Table 5.
Time-Varying WCRF/AICR Guideline Adherence Scores and Breast Cancer Risk by Hormone Receptor Subtype
| ER+ and PR+
|
ER+ or PR+
|
ER− and PR−
|
||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Cases N (%) |
Person- Years |
HR (95% CI)1,2 | P3 | Cases N (%) |
Person- Years |
HR (95% CI)1,2 | P3 | Cases N (%) |
Person- Years |
HR (95% CI)1,2 | P3 | |
| WCRF/AICR Score4 | 686 | 637,783 | 0.93 (0.83–1.03) | 0.16 | 196 | 632,920 | 1.02 (0.84–1.24) | 0.84 | 399 | 634,682 | 0.85 (0.74–0.98) | 0.03 |
| WCRF/AICR Score | 0.29 | 0.86 | 0.05 | |||||||||
| < 3.0 points | 362 | 338,321 | Reference | 109 | 335,853 | Reference | 211 | 336,659 | Reference | |||
| 3.0 – 4.0 points | 285 | 263,183 | 0.88 (0.73–1.07) | 73 | 261,018 | 0.88 (0.61–1.27) | 176 | 262,938 | 0.94 (0.72–1.20) | |||
| > 4.0 points | 39 | 36,279 | 0.97 (0.67–1.42) | 14 | 36,049 | 1.33 (0.70–2.53) | 12 | 36,085 | 0.32 (0.14–0.74) | |||
| Diet Score4,5,7 | 709 | 659,952 | 0.98 (0.85–1.13) | 0.80 | 198 | 654,821 | 0.99 (0.76–1.29) | 0.93 | 407 | 656,633 | 0.85 (0.70–1.03) | 0.09 |
| Diet Scoree,g | 0.55 | 0.81 | 0.32 | |||||||||
| < 2.0 points | 161 | 184,548 | Reference | 51 | 183,326 | Reference | 96 | 183,680 | Reference | |||
| 2.0 – 3.0 points | 496 | 433,039 | 1.13 (0.90–1.42) | 131 | 429,423 | 1.01 (0.66–1.54) | 282 | 430,772 | 1.01 (0.75–1.36) | |||
| > 3.0 points | 52 | 42,365 | 1.01 (0.69–1.49) | 16 | 42,072 | 0.84 (0.40–1.76) | 29 | 42,181 | 0.64 (0.36–1.13) | |||
| Body Weight6,7 | 0.49 | 0.76 | 0.39 | |||||||||
| Non-Adherence | 557 | 467,305 | Reference | 158 | 463,498 | Reference | 327 | 464,796 | Reference | |||
| Partial Adherence | 109 | 130,621 | 0.92 (0.72–1.16) | 33 | 129,720 | 1.06 (0.68–1.64) | 67 | 130,111 | 0.90 (0.66–1.23) | |||
| Adherence | 42 | 64,374 | 0.93 (0.65–1.34) | 12 | 63,988 | 1.09 (0.58–2.06) | 22 | 64,130 | 0.85 (0.53–1.37) | |||
| Physical Activity5,6 | 0.22 | 0.49 | 0.10 | |||||||||
| Non-Adherence | 334 | 297,124 | Reference | 101 | 294,886 | Reference | 197 | 295,610 | Reference | |||
| Partial Adherence | 299 | 279,179 | 0.94 (0.79–1.13) | 92 | 277,045 | 1.10 (0.78–1.54) | 173 | 277,850 | 0.88 (0.70–1.12) | |||
| Adherence | 75 | 81,901 | 0.82 (0.60–1.12) | 12 | 81,240 | 0.65 (0.34–1.24) | 41 | 81,511 | 0.71 (0.47–1.09) | |||
| Sugar Beverages5,6,7 | 0.07 | 0.98 | 0.37 | |||||||||
| Non-Adherence | 367 | 378,418 | Reference | 99 | 375,688 | Reference | 225 | 376,808 | Reference | |||
| Partial Adherence | 337 | 275,534 | 0.93 (0.78–1.11) | 99 | 273,121 | 1.02 (0.72–1.45) | 182 | 273,842 | 0.91 (0.71–1.16) | |||
| Adherence | 16 | 18,275 | 0.55 (0.32–0.93) | 7 | 18,214 | 0.95 (0.40–2.23) | 11 | 18,211 | 0.83 (0.44–1.54) | |||
| Plant Foods5,6,7 | 0.01 | 0.43 | 0.60 | |||||||||
| Non-Adherence | 496 | 505,600 | Reference | 138 | 501,863 | Reference | 302 | 503,280 | Reference | |||
| Partial Adherence | 186 | 139,871 | 1.20 (0.98–1.46) | 54 | 138,633 | 1.24 (0.85–1.81) | 94 | 139,008 | 0.90 (0.68–1.21) | |||
| Adherence | 27 | 15,238 | 1.63 (1.05–2.53) | 6 | 15,073 | 1.06 (0.42–2.70) | 11 | 15,097 | 1.02 (0.51–2.03) | |||
| Red/Processed Meat5,6,7 | 0.81 | 0.35 | 0.02 | |||||||||
| Non-Adherence | 151 | 154,822 | Reference | 40 | 153,624 | Reference | 98 | 154,106 | Reference | |||
| Partial Adherence | 434 | 395,505 | 0.98 (0.78–1.23) | 127 | 392,467 | 1.43 (0.89–2.29) | 252 | 393,581 | 0.82 (0.61–1.09) | |||
| Adherence | 135 | 121,899 | 0.97 (0.72–1.29) | 38 | 120,932 | 1.35 (0.76–2.41) | 68 | 121,175 | 0.64 (0.43–0.94) | |||
| Alcohol5,7 | 0.59 | 0.23 | 0.46 | |||||||||
| Non-Adherence | 4 | 4,437 | Reference | 4 | 8,819 | Reference | 6 | 638,228 | Reference | |||
| Partial Adherence | 29 | 10,656 | 2.70 (0.81–9.01) | 8 | 21,081 | 1.11 (0.29–4.18) | 16 | 21,117 | 1.02 (0.36–2.85 | |||
| Adherence | 687 | 321,014 | 2.25 (0.72–7.00) | 193 | 636,445 | 0.70 (0.22–2.22) | 396 | 8,835 | 0.83 (0.34–2.02) | |||
| Salt5,6,7 | 0.55 | 0.13 | 0.85 | |||||||||
| Non-Adherence | 319 | 294,848 | Reference | 94 | 292,562 | Reference | 170 | 293,166 | Reference | |||
| Partial Adherence | 237 | 240,035 | 0.77 (0.60–0.98) | 75 | 238,267 | 0.76 (0.48–1.21) | 141 | 238,957 | 0.88 (0.63–1.23) | |||
| Adherence | 164 | 137,208 | 0.90 (0.65–1.25) | 36 | 136,058 | 0.61 (0.32–1.16) | 107 | 136,603 | 1.03 (0.67–1.59) | |||
Abbreviations: AICR, American Institute for Cancer Research; CI, confidence interval; ER+, estrogen receptor positive; ER- estrogen receptor negative; HR, hazard ratio; N, number; PR+, progesterone receptor positive; PR-, progesterone receptor negative; WCRF, World Cancer Research Fund
Hazard ratios and 95% confidence intervals were calculated using proportional hazards regression.
Time-varying analysis using Anderson-Gill Method to update both WCRF score and covariates. Covariates: age, geographic region of residence (Northeast, South, Midwest, West, other), kilocalories/day (continuous), smoking (never, former, <15 cigarettes/day, ≥15 cigarettes/day), family history of breast cancer (yes/no), education (≤12, 13–15, ≥16 years), menopausal status (pre/post), oral contraceptive use (never, 0.5–5, ≥5 years), parity (none, 1–2, ≥3 children), menopausal hormone use (premenopausal, postmenopausal-never, postmenopausal-<5 years, postmenopausal- ≥ 5 years)
Test for trend.
Per 0.5 unit increase.
Additionally adjusted for: BMI (<25, 25-<30, ≥30 kg/m2)
Additionally adjusted for alcohol (<1, 1–6, 7–13, ≥14 drinks/week)
Additionally adjusted for physical activity (high, moderate, low) and sedentary time (≥ 8, 5–7, ≤ 5 hrs./day sitting)