Abstract 861: The association between cancer prevention guidelines and cancer risk in the Southern Community Cohort Study
Authors: Warren Andersen Shaneda N. , Sonderman Jennifer , Shu Xiao-Ou , Yu Danxia , Steinwandel Mark , McLaughlin Joesph K. , Hargreaves Margaret K. , Blot William J. , Zheng Wei 
Published: August 2015

Abstract
Background: Public health and cancer prevention guidelines recommend healthy behaviors to decrease overall cancer risk. The impact of cancer prevention guidelines on cancer incidence has been rarely studied in low-income Whites and African Americans.
Design: We quantified the association of meeting current American Cancer Society cancer prevention guidelines, as measured by non-smoking, none to moderate alcohol intake, higher diet quality, and regular physical activity with total and site-specific cancer incidence. Data were obtained at enrollment from 73,022 adults age 40-79, without a previous cancer diagnosis, participating in the Southern Community Cohort Study. The Southern Community Cohort Study is a prospective cohort study that enrolled participants during 2002-2009, in 12 southeastern US states via Community Health Centers (86%) or stratified random sampling of the general population (14%). Fifty-six percent of the cohort has a household income&lt;$15,000. The median follow-up time for cohort members was 6 years.
Exposures: We created a healthy guidelines score by counting the number of cancer prevention guidelines each participant met for tobacco smoking, alcohol intake, diet, and physical activity.
Outcomes: Breast (N = 503), prostate (N = 479), lung (N = 621), colorectal (N = 333), other (N = 1374), and total cancer incidence (N = 3,310) were identified from state cancer registries through December 31, 2011.
Results: Meeting fewer cancer prevention guidelines was associated with increased cancer incidence: hazard ratios (HRs) for overall cancer incidence comparing participants with four guidelines met vs three, two, one, or zero guidelines were 1.04 (95% confidence interval (CI): 0.79-1.38), 1.23 (0.94-1.61), 1.52 (1.16-1.98), and 1.86 (1.40-2.46), respectively. Tests for interactions with race and sex were not statistically significant. The association between the healthy guidelines score and total cancer incidence was most apparent in participants with normal weight (body mass index 18.5-24.9 kg/m2) (P-interaction = 0.02). The strongest association was observed for lung cancer risk largely attributable to the sizable numbers of current smokers in the cohort; the HR for participants meeting no guideline recommendations compared to participants meeting three or four healthy guidelines was 6.78 (95%CI: 4.24-10.84). Weaker and non-significant associations were observed between the healthy guidelines score and breast, colorectal, and prostate cancer risk (all P-trends&gt;0.10).
Conclusions: Meeting current public health guidelines is associated with substantial reductions in cancer incidence. This study provides support for individual lifestyle modification to reduce cancer incidence in this under-served population.
Citation Format: Shaneda N. Warren Andersen, Jennifer Sonderman, Xiao-Ou Shu, Danxia Yu, Mark Steinwandel, Joesph K. McLaughlin, Margaret K. Hargreaves, William J. Blot, Wei Zheng. The association between cancer prevention guidelines and cancer risk in the Southern Community Cohort Study. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 861. doi:10.1158/1538-7445.AM2015-861