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. 2025 Feb 19;17(4):708.
doi: 10.3390/cancers17040708.

Determinants of Adherence to World Cancer Research Fund/American Institute for Cancer Research Recommendations in Women with Breast Cancer

Vanessa Pachón Olmos  1 , Marina Pollán  2   3 , Nerea Fernández de Larrea-Baz  2   3 , Julia Fernández-Morata  4 , Emma Ruiz-Moreno  2   3 , Javier García-Pérez  2   3 , Adela Castelló  2   3 , María Ángeles Sierra  2   3 , Pilar Lucas  2 , Isabel Alonso-Ledesma  2   3 , Agostina Stradella  5 , Blanca Cantos  6 , Teresa Ramón Y Cajal  7 , Marta Santisteban  8 , Miguel Ángel Seguí  9 , Ana Santaballa Bertrán  10 , Mónica Granja  11 , Julia Camps-Herrero  12 , Sabela Recalde  13 , Miriam Mendez  6 , Nuria Calvo Verges  7 , Beatriz Pérez-Gómez  2   3 , Roberto Pastor-Barriuso  2   3 , Virginia Lope  2   3
Affiliations

Determinants of Adherence to World Cancer Research Fund/American Institute for Cancer Research Recommendations in Women with Breast Cancer

Vanessa Pachón Olmos et al. Cancers (Basel). .

Abstract

Background/objectives: The 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) cancer prevention recommendations benefit primary prevention and survivor outcomes. This study evaluated the adherence to these recommendations during the year prior to breast cancer diagnosis and identified related clinical and sociodemographic factors.

Methods: A total of 915 patients with breast cancer were recruited from eight hospitals in four regions of Spain. The participants completed an epidemiologic questionnaire and a food frequency questionnaire. The compliance with the WCRF/AICR recommendations was assessed using a standardized score based on seven recommendations. Standardized prevalences and standardized prevalence ratios (SPRs) for moderate and high adherence were calculated based on participant characteristics using binary and multinomial logistic regression models.

Results: The mean adherence was 3.5 points out of 7. The recommendations with the best and worst adherence were avoiding sugar-sweetened drinks (54.4% adherence) and maintaining a fiber-rich diet (4.4% consumed ≥30 g/day). The overall adherence was better in women aged ≥60 years (SPR = 1.55; 95% CI = 1.09-2.22), and worse in those with a caloric intake ≥2000 kcal/day (SPR = 0.48; 95% CI = 0.37-0.62) or ≥2 comorbidities (SPR = 0.66; 95% CI = 0.49-0.89). The adherence to maintaining a healthy weight was worse in those with ≥2 comorbidities and stage III-IV tumors. The physical activity adherence was worse in working women and those with ≥2 comorbidities. The alcohol restriction adherence was worse in smokers. Younger women, smokers and those with a low calorie intake were less adherent to the fruit/vegetable recommendation. The consumption of fiber and limited consumption of red/processed meat adherence was poor in all the subgroups. The adherence to a limited consumption of fast food and sugary drinks was worse in younger women and high-calorie-diet consumers.

Conclusions: The differences in the adherence to recommendations according to patient characteristics justify the design of personalized interventions for breast cancer patients.

Keywords: WCRF/AICR guidelines; breast cancer patients; cancer prevention recommendations; compliance; health behaviors; healthy lifestyle; lifestyle recommendations.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Standardized prevalence of compliance with specific WCRF/AICR lifestyle recommendations by participant characteristics at diagnosis. Prevalences (squares with area inversely proportional to their variances) and 95% confidence intervals (horizontal lines) were standardized to the overall distribution of age, recruiting region, educational level, working status, smoking status, caloric intake, menopausal status, parity, number of comorbidities, family history of breast cancer, years since diagnosis and the overall adherence to the other recommendations in the entire sample of breast cancer patients. Column colors correspond to tertiles of total adherence score.
Figure 2
Figure 2
Standardized prevalence of compliance with specific WCRF/AICR dietary recommendations by participant characteristics at diagnosis. Prevalences (squares with area inversely proportional to their variances) and 95% confidence intervals (horizontal lines) were standardized to the overall distribution of age, recruiting region, educational level, working status, smoking status, caloric intake, menopausal status, parity, number of comorbidities, family history of breast cancer, years since diagnosis and the overall adherence to the other recommendations in the entire sample of breast cancer patients. Column colors correspond to tertiles of total adherence score.
See this image and copyright information in PMC

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