In addition to recommendations regarding individual choices related to weight control, physical activity, and diet, the American Cancer Society (ACS) Guidelines underscore what communities can and should do to facilitate healthy eating and physical activity behaviors.
ACS Guidelines on Nutrition and Physical Activity for Cancer Prevention
ACS Recommendations for Individual Choices
Achieve and maintain a healthy weight throughout life.
Adopt a physically active lifestyle.
Consume a healthy diet, with an emphasis on plant foods.
If you drink alcoholic beverages, limit consumption.
ACS Recommendations For Community Action
Public, private, and community organizations should work collaboratively at national, state, and local levels to implement policy and environmental changes that:
Cancer, including types of cancer in which weight, diet and physical activity may play a role, such as breast cancer, colorectal cancer, endometrial cancer, kidney cancer, lung cancer, ovarian cancer, pancreatic cancer, prostate cancer, stomach cancer, and upper aerodigestive tract cancers
Obstetrics and Gynecology
Advanced Practice Nurses
Allied Health Personnel
Health Care Providers
Managed Care Organizations
Public Health Departments
- To advise health care professionals, policymakers and the general public about dietary and other lifestyle practices that reduce cancer risk
- To serve as a foundation for the communication, policy, and community strategies of the American Cancer Society (ACS) and to affect dietary and physical activity patterns among Americans
- To update the 2006 American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention
Children, adolescents, and adults seen in primary care settings in the United States
- Individual choices regarding diet and physical activity patterns
- Achieving and maintaining a healthy weight throughout life
- Adopting a physically active lifestyle
- Consuming a healthy diet, with an emphasis on plant sources
- Limiting consumption of alcoholic beverages
- Community actions that facilitate social and physical environments that support adoption of healthful nutrition and physically active behaviors
- Incidence of cancer
- Quality of life
- Cancer-related mortality
Searches of Electronic Databases
The Committee reviewed evidence from human population studies and laboratory experiments published since the last release of the Guidelines in 2006. The Committee also considered other comprehensive reviews of diet, obesity, and physical inactivity in relation to cancer. For many aspects of nutrition and physical activity, the most thorough reviews were the 2007 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) report and the subsequent Continuous Update reports on breast cancer and colorectal cancer; other comprehensive reviews or meta-analyses that were published in recent years were also considered.
PubMed was searched from 2005 to August 2010 using the following criteria:
- Search terms: varied by individual topics/exposures
- Study design: randomized controlled trials, prospective studies, and well-conducted, population-based, case-control studies
- Study size: more than 200 cancer cases, except for rarer cancers, when 100 would be acceptable (e.g., ovary, pancreas, endometrial)
- High-quality assessment of covariates and analytic methods: analyses controlled for important confounders (e.g., energy and other important risk factors for that particular cancer)
Review of Published Meta-Analyses
In weighing the evidence from randomized controlled trials (RCTs), the Committee considered the findings in relation to the design of the trial, the specific question being addressed, and the importance of the trial results in the context of other evidence from human populations. Prospective cohort studies were weighted more heavily than case-control studies, especially when results were available from several cohorts. Population-based case-control studies with at least 200 cases of cancer were considered more informative than smaller or hospital-based case-control studies. Studies that adjusted for total energy intake, considered other dietary factors, and controlled for other known risk factors were considered more credible than those that failed to meet these criteria.
These Guidelines, updated in 2012 by the American Cancer Society (ACS) Nutrition and Physical Activity Guidelines Advisory Committee, are based on synthesis of the current scientific evidence on diet and physical activity in relation to cancer risk.
These Guidelines are based on the totality of evidence from these sources, taking into account both the potential health benefits and possible risks from adopting them.
A formal cost analysis was not performed and published cost analyses were not reviewed.
Internal Peer Review
This report was approved by the American Cancer Society National Board of Directors on August 5, 2011.
The type of evidence is not specifically stated for each recommendation.
- Behaviors such as avoiding exposure to tobacco products, maintaining a healthy weight, staying physically active throughout life, and consuming a healthy diet can substantially reduce one's lifetime risk of developing or dying from cancer.
- The recommendations for community action recognize that a supportive social and physical environment is indispensable if individuals at all levels of society are to have genuine opportunities to choose and maintain healthy behaviors.
Men aged 40 years and older, women aged 50 years and older, and people with chronic illnesses or established cardiovascular risk factors should consult their physicians before beginning a vigorous physical activity program.
- For many issues concerning nutrition and cancer, the evidence is not definitive because the published results are inconsistent or because the methods of studying nutrition and chronic disease in human populations continue to evolve. Part of the uncertainty has resulted from studies that focus on specific nutrients or foods in isolation, thereby oversimplifying the complexity of foods and dietary patterns; the importance of the dose, timing, and duration of exposure; and the large variations in nutritional status among human populations. Nutrition and physical activity research is equally challenging in randomized controlled trials (RCTs), generally considered the gold standard for scientific inference. Studies may fail to find an effect if the intervention begins too late in life, is too small, or if the follow-up is too short for a benefit to appear. In addition, RCTs of lifestyle interventions cannot be blinded, and disease endpoints such as cancer require many years of follow-up. No single trial can resolve all of the questions that are relevant to the potential effects of nutrition throughout the lifespan. Moreover, many important questions about how diet, physical activity, and obesity relate to cancer cannot presently be addressed in RCTs. For example, while there is substantial interest in the effects of early-life body size and dietary patterns on the risk of adult cancer, it is practically not feasible to conduct RCTs to determine the long-term consequences of interventions that begin in infancy and extend for many years.
- Inferences about the many complex interrelationships between body weight, physical activity, diet, and cancer risk are therefore based, for the most part, on a combination of shorter-term clinical trials and observational studies coupled with advancing understanding of the biology of cancer. These Guidelines are based on the totality of evidence from these sources, taking into account both the potential health benefits and possible risks from adopting them. No diet or lifestyle pattern can guarantee full protection against any disease; the potential health benefit represents a decreased likelihood that the disease will occur, not a guarantee of total protection. These Guidelines provide a summary of the existing scientific information about weight control, physical activity, and nutrition in relation to cancer and are intended to be followed as a whole.
- While there continues to be scientific uncertainty about how specific aspects of excess adiposity, excessive energy intake, and physical inactivity relate to cancer, there is no debate that these contribute to an increased risk of many types of cancer and that they constitute a serious and growing health problem.
- Health professionals who counsel patients should emphasize that no one study provides the last word on any subject, and that individual news reports may overemphasize what appear to be contradictory or conflicting results.
An implementation strategy was not provided.
|Kushi LH, Doyle C, McCullough M, Rock CL, Demark-Wahnefried W, Bandera EV, Gapstur S, Patel AV, Andrews K, Gansler T, American Cancer Society 2010 Nutrition and Physical Activity Guidelines Advisory. American Cancer Society guidelines on nutrition and physical activity for cancer prevention: reducing the risk of cancer with healthy food choices and physical activity. CA Cancer J Clin. 2012 Jan-Feb;62(1):30-67. [376 references] PubMed|
Not applicable: The guideline was not adapted from another source.
2002 Mar (revised 2012 Jan)
American Cancer Society - Disease Specific Society
American Cancer Society
American Cancer Society 2010-11 Nutrition and Physical Activity Guidelines Advisory Committee
Primary Authors: Lawrence H. Kushi, ScD, Associate Director for Etiology and Prevention Research, Division of Research, Kaiser Permanente, Oakland, CA; Colleen Doyle, MS, RD, Director, Nutrition and Physical Activity, Cancer Control Science, American Cancer Society, Atlanta, GA; Marji McCullough, ScD, RD, Strategic Director, Nutritional Epidemiology, American Cancer Society, Atlanta, GA; Cheryl L. Rock, PhD, RD, Professor, Department of Family and Preventive Medicine, School of Medicine, University of California at San Diego, San Diego, CA; Wendy Demark-Wahnefried, PhD, RD, Professor and Webb Endowed Chair of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL; Elisa V. Bandera, MD, PhD, Assistant Professor, The Cancer Institute of New Jersey, New Brunswick, NJ; Susan Gapstur, PhD, MPH, Vice President, Epidemiology Research Program, American Cancer Society, Atlanta, GA; Alpa V. Patel, PhD, Strategic Director, Cancer Prevention Study-3, American Cancer Society, Atlanta, GA; Kimberly Andrews, Research Associate, American Cancer Society, Atlanta, GA; Ted Gansler, MD, MBA, MPH, Director of Medical Content, American Cancer Society, Atlanta, GA; and The American Cancer Society 2010 Nutrition and Physical Activity Guidelines Advisory Committee
The American Cancer Society 2010-11 Nutrition and Physical Activity Guidelines Advisory Committee Volunteer Members: Rachel Ballard-Barbash, MD, MPH (Associate Director, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD); Elisa V. Bandera, MD, PhD (Assistant Professor, The Cancer Institute of New Jersey, New Brunswick, NJ); Tim Byers, MD, MPH (Professor, Preventive Medicine, University of Colorado Health Sciences Center, Denver, CO); Bette Caan, DrPH (Division of Research, Kaiser Permanente, Oakland, CA); Kerry S. Courneya, PhD (Professor and Canada Research Chair in Physical Activity and Cancer, University of Alberta, Edmonton, Alberta, Canada); Wendy Demark-Wahnefried, PhD, RD (Professor and Webb Endowed Chair of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL); Barbara Grant, MS, RD (Oncology Nutritionist, Saint Alphonsus Regional Medical Center Cancer Care Center, Boise, ID); Kathryn K. Hamilton, MA, RD, CDN (Outpatient Oncology Dietitian, Carol G. Simon Cancer Center, Morristown Memorial Hospital, Morristown, NJ); Laurence N. Kolonel, MD, PhD (Deputy Director, Cancer Research Center of Hawaii, Honolulu, HI); Lawrence H. Kushi, ScD (Associate Director for Etiology and Prevention Research, Division of Research, Kaiser Permanente, Oakland, CA); Marilyn L. Kwan, PhD (Division of Research, Kaiser Permanente, Oakland, CA); Marıa Elena Martınez, PhD (Associate Professor of Public Health, Arizona Cancer Center, Tucson, AZ); Jeffrey Meyerhardt, MD, MPH (Associate Professor of Medicine, Harvard Medical School, Dana- Farber Cancer Institute, Boston, MA); Marion Morra (President, Morra Communications, Milford, CT); Marian L. Neuhouser, PhD (Cancer Prevention, Fred Hutchinson Cancer Research Center, Seattle, WA); Cheryl L. Rock, PhD, RD (Professor, Department of Family and Preventive Medicine, School of Medicine, University of California at San Diego, San Diego, CA); Anna L. Schwartz, FNP, PhD, FAAN (Affiliate Professor, University of Washington, Seattle, WA); and Stephanie Smith-Warner, PhD (Associate Professor of Nutritional Epidemiology, Harvard School of Public Health, Boston, MA)
American Cancer Society Staff Members: Terri Ades, DNP, FNP-BC, AOCN (Director, Cancer Information); Kimberly Andrews (Research Associate); Colleen Doyle, MS, RD (Director, Nutrition and Physical Activity); Ted Gansler, MD, MBA, MPH (Director of Medical Content); Susan Gapstur, PhD, MPH (Vice President, Epidemiology Research Program); Melissa Maitin-Shepard (Senior Policy Analyst); Marji McCullough, ScD, RD (Strategic Director, Nutritional Epidemiology) Alpa V. Patel, PhD (Strategic Director, Cancer Prevention Study-3); David Ringer, PhD, MPH (National Vice President of Extramural Grants, Research); and Michael Thun, MD (Vice President, Emeritus Epidemiology and Surveillance Research)
The authors report no conflicts of interest.
This is the current release of the guideline.
It updates a previous version: Kushi LH, Byers T, Doyle C, Bandera EV, McCullough M, McTiernan A, Gansler T, Andrews KS, Thun MJ, American Cancer Society 2006 Nutrition and Physical Activity Guidelines Advisory Committee. American Cancer Society Guidelines on Nutrition and Physical Activity for cancer prevention: reducing the risk of cancer with healthy food choices and physical activity. CA Cancer J Clin 2006 Sep-Oct;56(5):254-81; quiz 313-4. [198 references]
Electronic copies: Available from the CA: A Cancer Journal for Clinicians Web site .
Print copies: Available from the American Cancer Society, 250 Williams St., Suite 600, Atlanta, GA 30303; Web site: www.cancer.org .
The following is available:
- American Cancer Society guidelines on nutrition and physical activity for cancer prevention. Patient summary. 2012. 30 p. Available in Portable Document Format (PDF) from the American Cancer Society (ACS) Web site .
Also available by calling 1-800-227-2345.
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