(P21-014-24) Modifications of the 2018 World Cancer Research Fund (WCRF)/American Institute for Cancer Research (AICR) Score and Cancer Risk in the UK Biobank Prospective Cohort Study

Objectives: The 2018 WCRF/AICR Score (hereafter Score) is a standardised scoring system to assess adherence to the 2018 WCRF/AICR Cancer Prevention Recommendations, which aim to reduce cancer risk. We explored methodological changes to improve the Score and examine its impact on associations with cancer risk.

Methods: We included 94,778 cancer-free participants (53% female, mean age 56) from the UK Biobank prospective cohort study for whom a total Score (sum of all Score components) could be derived. Scores (range 0-7 points) were calculated from dietary, alcohol, physical activity, and anthropometric data. We applied the following modifications: i) expanding the body weight recommendation sub-score to include body fat percentage and A Body Shape Index; ii) expanding the physical activity recommendation sub-score to include sedentary behavior (proxy based on time spent driving, watching television, or using a computer), and iii) modifying physical activity and red meat recommendation score cut-points to align with evidence for more optimal health. Modifications were applied in different combinations, resulting in multiple total Score variants. Associations between Score variants and risk of all cancers combined were investigated using multivariate Cox proportional hazard models.

Results: Mean total original Score was 3.84 (SD 1.0) points. The largest difference in Score (-0.15 points, p< 0.001) followed application of the higher physical activity cut-point. Each variant Score correlated positively with the original Score (Pearson’s coefficient >0.96, p< 0.001). In a median follow-up time of 7.9 years, 7,296 participants developed cancer. Each 1-point increment in the original Score was associated with a 7% lower cancer risk (HR=0.93, 95%CI: 0.90-0.95, p< 0.001). Inverse associations of a similar magnitude were found for all Score variants; the greatest risk reduction was observed by incorporating sedentary behaviour and changing the red meat cut-point (HR=0.92, 95%CI: 0.90-0.94, p< 0.001).

Conclusions: We found inverse associations between variants of the 2018 WCRF/AICR Score and cancer risk. Incorporating sedentary behaviour and applying more stringent criteria for meeting the recommendation to limit red meat intake may improve predictive utility for cancer risk.

Funding Sources: This research was funded by the Wereld Kanker Onderzoek Fonds (WKOF).