Cancer-related risk factors and incidence of major cancers by race, gender and region; analysis of the NIH-AARP diet and health study.
BACKGROUND
Racial disparities in the incidence of major cancers may be attributed to differences in the prevalence of established, modifiable risk factors such as obesity, smoking, physical activity and diet.


METHODS
Data from a prospective cohort of 566,398 adults aged 50-71 years, 19,677 African-American and 450,623 Whites, was analyzed. Baseline data on cancer-related risk factors such as smoking, alcohol, physical activity and dietary patterns were used to create an individual adherence score. Differences in adherence by race, gender and geographic region were assessed using descriptive statistics, and Cox proportional hazards models were used to determine the association between adherence and cancer incidence.


RESULTS
Only 1.5% of study participants were adherent to all five cancer-related risk factor guidelines, with marked race-, gender- and regional differences in adherence overall. Compared with participants who were fully adherent to all five cancer risk factor criteria, those adherent to one or less had a 76% increased risk of any cancer incidence (HR: 1.76, 95% CI: 1.70 - 1.82), 38% increased risk of breast cancer (HR: 1.38, 95% CI: 1.25 - 1.52), and doubled the risk of colorectal cancer (HR: 2.06, 95% CI: 1.84 - 2.29). However, risk of prostate cancer was lower among participants adherent to one or less compared with those who were fully adherent (HR: 0.79, 95% CI: 0.75 - 0.85). The proportion of cancer incident cases attributable to low adherence was higher among African-Americans compared with Whites for all cancers (21% vs. 19%), and highest for colorectal cancer (25%) regardless of race.


CONCLUSION
Racial differences in the proportion of cancer incidence attributable to low adherence suggests unique opportunities for targeted cancer prevention strategies that may help eliminate racial disparities in cancer burden among older US adults.
['Akinyemiju|Tomi|T|', 'Wiener|Howard|H|', 'Pisu|Maria|M|']
D000368:Aged D004032:Diet D006801:Humans D015994:Incidence D008875:Middle Aged D009316:National Institutes of Health (U.S.) D009369:Neoplasms D016016:Proportional Hazards Models D011446:Prospective Studies D044469:Racial Groups D012307:Risk Factors D012737:Sex Factors D011795:Surveys and Questionnaires D014481:United States
Cancer-related risk factors Diet Obesity Physical activity Cancer incidence