title: Nutrition and physical activity cancer prevention guidelines, cancer risk, and mortality in the women's health initiative.
abstract: Healthy lifestyle behaviors are recommended to reduce cancer risk and overall mortality. Adherence to cancer-preventive health behaviors and subsequent cancer risk has not been evaluated in a diverse sample of postmenopausal women. We examined the association between the American Cancer Society (ACS) Nutrition and Physical Activity Cancer Prevention Guidelines score and risk of incident cancer, cancer-specific mortality, and all-cause mortality in 65,838 postmenopausal women enrolled in the Women's Health Initiative Observational Study. ACS guidelines scores (0-8 points) were determined from a combined measure of diet, physical activity, body mass index (current and at age 18 years), and alcohol consumption. After a mean follow-up of 12.6 years, 8,632 incident cancers and 2,356 cancer deaths were identified. The highest ACS guidelines scores compared with the lowest were associated with a 17% lower risk of any cancer [HR, 0.83; 95% confidence interval (CI), 0.75-0.92], 22% lower risk of breast cancer (HR, 0.78; 95% CI, 0.67-0.92), 52% lower risk of colorectal cancer (HR, 0.48; 95% CI, 0.32-0.73), 27% lower risk of all-cause mortality, and 20% lower risk of cancer-specific mortality (HR, 0.80; 95% CI, 0.71-0.90). Associations with lower cancer incidence and mortality were generally strongest among Asian, black, and Hispanic women and weakest among non-Hispanic whites. Behaviors concordant with Nutrition and Physical Activity Cancer Prevention Guidelines were associated with lower risk of total, breast, and colorectal cancers and lower cancer-specific mortality in postmenopausal women.
authors.affiliation: Health Promotion Sciences, Canyon Ranch Center for Prevention & Health Promotion, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Street, Tucson, AZ 85721. cthomson@email.arizona.edu.
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Thomson
authors.forename: Marjorie L
authors.initials: ML
authors.lastname: McCullough
authors.forename: Betsy C
authors.initials: BC
authors.lastname: Wertheim
authors.forename: Rowan T
authors.initials: RT
authors.lastname: Chlebowski
authors.forename: Maria Elena
authors.initials: ME
authors.lastname: Martinez
authors.forename: Marcia L
authors.initials: ML
authors.lastname: Stefanick
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Rohan
authors.forename: Joann E
authors.initials: JE
authors.lastname: Manson
authors.forename: Hilary A
authors.initials: HA
authors.lastname: Tindle
authors.forename: Judith
authors.initials: J
authors.lastname: Ockene
authors.forename: Mara Z
authors.initials: MZ
authors.lastname: Vitolins
authors.forename: Jean
authors.initials: J
authors.lastname: Wactawski-Wende
authors.forename: Gloria E
authors.initials: GE
authors.lastname: Sarto
authors.forename: Dorothy S
authors.initials: DS
authors.lastname: Lane
authors.forename: Marian L
authors.initials: ML
authors.lastname: Neuhouser
mesh_terms: D000368:Aged; D000428:Alcohol Drinking; D015992:Body Mass Index; D004032:Diet; D005006:Ethnicity; D015444:Exercise; D005260:Female; D005500:Follow-Up Studies; D017408:Guidelines as Topic; D006801:Humans; D015994:Incidence; D008019:Life Style; D009043:Motor Activity; D009369:Neoplasms / Q000401:mortality* / Q000517:prevention & control*; D017698:Postmenopause; D011446:Prospective Studies; D012307:Risk Factors; D016387:Women's Health