This is the current release of the guideline.

It updates a previous version: Byers T, Nestle M, McTiernan A, Doyle C, Currie-Williams A, Gansler T, Thun M. 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 2002 Mar-Apr;52(2):92-119.

Cancer including types of cancer in which weight, diet and physical activity may play a role, such as bladder cancer, breast cancer, cervical cancer, colorectal cancer, endometrial cancer, gallbladder cancer, Hodgkin lymphoma, kidney cancer, lung cancer, ovarian cancer, multiple myeloma, pancreatic cancer, prostate cancer, stomach cancer, thyroid cancer, and upper aerodigestive tract cancers

Counseling
Evaluation
Prevention
Risk Assessment

Family Practice
Gastroenterology
Geriatrics
Internal Medicine
Nursing
Nutrition
Obstetrics and Gynecology
Oncology
Pediatrics
Preventive Medicine

Advanced Practice Nurses
Allied Health Personnel
Dietitians
Health Care Providers
Health Plans
Hospitals
Managed Care Organizations
Nurses
Patients
Physician Assistants
Physicians
Public Health Departments

• To advise health care professionals 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

Children, adolescents, and adults seen in primary care settings in the United States

1. Individual choices regarding diet and physical activity patterns
   • 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
2. 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 2001. The Committee also considered other comprehensive reviews of diet, obesity, and physical inactivity in relation to cancer. For some aspects of nutrition, the most thorough review was the 1997 World Cancer Research Fund/American Institute for Cancer Research monograph; for others, such as physical activity, obesity, and fruit and vegetable consumption, there have been more recent comprehensive reviews.

Not stated

Expert Consensus (Committee)

Not applicable

Review

The Committee reviewed evidence from human population studies and laboratory experiments published since the last release of the Guidelines in 2001. The Committee also considered other comprehensive reviews of diet, obesity, and physical inactivity in relation to cancer. For some aspects of nutrition, the most thorough review was the 1997 World Cancer Research Fund/American Institute for Cancer Research monograph; for others, such as physical activity, obesity, and fruit and vegetable consumption, there have been more recent comprehensive reviews. 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.

Expert Consensus

These Guidelines, updated in 2006 by the American Cancer Society 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.

Not applicable

A formal cost analysis was not performed and published cost analyses were not reviewed.

Internal Peer Review

Not stated

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

None provided

The type of evidence is not specifically stated for each recommendation.

Healthy diet, physically active lifestyle, and absence of tobacco use contribute to substantially reduce the lifetime risk of developing cancer.

Men over 40, women over 50, and people with chronic illnesses and/or established cardiovascular risk factors should consult their physicians before beginning a vigorous physical activity program. Stretching and warm-up periods should be part of each exercise session to reduce risk of musculoskeletal injuries.

• For many issues concerning nutrition and cancer, the evidence is not definitive, either because the published results are inconsistent, and/or because the methods of studying nutrition and chronic disease in human populations are still in evolution. 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 dose, timing, and duration of exposure; and the large variations in nutritional status among human populations. Nutritional research is equally challenging in randomized controlled trials (RCTs), generally considered the gold standard for scientific conclusions. 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. 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, randomized trials of weight loss in relation to cancer risk are severely constrained by the current lack of effective behavioral or pharmacologic approaches to help people lose weight and sustain a healthy weight. The cost and difficulty of randomized trials to determine the long-term consequences of interventions that begin in infancy and extend for many years preclude long-term experimental interventions. Interventions are ethical only if they can plausibly improve the health of the participants. Although it might be easier to motivate people to increase their weight by consuming more calories and/or fat and by decreasing their physical activity, such studies are clearly unethical.
• Inferences about the many complex interrelationships among body weight, physical activity, diet, and cancer risk are therefore based, for the most part, on a combination of clinical trials and observational studies coupled with advancing understanding of the biology of cancer. These Guidelines are based on the totality of evidence from all sources, taking into account both the potential health benefits and possible risks from the intervention. 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.

An implementation strategy was not provided.

Staying Healthy

Effectiveness
Patient-centeredness

Not applicable: The guideline was not adapted from another source.

2002 Mar (revised 2006 Sep)

American Cancer Society - Disease Specific Society

American Cancer Society

American Cancer Society 2006 Nutrition and Physical Activity Guidelines Advisory Committee

Primary Authors: Lawrence H. Kushi, ScD; Tim Byers, MD, MPH; Colleen Doyle, MS, RD; Elisa V. Bandera, MD, PhD; Marji McCullough, ScD, RD; Ted Gansler, MD, MBA; Kimberly S. Andrews; Michael J. Thun, MD, MS

American Cancer Society Volunteer Participants: Barbara Ainsworth, PhD, MPH, Professor, Exercise and Nutritional Science, Cancer Prevention and Control Program, San Diego State University; Rachel Ballard-Barbash, MD, MPH, Associate Director, Applied Research Program, Division of Cancer Prevention and Control, National Cancer Institute, Rockville, MD; Elisa V. Bandera, MD, PhD, Assistant Professor, The Cancer Institute of New Jersey, New Brunswick, NJ; Abby F. Bloch, PhD, RD, FADA, Nutrition Consultant, New York, NY; Tim Byers, MD, MPH, Professor, Department of Preventive Medicine and Biometrics; and Deputy Director, University of Colorado Cancer Center, Aurora, CO; June M. Chan, ScD, Assistant Professor and Program Director, Genitourinary Cancer Epidemiology and Population Science, University of California, San Francisco; Ralph J. Coates, PhD;, Associate Director for Science, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention (CDC), Atlanta, GA; Wendy Demark–Wahnefried, PhD, RD, LDN, Professor, Surgery and School of Nursing, Duke University Medical Center, Durham, NC; Jo Freudenheim, PhD, University of Buffalo Distinguished Professor and Chair, Department of Social and Preventive Medicine, School of Public Health and Health Professions, University at Buffalo, State University of New York; Peter Gann, MD, ScD, Professor and Director of Pathology Research, Department of Pathology, College of Medicine, University of Illinois at Chicago; Edward Giovannucci, MD, ScD, Professor of Nutrition and Epidemiology, Harvard School of Public Health, Boston, MA; Terry Hartman, PhD, MPH, RD, Associate Professor, Nutrition, The Pennsylvania State University, University Park, PA; Laurence Kolonel, MD, PhD, Deputy Director, Cancer Research Center, University of Hawaii, Honolulu, HI; Lawrence H. Kushi, PhD, Associate Director for Etiology and Prevention Research, Kaiser Permanente, Oakland, CA; Alice H. Lichtenstein, DSc, Gershoff Professor of Nutrition Science and Policy; and Director and Senior Scientist, Tufts University, Boston, MA; Maria Elena Martinez, PhD, RD, Associate Professor of Public Health, Arizona Cancer Center, Tucson, AZ; Anne McTiernan, MD, PhD, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA; Marion Morra, MA, ScD, President, Morra Communications, Milford, CT; Arthur Schatzkin, MD, DrPH, Chief, Nutrition Epidemiology Branch, National Cancer Institute, Bethesda, MD; Marty Slattery, PhD, MPH, Professor, Family and Preventive Medicine, School of Medicine, University of Utah, Salt Lake City, UT; Stephanie Smith-Warner, PhD, Assistant Professor of Nutritional Epidemiology, Department of Nutrition, Harvard School of Public Health, Boston, MA; Judith Wylie-Rosett, EdD, RD, Professor of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY; Wei Zheng, MD, PhD, Professor, Vanderbilt-Ingram Cancer Center, Nashville, TN

American Cancer Society Staff Members: Terri Ades, RN, MS, AOCN, Director, Cancer Information; Kimberly S. Andrews, Research Associate, Cancer Control Science; Vilma Cokkinides, PhD, Program Director, Risk Factor Surveillance; Colleen Doyle, MS, RD, Director, Nutrition and Physical Activity; Ted Gansler, MD, MBA, Director of Medical Content; Marji McCullough, ScD, RD, Nutritional Epidemiologist; Alicia Samuels, MPH, Manager, Medical and Scientific Communication; David P. Ringer, PhD, MPH;, Scientific Program Director, Research Department; Robert A. Smith, PhD, Director of Cancer Screening; Michael J. Thun, MD, MS, Vice President, Epidemiology and Surveillance Research

Not stated

This is the current release of the guideline.

It updates a previous version: Byers T, Nestle M, McTiernan A, Doyle C, Currie-Williams A, Gansler T, Thun M. 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 2002 Mar-Apr;52(2):92-119.

None available

This NGC summary was completed by ECRI on January 13, 2004. It was updated by ECRI Institute on February 4, 2008. The updated information was verified by the guideline developer on February 29, 2008.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.