Table 3.

Associations between ACS guidelines score and cancer incidence (n = 65,838)

EventsAge-adjustedFully adjusteda
Cancer outcomeACS scorePerson-years, (millions)n (%)HR (95% CI)HR (95% CI)
Any cancer (other than non-melanoma skin cancer)
0—21,3411,475 (13.7)1.001.00
32,0111,768 (13.5)0.95 (0.89–1.02)0.97 (0.91–1.04)
42,7111,985 (13.2)0.90 (0.84–0.96)0.93 (0.86–0.99)
52,2611,777 (13.0)0.87 (0.81–0.93)0.90 (0.84–0.97)
61,0081,120 (12.4)0.82 (0.75–0.88)0.85 (0.78–0.92)
7—8216507 (12.1)0.79 (0.72–0.88)0.83 (0.75–0.92)
Ptrendb<0.001<0.001
Trendb0.96 (0.94–0.97)0.96 (0.95–0.98)
Breast
0—213,76619 (5.75)1.001.00
32,065724 (5.51)0.95 (0.85–1.05)0.94 (0.84–1.04)
42,779813 (5.39)0.90 (0.81–1.00)0.88 (0.79–0.98)
52,318732 (5.36)0.88 (0.79–0.98)0.85 (0.76–0.95)
61,034449 (4.97)0.80 (0.71–0.91)0.76 (0.67–0.86)
7—8221212 (5.07)0.82 (0.70–0.96)0.78 (0.67–0.92)
Ptrendb<0.001<0.001
Trendb0.96 (0.94–0.98)0.95 (0.93–0.97)
Colorectal
0—21410145 (1.35)1.001.00
32114185 (1.41)0.99 (0.80–1.23)1.03 (0.83–1.28)
42845169 (1.12)0.76 (0.61–0.95)0.81 (0.65–1.02)
52376145 (1.06)0.70 (0.56–0.87)0.77 (0.61–0.98)
6105779 (0.87)0.57 (0.44–0.76)0.64 (0.49–0.85)
7—822628 (0.67)0.43 (0.29–0.65)0.48 (0.32–0.73)
Ptrendb<0.001<0.001
Trendb0.87 (0.83–0.91)0.89 (0.85–0.94)
Endometrial
0—21,41197 (0.90)1.001.00
32,118103 (0.78)0.86 (0.65–1.13)0.85 (0.65–1.13)
42,846112 (0.74)0.79 (0.60–1.04)0.77 (0.58–1.01)
52,37896 (0.70)0.74 (0.56–0.95)0.69 (0.52–0.92)
61,05768 (0.75)0.78 (0.57–1.11)0.71 (0.51–0.97)
7—822633 (0.79)0.82 (0.55–1.21)0.73 (0.49–1.09)
Ptrendb0.0480.008
Trendb0.95 (0.89–1.00)0.93 (0.87–0.98)
Ovarian
0—21,41651 (0.47)1.001.00
32,12458 (0.44)0.92 (0.63–1.34)0.93 (0.64–1.36)
42,85382 (0.54)1.10 (0.78–1.56)1.13 (0.79–1.61)
52,38460 (0.44)0.87 (0.60–1.27)0.90 (0.61–1.31)
61,05952 (0.58)1.12 (0.76–1.65)1.16 (0.78–1.72)
7—822723 (0.55)1.07 (0.66–1.75)1.13 (0.68–1.87)
Ptrendb0.6340.494
Trendb1.02 (0.95–1.09)1.03 (0.95–1.10)
Lung
0—21,413143 (1.33)1.001.00
32,120185 (1.41)1.01 (0.81–1.25)1.15 (0.93–1.44)
42,848173 (1.15)0.79 (0.63–0.98)1.00 (0.80–1.25)
52,380181 (1.32)0.88 (0.71–1.10)1.22 (0.97–1.52)
61,058107 (1.19)0.78 (0.60–1.00)1.17 (0.91–1.52)
7—822744 (1.05)0.68 (0.49–0.96)1.14 (0.81–1.60)
Ptrendb0.0040.163
Trendb0.94 (0.90–0.98)1.03 (0.99–1.08)
Otherc
0—21,398445 (4.14)1.001.00
32,096526 (4.01)0.93 (0.82–1.06)0.95 (0.84–1.08)
42.815652 (4.33)0.97 (0.86–1.10)1.00 (0.88–1.13)
52.352580 (4.24)0.93 (0.82–1.05)0.96 (0.84–1.09)
61,046387 (4.29)0.93 (0.81–1.06)0.96 (0.83–1.10)
7—8224172 (4.11)0.88 (0.74–1.05)0.92 (0.77–1.10)
Ptrendb0.1280.383
Trendb0.98 (0.96–1.01)0.99 (0.96–1.01)
  • aAdjusted for age (continuous), education (≤high school, some college, ≥college), smoking pack-years (never smoking, <5, 5–19, 20+), NSAID use at baseline (yes, no), aspirin use at baseline (yes, no), unopposed estrogen use (never, former, current), estrogen + progestin use (never, former, current), multivitamin use at baseline (yes, no), race/ethnicity (NHW, Hispanic, black, Asian, Native American, other), total energy intake (continuous), parous (yes, no, unknown), mammogram (ever, never; included only in models for any cancer and breast cancer), colonoscopy/sigmoidoscopy (ever, never; included only in models for any cancer and colorectal cancer), family history (mother/father, full-blooded sister/brother, daughter/son, grandmother) of cancer (yes, no, unknown), and having a current healthcare provider (yes, no).

  • bTrend tested by modeling ACS score as an ordinal variable (0–8).

  • cAny cancer other than breast, colorectal, endometrial, ovarian, lung, and non-melanoma skin cancer.