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Accepted manuscript

Adherence to WCRF/AICR cancer prevention recommendations and reduction in breast cancer risk: results of a large-scale case-control study in Morocco

Published online by Cambridge University Press:  11 February 2026

Najoua LAMCHABBEK*
Affiliation:
Mohammed VI International School of Public Health, Mohammed VI University of Sciences and Health, Casablanca, Morocco. Department of Public Health and Clinical Research, Mohammed VI Center for Research and Innovation, Rabat, Morocco.
Siham MRAH
Affiliation:
Mohammed VI University Hospital of Tangier, Faculty of Medicine and Pharmacy of Tangier, Abdelmalek Essaadi University, Tetouan, Morocco.
Najia MANE
Affiliation:
Department of Epidemiology, A Morocco.
Chaimaa ELATTABI
Affiliation:
Mohammed VI International School of Public Health, Mohammed VI University of Sciences and Health, Casablanca, Morocco. Department of Public Health and Clinical Research, Mohammed VI Center for Research and Innovation, Rabat, Morocco.
Imad EL BADISY
Affiliation:
Department of Public Health and Clinical Research, Mohammed VI Center for Research and Innovation, Rabat, Morocco.
Abdellatif BOUR
Affiliation:
Laboratory of Biology and Health, Department of Biology, Faculty of Sciences, University Ibn Tofail, Kenitra, Morocco.
Fatima Zahra EL M’RABET
Affiliation:
Mohammed VI University Hospital of Tangier, Faculty of Medicine and Pharmacy of Tangier, Abdelmalek Essaadi University, Tetouan, Morocco.
Adil NAJDI
Affiliation:
Mohammed VI University Hospital of Tangier, Faculty of Medicine and Pharmacy of Tangier, Abdelmalek Essaadi University, Tetouan, Morocco.
Nawfel MELLAS
Affiliation:
Department of Oncology, Hassan II University Hospital of Fez, Morocco
Karima BENDAHOU
Affiliation:
Department of Epidemiology, Faculty of Medicine and Pharmacy of Casablanca, Hassan II University of Casablanca, Casablanca, Morocco.
Saber BOUTAYEB
Affiliation:
Department of Public Health and Clinical Research, Mohammed VI Center for Research and Innovation, Rabat, Morocco. Department of Medical Oncology, National Institute of Oncology, Rabat, Morocco.
Lahcen BELYAMANI
Affiliation:
Mohammed VI International School of Public Health, Mohammed VI University of Sciences and Health, Casablanca, Morocco. Department of Public Health and Clinical Research, Mohammed VI Center for Research and Innovation, Rabat, Morocco.
Elodie FAUR
Affiliation:
Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, CESP, 94805 Villejuif, France
Inge HUYBRECHTS
Affiliation:
International Agency for Research on Cancer, World Health Organization, Lyon, France.
Mohamed KHALIS*
Affiliation:
Mohammed VI International School of Public Health, Mohammed VI University of Sciences and Health, Casablanca, Morocco. Department of Public Health and Clinical Research, Mohammed VI Center for Research and Innovation, Rabat, Morocco. Higher Institute of Nursing Professions and Health Techniques, Rabat, Ministry of Health and Social Protection, Rabat, Morocco.
*
*Corresponding author: LAMCHABBEK Najoua, PhD. International School of Public Health, Mohammed VI University of Health Sciences, Casablanca, Morocco. Boulevard Mohammed Taïeb Naciri, Commune Hay Hassani, najoua.lamchabbek@gmail.com Mohamed Khalis, International School of Public Health, Mohammed VI University of Health Sciences, Casablanca, Morocco. Boulevard Mohammed Taïeb Naciri, Commune Hay Hassani Casablanca 82403 Casablanca, Morocco. E-mail address: mkhalis333@gmail.com
*Corresponding author: LAMCHABBEK Najoua, PhD. International School of Public Health, Mohammed VI University of Health Sciences, Casablanca, Morocco. Boulevard Mohammed Taïeb Naciri, Commune Hay Hassani, najoua.lamchabbek@gmail.com Mohamed Khalis, International School of Public Health, Mohammed VI University of Health Sciences, Casablanca, Morocco. Boulevard Mohammed Taïeb Naciri, Commune Hay Hassani Casablanca 82403 Casablanca, Morocco. E-mail address: mkhalis333@gmail.com
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Abstract

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Limited evidence exists on the combined effect of lifestyle factors on breast cancer (BC) risk, particularly in developing countries. This study aimed to investigate the association between adherence to WCRF/AICR cancer prevention recommendations and BC risk among Moroccan women. We conducted a large case control study including 1400 cases and 1400 matched controls (by age and place of residence), between 2019 and 2023. A structured general questionnaire and a food frequency questionnaire were used for data collection. Adherence to cancer recommendations was assessed using a scale ranging from 0 to 7, including 7 components about: food categories, physical activity, healthy weight, and breastfeeding. Multivariate logistic regression models were used to calculate multivariable odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for Potential confounding variables. For each one-point increase in the WCRF/AICR adherence score, the odds of BC decreased by 67% overall (95% CI: 0.29–0.37). This inverse association was consistent among both premenopausal women (OR = 0.29; 95% CI: 0.24–0.35) and postmenopausal women (OR = 0.35; 95% CI: 0.30–0.41). Analysis of individual recommendations showed that being physically active, maintaining a healthy weight, breastfeeding, consuming a plant-rich diet, and limiting the intake of fast foods and other processed foods were the main key drivers of the observed inverse associations with BC. In conclusion, the present study suggests that greater adherence to the WCRF/AICR recommendations is associated with decreased risk of BC risk in Morocco. Prevention strategies should consider comprehensive interventions targeting multiple lifestyle factors.

Information

Type
Research Article
Copyright
© The Author(s), 2026. Published by Cambridge University Press on behalf of The Nutrition Society