Association between adherence to cancer prevention guidelines and cancer risk: a comprehensive systematic review and dose-response meta-analysis of cohort studies
A partir d'une revue systématique de la littérature publiée jusqu'en juillet 2025 (28 articles), cette méta-analyse évalue l'association entre le respect des principales recommandations en matière de prévention du cancer et le risque de développer la maladie
Background: No systematic review and meta-analysis has comprehensively assessed the association between adherence to major cancer prevention guidelines and risks of cancers in cohort studies. We aimed to evaluate the associations of adherence to the 2018 and the 2007 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) and the 2012 American Cancer Society (ACS) guidelines with risks of multiple cancer outcomes.
Methods: This systematic review and meta-analysis was conducted by searching cohort studies across PubMed, Web of Science, Embase, and Scopus, from database inception to July 31, 2025. We assessed associations between adherence to the three major global cancer prevention guidelines: the 2018 WCRF/AICR guidelines, the 2007 WCRF/AICR guidelines, and the 2012 ACS guidelines, and the risk of total cancer, obesity-related cancer, and 13 site-specific cancers (Colorectal, Breast, Lung, Prostate, Bladder, Kidney, Stomach, Pancreas, Esophagus, Liver, Ovary, Uterus, Gallbladder). Hazard ratios (HRs) with 95% confidence intervals (CIs) were extracted to evaluate risks of cancers. DerSimonian and Laird random-effects models were used to pool effect sizes, and the I2 statistic was employed to quantify heterogeneity. The strength of associations was quantified by the magnitude of HRs and 95% CIs. A qualitative synthesis was undertaken to assess additional cancers. Study quality was evaluated using the Newcastle-Ottawa Scale. Publication bias was examined by funnel plots, Egger's test, and Begg's test.
Findings: This study comprised 28 cohort articles, examining 15 cancer types for quantitative analysis and 15 additional cancer types for qualitative analysis. It revealed that adherence to cancer prevention guidelines was associated with a significant 14% reduction in total cancer risk (HR = 0.86, 95% CI: 0.83–0.88, I2 = 68.1%). Significant risk reductions were consistently observed across three guidelines for the following cancers: colorectal cancer (HR = 0.69, 95% CI: 0.63–0.74, I2 = 65.3%), breast cancer (HR = 0.80, 95% CI: 0.74–0.85, I2 = 64.5%), lung cancer (HR = 0.80, 95% CI: 0.69–0.91, I2 = 83.6%), kidney cancer (HR = 0.62, 95% CI: 0.56–0.69, I2 = 22.7%), esophageal cancer (HR = 0.61, 95% CI: 0.52–0.70, I2 = 0.0%), obesity-related cancers (HR = 0.78, 95% CI: 0.71–0.85, I2 = 59.3%), uterus cancer (HR = 0.65, 95% CI: 0.47–0.83, I2 = 89.9%). In contrast, no significant associations were found for prostate cancer (HR = 1.00, 95% CI: 0.93–1.06, I2 = 52.6%) or ovarian cancer (HR = 0.87, 95% CI: 0.67–1.06, I2 = 66.4%), findings that were consistent across all three guidelines.
Interpretation: Adherence to cancer prevention guidelines was associated with reduced risks of total cancer and multiple major cancers, while no significant associations were observed for prostate cancer or ovarian cancer. These findings reinforce the importance of integrating cancer prevention guidelines into public health strategies for cancer prevention. Further research is warranted to elucidate associations of 2018 WCRF/AICR with risk of a broader spectrum of cancers, particularly in Asian populations.
eClinicalMedicine , article en libre accès, 2025