Cancer Res Treat.  2023 Jan;55(1):15-27. 10.4143/crt.2021.1031.

Adherence to Cancer Prevention Guidelines and Cancer Incidence and Mortality: A Population-Based Cohort Study

• Oh JK
• Han M
• Kim B
• Park EY

• KMID: 2537988
• DOI: http://doi.org/10.4143/crt.2021.1031

Abstract

Purpose
This study aimed to estimate the risk of cancer incidence and mortality according to adherence to lifestyle-related cancer prevention guidelines.
Materials and Methods
Men and women who participated in the general health screening program in 2002 and 2003 provided by the National Health Insurance Service were included (n=8,325,492). Self-reported smoking, alcohol consumption, and physical activity habits and directly measured body mass index were collected. The participants were followed up until the date of cancer onset or death or 31 December 2018. The Cox proportional hazard model was used to evaluate the hazard ratio (HR) for cancer incidence and mortality according to different combinations of lifestyle behaviors.
Results
Only 6% of men and 15% of women engaged in healthy behavior at baseline, such as not smoking, not drinking alcohol, being moderately or highly physically active, and within a normal body mass index range. Compared to the best combination of healthy lifestyle behaviors, the weak and moderate associations with increased all cancer incidence (HR < 1.7) and mortality (HR < 2.5) were observed in those with heavy alcohol consumption and in former or current smokers. HRs of cancer mortality were significantly increased among current smokers in most combinations.
Conclusion
Compared to full adherence to cancer prevention recommendations, unhealthy behaviors increase cancer risk. As few people meet these recommendations, there is a great opportunity for cancer prevention.

Keyword

Neoplasms; Prevention; Smoking; Alcohol; Body mass index; Physical activity; Republic of Korea

Figure

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  Fig. 1 Study flow diagram: selection of the study population and cancer outcomes. BMI, body mass index; NHIS, National Health Insurance System.

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  Fig. 2 (A–G) Relative risks of cancer incidence according to 81 combinations of adherence to cancer prevention guidelines. Smoking: 0, never; 1, former; 2, current smoker. Alcohol consumption: 0, nondrinking (0 g/day); 1, moderate drinking (≤ 50 g/day); 2, heavy drinking (> 50 g/day). Physical activity: 0, very active (5 or more times per week); 1, moderate (1–4 times per week); 2, inactive (< 1 time per week). Body mass index (BMI): 0, normal weight (< 23.0 kg/m2); 1, overweight (23.0–24.9 kg/m2); 2, obese (≥ 25.0 kg/m2). Reference group: full adherence to a healthy lifestyle (combination of never smoking, no consumption of alcohol, normal BMI and physically very active). Adjusted for age, sex, and (for liver cancer) chronic hepatitis. Bold fonts indicate statistically significant according to a Bonferroni-adjusted significance level of 0.000625. Gray and italic fonts indicate cells with an insufficient number of cases. HR, hazard ratio.

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  Fig. 3 Relative risks of all cancer mortality according to 81 combinations of adherence to cancer prevention guidelines. Smoking: never, former, current smoker. Alcohol consumption: 0 g/day, nondrinking; ≤ 50 g/day, moderate drinking; > 50 g/day, heavy drinking. Physical activity: very active, 5 or more time a week; moderate, 1–4 times per week; inactive, < 1 time per week. Body mass index (BMI): normal weight, < 23.0 kg/m2; overweight, 23.0–24.9 kg/m2; obesity, ≥ 25.0 kg/m2. Reference group: full adherence to a healthy lifestyle (combination of never smoking, no consumption of alcohol, normal BMI and physically very active). Adjusted for age and sex. Bold fonts indicate statistically significant according to a Bonferroni-adjusted significance level of 0.000625. HR, hazard ratio.

Reference

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