Characteristics of the Retail Food Environment and Associations With Cancer Outcomes: A Scoping Review

Dietary intake and obesity are established risk factors for cancer. The retail food environment, which comprises the settings where individuals access and purchase food, is a factor that shapes diet and body weight, prompting investigation into whether these food environmental exposures correlate with cancer risk. The aim of this scoping review was to synthesize the evidence of associations between the retail food environment and cancer, including incidence, mortality, and survival. A systematic search for relevant articles was conducted in 4 databases; Embase, Medline, Web of Science, and Scopus. Studies were included if they were published in English, examined retail food environment exposures in a high-income country, and assessed cancer, incidence, mortality, or survival in adult populations. Of 1277 articles identified in the search, 21 were included in the scoping review. Colorectal and breast cancer were the most frequently studied cancer types. All the studies originated from the United States. Of the 10 articles that examined cancer incidence, 5 reported that areas with limited access to healthy food were associated with increased cancer incidence. Similarly, of the 14 studies on cancer mortality or survival, 11 found that areas with limited access to healthy foods or high access to fast-food outlets were associated with higher mortality and/or lower survival, with statistically significant hazard ratios between 1.15 and 5.12. Associations between the food environment and cancer risk were particularly evident for obesity-related cancers. Comparisons across studies are, however, limited by the heterogeneous retail food environment exposures used, and should be replicated in other settings to understand generalizability. This scoping review highlights the potential importance of the food environment as a population-level target for cancer-prevention strategies, particularly obesity-related cancers.