Association between adherence to cancer prevention guidelines and cancer risk: a comprehensive systematic review and dose-response meta-analysis of cohort studies
Bibliographic record
Abstract
Background No systematic review and meta-analysis has comprehensively assessed the association between adherence to major cancer prevention guidelines and risks of cancers in cohort studies. We aimed to evaluate the associations of adherence to the 2018 and the 2007 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) and the 2012 American Cancer Society (ACS) guidelines with risks of multiple cancer outcomes. Methods This systematic review and meta-analysis was conducted by searching cohort studies across PubMed, Web of Science, Embase, and Scopus, from database inception to July 31, 2025. We assessed associations between adherence to the three major global cancer prevention guidelines: the 2018 WCRF/AICR guidelines, the 2007 WCRF/AICR guidelines, and the 2012 ACS guidelines, and the risk of total cancer, obesity-related cancer, and 13 site-specific cancers (Colorectal, Breast, Lung, Prostate, Bladder, Kidney, Stomach, Pancreas, Esophagus, Liver, Ovary, Uterus, Gallbladder). Hazard ratios (HRs) with 95% confidence intervals (CIs) were extracted to evaluate risks of cancers. DerSimonian and Laird random-effects models were used to pool effect sizes, and the I 2 statistic was employed to quantify heterogeneity. The strength of associations was quantified by the magnitude of HRs and 95% CIs. A qualitative synthesis was undertaken to assess additional cancers. Study quality was evaluated using the Newcastle-Ottawa Scale. Publication bias was examined by funnel plots, Egger's test, and Begg's test. Findings This study comprised 28 cohort articles, examining 15 cancer types for quantitative analysis and 15 additional cancer types for qualitative analysis. It revealed that adherence to cancer prevention guidelines was associated with a significant 14% reduction in total cancer risk (HR = 0.86, 95% CI: 0.83–0.88, I 2 = 68.1%). Significant risk reductions were consistently observed across three guidelines for the following cancers: colorectal cancer (HR = 0.69, 95% CI: 0.63–0.74, I 2 = 65.3%), breast cancer (HR = 0.80, 95% CI: 0.74–0.85, I 2 = 64.5%), lung cancer (HR = 0.80, 95% CI: 0.69–0.91, I 2 = 83.6%), kidney cancer (HR = 0.62, 95% CI: 0.56–0.69, I 2 = 22.7%), esophageal cancer (HR = 0.61, 95% CI: 0.52–0.70, I 2 = 0.0%), obesity-related cancers (HR = 0.78, 95% CI: 0.71–0.85, I 2 = 59.3%), uterus cancer (HR = 0.65, 95% CI: 0.47–0.83, I 2 = 89.9%). In contrast, no significant associations were found for prostate cancer (HR = 1.00, 95% CI: 0.93–1.06, I 2 = 52.6%) or ovarian cancer (HR = 0.87, 95% CI: 0.67–1.06, I 2 = 66.4%), findings that were consistent across all three guidelines. Interpretation Adherence to cancer prevention guidelines was associated with reduced risks of total cancer and multiple major cancers, while no significant associations were observed for prostate cancer or ovarian cancer. These findings reinforce the importance of integrating cancer prevention guidelines into public health strategies for cancer prevention. Further research is warranted to elucidate associations of 2018 WCRF/AICR with risk of a broader spectrum of cancers, particularly in Asian populations. Funding This research was supported by a National Research Foundation of Korea (NRF) grant funded by the Korean government through the Ministry of Science and ICT (MSIT) (grant number: RS-2025-00556573).
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.013 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.004 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".