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The Science Nook on WCRC/AICR Score and Risk of Breast, Prostate, and Colorectal Cancers

by Jenna Koroly, MS, RD, CSOWM, CDN

The World Cancer Research Fund estimates that about one fourth to one third of the most common cancers are related to excess body weight, low physical activity, and a non-nutritious eating pattern [World Cancer Research Fund/American Institute for Cancer Research, 2009, as cited in reference I]. With prostate cancer being the most common cancer in males, breast cancer the most common in females, and colorectal cancer the most common in both males and females in Spain, the below study explores lifestyle factors and risks of these cancers in Spain [Ferlay J, Soerjomataram I, Dikshit R, et al., 2012, as cited in reference I]. The World Cancer Research Fund and the American Institute for Cancer Research report as part of the Continuous Update Project report that lung and breast cancers were the most common and colorectal the third most common worldwide in 2018.


Adherence to nutrition-based cancer prevention guidelines and breast, prostate and colorectal cancer risk in the MCC-Spain case-control study

Journal: International Journal of Cancer

This study involved over 1700 colorectal, over 1300 breast, and over 800 prostate cancer cases along with over 3400 population-based controls. These individuals were part of a multicase-control study called MCC-Spain from 2008-2013 with participant ages ranging from 20 to 85 years in 23 Spanish hospitals in 12 Spanish provinces.

The authors constructed The World Cancer Research Fund/American Institute for Cancer Research (WCRC/AICR) score (0-6) based on 2007 recommendations related to eating pattern, physical activity, and body fatness. The score involved six recommendations: “body fatness, physical activity, foods and drinks that promote weight gain, plant foods, animal foods, alcoholic drinks.”


The authors found:

1. Each point increment in the WCRF/AICR score was associated with 25% lower risk of colorectal cancer, with a stronger associated between never smokers than former or current smokers

2. Each point increment in the WCRF/AICR score was associated with 15% lower risk of breast cancer in postmenopausal women

3. No associated between WCRF/AICR score and prostate cancer risk

For the Patient and Caregiver

The WCRF/AICR score is based on lifestyle factors, which may have an influence on risk of colorectal and breast cancers. With this in mind, an actionable goal is maintaining a healthy body weight (BMI < 24.9 kg/m2) through physical activity of at least 30 minutes of brisk walking (or an equivalent activity) each day and a nutritious eating pattern outlined as follows. Specifically, the present score is based on recommendations of limiting consumption of energy-dense foods (such as soda and other sugary beverages), eating at least 5 servings of vegetables and fruits each day, eating less than 500 g (~18 oz) of red meat per week, with very little if any processed meat, and limiting consumption of alcohol to two drinks per day for men and one drink per day for women.

For the Healthcare Team

With the above recommendations determining the WCRF/AICR score, work with patients to develop SMART (specific, measurable, achievable, relevant, and time-based) goals. An example of this may be: include 1 cup of blueberries at breakfast and 2 cups of spinach or kale at dinner at least 4 out of 7 days per week. When focusing on maintaining a healthy body weight, encourage cardiovascular and strength-training exercises as part of long-term lifestyle changes rather than short-term diet and exercise programs which tend to lead to weight fluctuations. Of note, the authors discuss the findings on smokers may be due to tobacco counteracting beneficial effects of other lifestyle factors, and the findings on prostate cancer are consistent with those of previous research finding no association between eating pattern and prostate cancer risk.

[i] Romaguera D, Gracia-Lavedan E, Molinuevo A, Batlle J, Mendez M, Moreno V, Vidal C…Amiano P. (2017). Adherence to nutrition-based cancer prevention guidelines and breast, prostate and colorectal cancer risk in the MCC-Spain case–control study. International Journal of Cancer: 141, 83-93. doi: 10.1002/ijc.30722

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