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
Menée à l'aide des données d'une étude italienne portant sur 11 312 personnes (durée médiane de suivi : 13,2 ans), cette étude analyse l'association entre le respect des recommandations 2018 du "World Cancer Research Fund/American Institute of Cancer Research" et le risque de cancer du sein (290 cas) par sous-type et en fonction du statut ménopausique
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.
Cancer Epidemiology , résumé, 2026