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Nutrition and physical activity cancer prevention guidelines, cancer risk, and mortality in the women's health initiative.

  • Thomson, Cynthia A
  • McCullough, Marjorie L
  • Wertheim, Betsy C
  • Chlebowski, Rowan T
  • Martinez, Maria Elena
  • Stefanick, Marcia L
  • Rohan, Thomas E
  • Manson, Joann E
  • Tindle, Hilary A
  • Ockene, Judith
  • Vitolins, Mara Z
  • Wactawski-Wende, Jean
  • Sarto, Gloria E
  • Lane, Dorothy S
  • Neuhouser, Marian L
Published Article
Cancer prevention research (Philadelphia, Pa.)
Publication Date
Jan 01, 2014
DOI: 10.1158/1940-6207.CAPR-13-0258
PMID: 24403289


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.


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