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Pre-diagnostic concordance with the WCRF/AICR guidelines and survival in European colorectal cancer patients: a cohort study

Romaguera D 1 , Ward H 2 , Wark PA 3 , Vergnaud AC 4 , Peeters PH 5 , van Gils CH 6 Show all authors , Ferrari P 7 , Fedirko V 8 , Jenab M 9 , Boutron-Ruault MC 10 , Dossus L 11 , Dartois L 12 , Hansen CP 13 , Dahm CC 14 , Buckland G 15 , Sánchez MJ 16 , Dorronsoro M 17 , Navarro C 18 , Barricarte A 19 , Key TJ 20 , Trichopoulou A 21 , Tsironis C 22 , Lagiou P 23 , Masala G 24 , Pala V 25 , Tumino R 26 , Vineis P 27 , Panico S 28 , Bueno-de-Mesquita HB 29 , Siersema PD 30 , Ohlsson B 31 , Jirström K 32 , Wennberg M 33 , Nilsson LM 34 , Weiderpass E 35 , Kühn T 36 , Katzke V 37 , Khaw KT 38 , Wareham NJ 39 , Tjønneland A 40 , Boeing H 41 , Quirós JR 42 , Gunter MJ 43 , Riboli E 44 , Norat T 45

Affiliations 

  • 1 Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus, Norfolk Place, W2 1PG, London, UK. d.romaguera-bosch@imperial.ac.uk
  • 2 Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus, Norfolk Place, W2 1PG, London, UK. heather.ward@imperial.ac.uk
  • 3 Global eHealth Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, The Reynolds Building, St Dunstan's Road, London, W6 8RP, UK. p.wark@imperial.ac.uk
  • 4 Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus, Norfolk Place, W2 1PG, London, UK. a.vergnaud@imperial.ac.uk
  • 5 Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus, Norfolk Place, W2 1PG, London, UK. p.peeters@imperial.ac.uk
  • 6 Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. Box 85500 3508 GA, Utrecht, The Netherlands. c.vangils@umcutrecht.nl
  • 7 International Agency for Cancer Research (IARC), 150 Cours Albert Thomas, 69372, Lyon, CEDEX 08, France. ferrarip@iarc.fr
  • 8 Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA, USA. veronika.fedirko@emory.edu
  • 9 International Agency for Cancer Research (IARC), 150 Cours Albert Thomas, 69372, Lyon, CEDEX 08, France. jenab@iarc.fr
  • 10 Inserm (Institut National de la Santé et de la Recherche Médicale), Centre for Research in Epidemiology and Population Health (CESP), U1018, Team 9, 114 rue Édouard Vaillant, 94805, Villejuif, Cedex, France. marie-christine.boutron@igr.fr
  • 11 Inserm (Institut National de la Santé et de la Recherche Médicale), Centre for Research in Epidemiology and Population Health (CESP), U1018, Team 9, 114 rue Édouard Vaillant, 94805, Villejuif, Cedex, France. laure.dossus@inserm.fr
  • 12 Inserm (Institut National de la Santé et de la Recherche Médicale), Centre for Research in Epidemiology and Population Health (CESP), U1018, Team 9, 114 rue Édouard Vaillant, 94805, Villejuif, Cedex, France. laureen.dartois@igr.fr
  • 13 Section for Epidemiology, Department of Public Health, Aarhus University, Bartholins Allé 2, DK-8000, Aarhus C, Denmark. cph@ph.au.dk
  • 14 Section for Epidemiology, Department of Public Health, Aarhus University, Bartholins Allé 2, DK-8000, Aarhus C, Denmark. ccd@ph.au.dk
  • 15 Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO-IDIBELL), Avda. de la Granvia de l'Hospitalet, 199-203, 08908, Barcelona, Spain. gbuckland@iconcologia.net
  • 16 Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs. GRANADA, Hospitales Universitarios de Granada/Universidad de Granada, Campus Universitario de Cartuja, Cuesta del Observatorio, 4, 18011, Granada, Spain. mariajose.sanchez.easp@juntadeandalucia.es
  • 17 CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, C/ Monforte de Lemos 3-5. Pabellón 11. Planta 0. 28029, Madrid, Spain. m-dorronsoro@ej-gv.es
  • 18 CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, C/ Monforte de Lemos 3-5. Pabellón 11. Planta 0. 28029, Madrid, Spain. carmen.navarro@carm.es
  • 19 CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, C/ Monforte de Lemos 3-5. Pabellón 11. Planta 0. 28029, Madrid, Spain. abarricg@cfnavarra.es
  • 20 Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Roosevelt Drive, Oxford, OX3 7LF, UK. tim.key@ceu.ox.ac.uk
  • 21 Hellenic Health Foundation, 13 Kaisareias Street, Athens, GR-115 27, Greece. atrichopoulou@hhf-greece.gr
  • 22 Hellenic Health Foundation, 13 Kaisareias Street, Athens, GR-115 27, Greece. c.tsironis@hhf-greece.gr
  • 23 Bureau of Epidemiologic Research, Academy of Athens, 23 Alexandroupoleos Street, Athens, GR-115 27, Greece. pdlagiou@med.uoa.gr
  • 24 Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Via delle Oblate 4, 50141, Florence, Italy. g.masala@ispo.toscana.it
  • 25 Epidemiology and Prevention Unit, Fondazione IRCCS, Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, Milan, Italy. valeria.pala@istitutotumori.mi.it
  • 26 Cancer Registry and Histopathology Unit, "Civic - M.P. Arezzo" Hospital, Via Dante Alighieri 109, I-97100, ASP, Ragusa, Italy. rtumino@tin.it
  • 27 Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus, Norfolk Place, W2 1PG, London, UK. p.vineis@imperial.ac.uk
  • 28 Dipartimento di Medicina Clinica e Chirurgia, Federico II University, VIA PANSINI 5, 80131, Naples, Italy. spanico@unina.it
  • 29 Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus, Norfolk Place, W2 1PG, London, UK. bas.bueno.de.mesquita@rivm.nl
  • 30 Department of Gastroenterology and Hepatology, University Medical Centre, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands. p.d.siersema@umcutrecht.nl
  • 31 Division of Internal Medicine, Department of Clinical Sciences, Skane University Hospital, Malmo, Lund University, Inga-Maria Nilssons gata 32, 205 02, Lund, Sweden. bodil.ohlsson@med.lu.se
  • 32 Department of Clinical Sciences, Division of Oncology and Pathology, Lund University, Barngatan 2B, SE- 221 85, Lund, Sweden. karin.jirstrom@med.lu.se
  • 33 Public Health and Clinical Medicine, Nutritional Research, Umeå University, S-901 87, Umeå, Sweden. maria.wennberg@umu.se
  • 34 Arctic Research Centre, Umeå University, S-901 87, Umeå, Sweden. lena.nilsson@umu.se
  • 35 Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, ISM - Universitetet i Tromsø, 9037, Tromsø, Norway. elisabete.weiderpass.vainio@ki.se
  • 36 German Cancer Research Center (DKFZ), Division of Cancer Epidemiology Im Neuenheimer Feld 581, D-69120, Heidelberg, Germany. t.kuehn@dkfz-heidelberg.de
  • 37 German Cancer Research Center (DKFZ), Division of Cancer Epidemiology Im Neuenheimer Feld 581, D-69120, Heidelberg, Germany. v.katzke@dkfz-heidelberg.de
  • 38 University of Cambridge School of Clinical Medicine, Clinical Gerontology Unit Box 251, Addenbrooke's Hospital, Cambridge, CB2 2QQ, UK. kk101@medschl.cam.ac.uk
  • 39 MRC Epidemiology Unit, University of Cambridge, Addenbrooke's Hospital, Cambridge, CB2 2QQ, UK. nick.wareham@mrc-epid.cam.ac.uk
  • 40 Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark. annet@cancer.dk
  • 41 Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, 69120, Germany. boeing@mail.dife.de
  • 42 Public Health Directorate, Ciriaco Miguel Vigil 9, Oviedo, 33417, Asturias, Spain. joseramon.quirosgarcia@asturias.org
  • 43 Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus, Norfolk Place, W2 1PG, London, UK. m.gunter@imperial.ac.uk
  • 44 Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus, Norfolk Place, W2 1PG, London, UK. e.riboli@imperial.ac.uk
  • 45 Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus, Norfolk Place, W2 1PG, London, UK. t.norat@imperial.ac.uk
BMC Med, 2015 May 07;13:107.
PMID: 25948112 DOI: 10.1186/s12916-015-0332-5

Abstract

BACKGROUND: Cancer survivors are advised to follow lifestyle recommendations on diet, physical activity, and body fatness proposed by the World Cancer Research Fund/American Institute of Cancer Research (WCRF/AICR) for cancer prevention. Previous studies have demonstrated that higher concordance with these recommendations measured using an index score (the WCRF/AICR score) was associated with lower cancer incidence and mortality. The aim of this study was to evaluate the association between pre-diagnostic concordance with WCRF/AICR recommendations and mortality in colorectal cancer (CRC) patients.

METHODS: The association between the WCRF/AICR score (score range 0-6 in men and 0-7 in women; higher scores indicate greater concordance) assessed on average 6.4 years before diagnosis and CRC-specific (n = 872) and overall mortality (n = 1,113) was prospectively examined among 3,292 participants diagnosed with CRC in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort (mean follow-up time after diagnosis 4.2 years). Multivariable Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality.

RESULTS: The HRs (95% CIs) for CRC-specific mortality among participants in the second (score range in men/women: 2.25-2.75/3.25-3.75), third (3-3.75/4-4.75), and fourth (4-6/5-7) categories of the score were 0.87 (0.72-1.06), 0.74 (0.61-0.90), and 0.70 (0.56-0.89), respectively (P for trend <0.0001), compared to participants with the lowest concordance with the recommendations (category 1 of the score: 0-2/0-3). Similar HRs for overall mortality were observed (P for trend 0.004). Meeting the recommendations on body fatness and plant food consumption were associated with improved survival among CRC cases in mutually adjusted models.

CONCLUSIONS: Greater concordance with the WCRF/AICR recommendations on diet, physical activity, and body fatness prior to CRC diagnosis is associated with improved survival among CRC patients.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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