical Science, Seoul National University Graduate School, Seoul, Korea
5Medical Research Center, Genomic Medicine Institute, Seoul National University College of Medicine, Seoul, Korea
6Department of Biomedical Science, Seoul National University Graduate School, Seoul, Korea
7Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, Korea
8JW LEE Center for Global Medicine, Seoul National University College of Medicine, Seoul, Korea
Corresponding author:  Aesun Shin,
Email: shinaesun@snu.ac.kr
Received: 17 February 2023   • Accepted: 4 July 2023

OBJECTIVES
The purpose of this study was to explore the association between adherence to 2 cancer prevention recommendations and cancer risk.
METHODS
In total, 104,386 individuals aged 40-69 years old who were recruited between 2004 and 2013 in the Health Examinees-Gem study were included. Adherence scores were constructed based on 8 items from the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) cancer prevention recommendations, including body weight, physical activity, diet, alcohol consumption and breastfeeding, and on 6 items from the Korean cancer prevention guidelines (smoking status, eating vegetables and fruits, salty foods, alcohol intake, physical activity, and body weight). A Cox proportional hazards model was used to estimate the associations between adherence scores and the risk of total and 5 major cancers.
RESULTS
The multivariable hazard ratio (HR) for total cancer with the high adherence score versus the lowest score (4.25-7.00 vs. 0.00-3.25) for the WCRF/AICR guidelines was 0.91 (95% confidence interval [CI], 0.82 to 1.00) in men. A reduced breast cancer risk was observed among women with the highest score. Men within the highest category of the Korean cancer prevention guideline score (3.25-6.00) had an HR of 0.80 (95% CI, 0.73 to 0.88) for developing total cancer compared to men within the lowest score (0.00-2.50). The higher adherence group among men showed lower risks of developing stomach, colorectal, and lung cancers.
CONCLUSIONS
Adhering to guidelines for cancer prevention can help to reduce the risk of developing cancer in Korean men. The association might differ by cancer type and gender.


Epidemiol Health : Epidemiology and Health