Adherence to the World Cancer Research Fund/American Institute for Cancer Research recommendations and endometrial cancer risk: a multicentric case-control study

The World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) published evidence-based recommendations for cancer prevention focusing on body weight, physical activity and diet. Our aim is to evaluate whether adherence to the WCRF/AICR recommendations could reduce endometrial cancer risk. We used data from a multicentric, Italian hospital-based case-control study (1992-2006) including 454 endometrial cancer cases and 908 age-matched controls. Adherence to the WCRF/AICR recommendations was measured using a score (range: 0-7) based on seven components: body mass index (BMI), physical activity and five dietary items; higher scores indicated higher adherence. Odds ratios (ORs) were estimated by multiple (adjusted) conditional logistic regression models including terms for major confounders and energy intake. Adherence to the WCRF/AICR recommendations was inversely related with endometrial cancer risk (OR=0.42, 95% confidence interval (CI): 0.30-0.61 for the highest compared to the lowest score quartile), with a significant trend of decreasing risk with increasing adherence. An inverse association was also observed for a score including only dietary recommendations (OR=0.67, 95% CI: 0.46-0.96 for the highest compared to the lowest score tertile). In stratified analyses, the association was stronger among women with a normal weight, those who were older, and consequently those in postmenopause, and those with ≥2 children. In conclusion, high adherence to the WCRF/AICR recommendations has a favorable role in endometrial cancer risk, which is not fully explained by body weight.