Adherence to the WCRF/AICR Cancer Prevention Recommendations and Cancer Risk in the European Prospective Investigation into Cancer and Nutrition (EPIC)

  • Topic: Cancer-related outcomes
  • Institution: Imperial College London
  • Country: United Kingdom
  • Status: Completed
Researcher: Teresa Norat

Scientific abstract

(View plain language abstract)


In 2007, the World Cancer Research Fund (WCRF) and the American Institute for Cancer Research (AICR) issued 10 recommendations on diet, physical activity, and weight management for cancer prevention on the basis of the most comprehensive collection of available evidence.


We investigated whether concordance with WCRF/AICR recommendations is related to risk of cancers and death.


The current study included about 380,000 participants enrolled in the European Prospective Investigation into Cancer and Nutrition study. At recruitment dietary, anthropometric, and lifestyle information was collected.

A WCRF/AICR score, which incorporated 6 of the recommendations for men and 7 for women, was constructed. Associations between the WCRF/AICR score and risks of cancers, total and cause-specific death were estimated by using Cox regression analysis.


The analyses included 36,994 cancer cases (13,838 in men and 23,156 in women) and 23,828 deaths identified during more than 10 years of follow-up in the EPIC study. Participants within the highest category of the WCRF/AICR score (5-6 points in men; 6-7 points in women) had an 18% (95% CI: 0.75, 0.90) lower hazard of cancer and 34% lower hazard of death (95% CI: 0.59, 0.75) compared with participants within the lowest category of the WCRF/AICR score (0-2 points in men; 0-3 points in women). A 1-point increment in the score was associated with a risk reduction of 5% (95% CI: 3%, 7%) for total cancer and 34% (95% CI: 0.60, 0.73) reduction of risk of death.

Significant associations were observed for cancers of the colorectal, stomach, breast, endometrium, lung, kidney, upper aerodigestive tract, liver, and oesophagus but not for prostate, ovarian, pancreatic, and bladder cancers. The WCRF/AICR score was also significantly associated with a lower hazard of dying from cancer, circulatory disease, and respiratory disease.


Results of this study suggest that following WCRF/AICR recommendations could significantly lower the risk of developing most types of cancer and increase longevity.

Plain language abstract


The underlying hypothesis is that individuals with a lifestyle as recommended in the WCRF/AICR recommendations should have lower probability of getting a cancer and experience longer survival than individuals with lifestyles that are not in agreement with those recommendations.

More specifically, individuals will have a lower probability of having a cancer and will live longer than the other individuals if they:

– Have a weight considered in the normal range
– Are physically active
– Have a diet characterised by:

  • high consumption of plant foods and whole grain cereals
  • low consumption of sugary drinks
  • low consumption of meats
  • low consumption of alcoholic drinks
  • low consumption of salt and salt-preserved foods


Many well conducted populations studies have investigated how diet, weight control, alcohol drinking and physical activity influence the risk of cancer. Based on the results of these studies, experts have developed 10 recommendations for cancer prevention that if followed by the individuals, should lower their risk of getting a cancer.


We developed a score that summarise the recommendations (WCRF-score) and investigated how the concordance of the lifestyle of more than 300,000 individuals from 9 European countries predicted their probability of getting a cancer during the following 10 years.

We assigned points to the recommendations and created a score adding the points for all recommendations. We then assigned scores to the study participants according to their lifestyle and body weight.

Key findings

We observed that the chance of getting a cancer was decreased in individuals whose lifestyle was in agreement with the WCRF recommendations. Individuals with lifestyle according to WCRF recommendations (score higher than 5) had 15% lower risk of getting a cancer in the next 10 years than individuals with a lifestyle with less agreement with the recommendations (score 2-3 or less).

The most cancers that were more influenced by the lifestyle were colorectal, stomach, upper aerodigestive tract, oesophageal cancers and breast, lung, endometrial, kidney and liver cancer. We also observed that the lifestyle recommended by WCRF have a strong influence on the risk of death which was 34% lower in individuals that had a lifestyle in agreement with WCRF recommendations (score higher than 5) compared to individuals with lower agreement (score 2-3 recommendations or less).

In the population studied, 12.6% of all cancers that were diagnosed in 10 years could have been prevented if the whole study population would have scored 5–6 in men and 6–7 in women. The age-related increase in the death rate could be postponed by 1.2 year for each additional score point of the WCRF/AICR recommendation that participants follow.

For example, participants who had score 4 reached the risk of death of participants who adhered to 3 recommendations 1.2 years later, meaning that mortality could have been lower.

Grant publications

> Is concordance with World Cancer Research Fund/American Institute for Cancer Research guidelines for cancer prevention related to subsequent risk of cancer? Results from the EPIC study
> Adherence to the World Cancer Research Fund/American Institute for Cancer Research guidelines and risk of death in Europe: results from the European Prospective Investigation into Nutrition and Cancer cohort study
> Pre-diagnostic concordance with the WCRF/AICR guidelines and survival in European colorectal cancer patients: a cohort study