Cancer Causes & Control

, Volume 27, Issue 7, pp 869–879 | Cite as

Is adherence to diet, physical activity, and body weight cancer prevention recommendations associated with colorectal cancer incidence in African American women?

  • Sarah J. O. NomuraEmail author
  • Chiranjeev Dash
  • Lynn Rosenberg
  • Jeffrey Yu
  • Julie R. Palmer
  • Lucile L. Adams-Campbell
Original paper



The purpose of this study was to evaluate whether adherence to the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) cancer prevention recommendations was associated with colorectal cancer incidence in the Black Women’s Health Study (BWHS).


In this ongoing prospective cohort of African American women (analytic cohort n = 49,103), 354 incident colorectal cancers were diagnosed between baseline (1995) and 2011. Adherence scores for seven WCRF/AICR recommendations (adherent = 1 point, non-adherent level 1 = 0.5 points, non-adherent level 2 = 0 points) were created using questionnaire data and summed to an overall adherence score (maximum = 7). Recommendation adherence and colorectal cancer incidence were evaluated using baseline and time-varying data in Cox regression models.


At baseline, 8.5 % of women adhered >4 recommendations. In time-varying analyses, the HR was 0.98 (95 % CI 0.84–1.15) per 0.5 point higher score and 0.51 (95 % CI 0.23–1.10) for adherence to >4 compared to <3 recommendations. Adherence to individual recommendations was not associated with colorectal cancer risk. Results were similar in models that considered baseline exposures only.


Adherence to cancer prevention recommendations was low and not associated with colorectal cancer risk among women in the BWHS. Research in diverse populations is essential to evaluate the validity of existing recommendations, and assess whether there are alternative recommendations that are more beneficial for cancer prevention in specific populations.


Colorectal cancer Diet Physical activity Obesity Cancer prevention 



S.J.O.N., L.L.A., L.R., and J.P. designed research; S.J.O.N. and J.Y. analyzed data; S.J.O.N., C.D., and L.R. wrote the paper; S.J.O.N. and L.R. had primary responsibility for final content. All authors read and approved the final manuscript. This work was supported by National Cancer Institute grants R01 CA058420 (L. Rosenberg) and UM1 CA164974 (L. Rosenberg). S.J.O.N. is supported by 5T32CA009686-19 (PI: A. Riegel). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute or the National Institutes of Health. Data on breast cancer pathology were obtained from several state cancer registries (AZ, CA, CO, CT, DE, DC, FL, GA, IL, IN, KY, LA, MD, MA, MI, NJ, NY, NC, OK, PA, SC, TN, TX, VA), and results reported do not necessarily represent their views. The authors are grateful to the participants and staff of the BWHS. This study was done in compliance with ethical standards with approval from the Institutional Review Board of Boston University Medical Center and informed consent was obtained from all participants.

Conflict of interest

The authors have no conflicts of interest to disclose.


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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Sarah J. O. Nomura
    • 1
    Email author
  • Chiranjeev Dash
    • 1
  • Lynn Rosenberg
    • 2
  • Jeffrey Yu
    • 2
  • Julie R. Palmer
    • 2
  • Lucile L. Adams-Campbell
    • 1
  1. 1.Lombardi Comprehensive Cancer CenterGeorgetown UniversityWashingtonUSA
  2. 2.Slone Epidemiology CenterBoston UniversityBostonUSA

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