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Botteri E, Peveri G, Berstad P, Bagnardi V, Hoff G, Heath AK, Cross AJ, Vineis P, Dossus L, Johansson M, Freisling H, Matta K, Huybrechts I, Chen SLF, B Borch K, Sandanger TM, H Nøst T, Dahm CC, Antoniussen CS, Tin Tin S, Fournier A, Marques C, Artaud F, Sánchez MJ, Guevara M, Santiuste C, Agudo A, Bajracharya R, Katzke V, Ricceri F, Agnoli C, Bergmann MM, Schulze MB, Panico S, Masala G, Tjønneland A, Olsen A, Stocks T, Manjer J, Aizpurua-Atxega A, Weiderpass E, Riboli E, Gunter MJ, Ferrari P. Lifestyle changes in middle age and risk of cancer: evidence from the European Prospective Investigation into Cancer and Nutrition. Eur J Epidemiol 2024; 39:147-159. [PMID: 38180593 DOI: 10.1007/s10654-023-01059-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 10/09/2023] [Indexed: 01/06/2024]
Abstract
In this study, we aimed to provide novel evidence on the impact of changing lifestyle habits on cancer risk. In the EPIC cohort, 295,865 middle-aged participants returned a lifestyle questionnaire at baseline and during follow-up. At both timepoints, we calculated a healthy lifestyle index (HLI) score based on cigarette smoking, alcohol consumption, body mass index and physical activity. HLI ranged from 0 (most unfavourable) to 16 (most favourable). We estimated the association between HLI change and risk of lifestyle-related cancers-including cancer of the breast, lung, colorectum, stomach, liver, cervix, oesophagus, bladder, and others-using Cox regression models. We reported hazard ratios (HR) with 95% confidence intervals (CI). Median time between the two questionnaires was 5.7 years, median age at follow-up questionnaire was 59 years. After the follow-up questionnaire, we observed 14,933 lifestyle-related cancers over a median follow-up of 7.8 years. Each unit increase in the HLI score was associated with 4% lower risk of lifestyle-related cancers (HR 0.96; 95%CI 0.95-0.97). Among participants in the top HLI third at baseline (HLI > 11), those in the bottom third at follow-up (HLI ≤ 9) had 21% higher risk of lifestyle-related cancers (HR 1.21; 95%CI 1.07-1.37) than those remaining in the top third. Among participants in the bottom HLI third at baseline, those in the top third at follow-up had 25% lower risk of lifestyle-related cancers (HR 0.75; 95%CI 0.65-0.86) than those remaining in the bottom third. These results indicate that lifestyle changes in middle age may have a significant impact on cancer risk.
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Affiliation(s)
- Edoardo Botteri
- Department of Research, Cancer Registry of Norway, Oslo, Norway
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
| | - Giulia Peveri
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Paula Berstad
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Geir Hoff
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
- Department of Research, Telemark Hospital, Skien, Norway
| | - Alicia K Heath
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Amanda J Cross
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Paolo Vineis
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Laure Dossus
- International Agency for Research On Cancer (IARC-WHO), World Health Organization, 25, Avenue Tony Garnier, CS 90627, 69366, Lyon Cedex 07, France
| | - Mattias Johansson
- International Agency for Research On Cancer (IARC-WHO), World Health Organization, 25, Avenue Tony Garnier, CS 90627, 69366, Lyon Cedex 07, France
| | - Heinz Freisling
- International Agency for Research On Cancer (IARC-WHO), World Health Organization, 25, Avenue Tony Garnier, CS 90627, 69366, Lyon Cedex 07, France
| | - Komodo Matta
- International Agency for Research On Cancer (IARC-WHO), World Health Organization, 25, Avenue Tony Garnier, CS 90627, 69366, Lyon Cedex 07, France
| | - Inge Huybrechts
- International Agency for Research On Cancer (IARC-WHO), World Health Organization, 25, Avenue Tony Garnier, CS 90627, 69366, Lyon Cedex 07, France
| | - Sairah L F Chen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Kristin B Borch
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Torkjel M Sandanger
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Therese H Nøst
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- HUNT Center for Molecular and Clinical Epidemiology, Department of Public Health and Nursing , NTNU - Norwegian University of Science and Technology , Trondheim, Norway
| | | | | | - Sandar Tin Tin
- Cancer Epidemiology Unit, Oxford Population Health, University of Oxford, Oxford, UK
| | - Agnès Fournier
- Université Paris-Saclay, UVSQ, Inserm "Exposome, Heredity, Cancer and Health" Team, CESP U1018, Gustave Roussy, Villejuif, France
| | - Chloé Marques
- Université Paris-Saclay, UVSQ, Inserm "Exposome, Heredity, Cancer and Health" Team, CESP U1018, Gustave Roussy, Villejuif, France
| | - Fanny Artaud
- Université Paris-Saclay, UVSQ, Inserm "Exposome, Heredity, Cancer and Health" Team, CESP U1018, Gustave Roussy, Villejuif, France
| | - Maria-José Sánchez
- Escuela Andaluza de Salud Pública (EASP), Granada, Spain
- Instituto de Investigación Biosanitaria Ibs.GRANADA, Granada, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
| | - Marcela Guevara
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Instituto de Salud Pública y Laboral de Navarra, 31003, Pamplona, Spain
- Navarre Institute for Health Research (IdiSNA), 31008, Pamplona, Spain
| | - Carmen Santiuste
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
| | - Antonio Agudo
- Unit of Nutrition and Cancer, Catalan Institute of Oncology - ICO, L'Hospitalet de Llobregat, Spain
- Nutrition and Cancer Group; Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Bellvitge Biomedical Research Institute - IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Rashmita Bajracharya
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Verena Katzke
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Fulvio Ricceri
- Department of Clinical and Biological Sciences, Centre for Biostatistics, Epidemiology, and Public Health, University of Turin, Turin, Italy
| | - Claudia Agnoli
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133, Milan, Italy
| | - Manuela M Bergmann
- German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - Matthias B Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
- Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany
| | - Salvatore Panico
- Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Naples, Italy
| | - Giovanna Masala
- Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anja Olsen
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Tanja Stocks
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Jonas Manjer
- Department of Surgery, Skåne University Hospital Malmö, Lund University, Malmö, Sweden
| | - Amaia Aizpurua-Atxega
- Epidemiology of Chronic and Communicable Diseases Group, Biodonostia Health Research Institute, San Sebastián, Spain
- Sub Directorate for Public Health and Addictions of Gipuzkoa, Ministry of Health of the Basque Government, San Sebastián, Spain
| | - Elisabete Weiderpass
- International Agency for Research On Cancer (IARC-WHO), World Health Organization, 25, Avenue Tony Garnier, CS 90627, 69366, Lyon Cedex 07, France
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Marc J Gunter
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- International Agency for Research On Cancer (IARC-WHO), World Health Organization, 25, Avenue Tony Garnier, CS 90627, 69366, Lyon Cedex 07, France
| | - Pietro Ferrari
- International Agency for Research On Cancer (IARC-WHO), World Health Organization, 25, Avenue Tony Garnier, CS 90627, 69366, Lyon Cedex 07, France.
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Gapstur SM, Bouvard V, Nethan ST, Freudenheim JL, Abnet CC, English DR, Rehm J, Balbo S, Buykx P, Crabb D, Conway DI, Islami F, Lachenmeier DW, McGlynn KA, Salaspuro M, Sawada N, Terry MB, Toporcov T, Lauby-Secretan B. The IARC Perspective on Alcohol Reduction or Cessation and Cancer Risk. N Engl J Med 2023; 389:2486-2494. [PMID: 38157507 DOI: 10.1056/nejmsr2306723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Affiliation(s)
- Susan M Gapstur
- From the International Agency for Research on Cancer, Lyon, France (S.M.G., V.B., S.T.N., B.L.-S.); the School of Public Health and Health Professions, University at Buffalo, Buffalo (J.L.F.), and the Mailman School of Public Health and the Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, Columbia University, New York (M.B.T.) - both in New York; the Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (C.C.A., K.A.M.); Cancer Council Victoria and Melbourne School of Population and Global Health, University of Melbourne, Melbourne (D.R.E.), and the University of Newcastle, Callaghan, NSW (P.B.) - both in Australia; the Centre for Addiction and Mental Health, Toronto (J.R.); the School of Public Health, University of Minnesota, Minneapolis (S.B.); Eskenazi Health and Indiana University School of Medicine, Indianapolis (D.C.); the School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow, United Kingdom (D.I.C.); American Cancer Society, Atlanta (F.I.); Chemical and Veterinary Investigation Agency Karlsruhe, Karlsruhe, Germany (D.W.L.); University of Helsinki, Helsinki (M.S.); the Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo (N.S.); and the School of Public Health, Universidade de São Paulo, São Paulo (T.T.)
| | - Véronique Bouvard
- From the International Agency for Research on Cancer, Lyon, France (S.M.G., V.B., S.T.N., B.L.-S.); the School of Public Health and Health Professions, University at Buffalo, Buffalo (J.L.F.), and the Mailman School of Public Health and the Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, Columbia University, New York (M.B.T.) - both in New York; the Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (C.C.A., K.A.M.); Cancer Council Victoria and Melbourne School of Population and Global Health, University of Melbourne, Melbourne (D.R.E.), and the University of Newcastle, Callaghan, NSW (P.B.) - both in Australia; the Centre for Addiction and Mental Health, Toronto (J.R.); the School of Public Health, University of Minnesota, Minneapolis (S.B.); Eskenazi Health and Indiana University School of Medicine, Indianapolis (D.C.); the School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow, United Kingdom (D.I.C.); American Cancer Society, Atlanta (F.I.); Chemical and Veterinary Investigation Agency Karlsruhe, Karlsruhe, Germany (D.W.L.); University of Helsinki, Helsinki (M.S.); the Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo (N.S.); and the School of Public Health, Universidade de São Paulo, São Paulo (T.T.)
| | - Suzanne T Nethan
- From the International Agency for Research on Cancer, Lyon, France (S.M.G., V.B., S.T.N., B.L.-S.); the School of Public Health and Health Professions, University at Buffalo, Buffalo (J.L.F.), and the Mailman School of Public Health and the Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, Columbia University, New York (M.B.T.) - both in New York; the Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (C.C.A., K.A.M.); Cancer Council Victoria and Melbourne School of Population and Global Health, University of Melbourne, Melbourne (D.R.E.), and the University of Newcastle, Callaghan, NSW (P.B.) - both in Australia; the Centre for Addiction and Mental Health, Toronto (J.R.); the School of Public Health, University of Minnesota, Minneapolis (S.B.); Eskenazi Health and Indiana University School of Medicine, Indianapolis (D.C.); the School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow, United Kingdom (D.I.C.); American Cancer Society, Atlanta (F.I.); Chemical and Veterinary Investigation Agency Karlsruhe, Karlsruhe, Germany (D.W.L.); University of Helsinki, Helsinki (M.S.); the Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo (N.S.); and the School of Public Health, Universidade de São Paulo, São Paulo (T.T.)
| | - Jo L Freudenheim
- From the International Agency for Research on Cancer, Lyon, France (S.M.G., V.B., S.T.N., B.L.-S.); the School of Public Health and Health Professions, University at Buffalo, Buffalo (J.L.F.), and the Mailman School of Public Health and the Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, Columbia University, New York (M.B.T.) - both in New York; the Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (C.C.A., K.A.M.); Cancer Council Victoria and Melbourne School of Population and Global Health, University of Melbourne, Melbourne (D.R.E.), and the University of Newcastle, Callaghan, NSW (P.B.) - both in Australia; the Centre for Addiction and Mental Health, Toronto (J.R.); the School of Public Health, University of Minnesota, Minneapolis (S.B.); Eskenazi Health and Indiana University School of Medicine, Indianapolis (D.C.); the School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow, United Kingdom (D.I.C.); American Cancer Society, Atlanta (F.I.); Chemical and Veterinary Investigation Agency Karlsruhe, Karlsruhe, Germany (D.W.L.); University of Helsinki, Helsinki (M.S.); the Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo (N.S.); and the School of Public Health, Universidade de São Paulo, São Paulo (T.T.)
| | - Christian C Abnet
- From the International Agency for Research on Cancer, Lyon, France (S.M.G., V.B., S.T.N., B.L.-S.); the School of Public Health and Health Professions, University at Buffalo, Buffalo (J.L.F.), and the Mailman School of Public Health and the Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, Columbia University, New York (M.B.T.) - both in New York; the Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (C.C.A., K.A.M.); Cancer Council Victoria and Melbourne School of Population and Global Health, University of Melbourne, Melbourne (D.R.E.), and the University of Newcastle, Callaghan, NSW (P.B.) - both in Australia; the Centre for Addiction and Mental Health, Toronto (J.R.); the School of Public Health, University of Minnesota, Minneapolis (S.B.); Eskenazi Health and Indiana University School of Medicine, Indianapolis (D.C.); the School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow, United Kingdom (D.I.C.); American Cancer Society, Atlanta (F.I.); Chemical and Veterinary Investigation Agency Karlsruhe, Karlsruhe, Germany (D.W.L.); University of Helsinki, Helsinki (M.S.); the Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo (N.S.); and the School of Public Health, Universidade de São Paulo, São Paulo (T.T.)
| | - Dallas R English
- From the International Agency for Research on Cancer, Lyon, France (S.M.G., V.B., S.T.N., B.L.-S.); the School of Public Health and Health Professions, University at Buffalo, Buffalo (J.L.F.), and the Mailman School of Public Health and the Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, Columbia University, New York (M.B.T.) - both in New York; the Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (C.C.A., K.A.M.); Cancer Council Victoria and Melbourne School of Population and Global Health, University of Melbourne, Melbourne (D.R.E.), and the University of Newcastle, Callaghan, NSW (P.B.) - both in Australia; the Centre for Addiction and Mental Health, Toronto (J.R.); the School of Public Health, University of Minnesota, Minneapolis (S.B.); Eskenazi Health and Indiana University School of Medicine, Indianapolis (D.C.); the School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow, United Kingdom (D.I.C.); American Cancer Society, Atlanta (F.I.); Chemical and Veterinary Investigation Agency Karlsruhe, Karlsruhe, Germany (D.W.L.); University of Helsinki, Helsinki (M.S.); the Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo (N.S.); and the School of Public Health, Universidade de São Paulo, São Paulo (T.T.)
| | - Jürgen Rehm
- From the International Agency for Research on Cancer, Lyon, France (S.M.G., V.B., S.T.N., B.L.-S.); the School of Public Health and Health Professions, University at Buffalo, Buffalo (J.L.F.), and the Mailman School of Public Health and the Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, Columbia University, New York (M.B.T.) - both in New York; the Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (C.C.A., K.A.M.); Cancer Council Victoria and Melbourne School of Population and Global Health, University of Melbourne, Melbourne (D.R.E.), and the University of Newcastle, Callaghan, NSW (P.B.) - both in Australia; the Centre for Addiction and Mental Health, Toronto (J.R.); the School of Public Health, University of Minnesota, Minneapolis (S.B.); Eskenazi Health and Indiana University School of Medicine, Indianapolis (D.C.); the School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow, United Kingdom (D.I.C.); American Cancer Society, Atlanta (F.I.); Chemical and Veterinary Investigation Agency Karlsruhe, Karlsruhe, Germany (D.W.L.); University of Helsinki, Helsinki (M.S.); the Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo (N.S.); and the School of Public Health, Universidade de São Paulo, São Paulo (T.T.)
| | - Silvia Balbo
- From the International Agency for Research on Cancer, Lyon, France (S.M.G., V.B., S.T.N., B.L.-S.); the School of Public Health and Health Professions, University at Buffalo, Buffalo (J.L.F.), and the Mailman School of Public Health and the Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, Columbia University, New York (M.B.T.) - both in New York; the Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (C.C.A., K.A.M.); Cancer Council Victoria and Melbourne School of Population and Global Health, University of Melbourne, Melbourne (D.R.E.), and the University of Newcastle, Callaghan, NSW (P.B.) - both in Australia; the Centre for Addiction and Mental Health, Toronto (J.R.); the School of Public Health, University of Minnesota, Minneapolis (S.B.); Eskenazi Health and Indiana University School of Medicine, Indianapolis (D.C.); the School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow, United Kingdom (D.I.C.); American Cancer Society, Atlanta (F.I.); Chemical and Veterinary Investigation Agency Karlsruhe, Karlsruhe, Germany (D.W.L.); University of Helsinki, Helsinki (M.S.); the Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo (N.S.); and the School of Public Health, Universidade de São Paulo, São Paulo (T.T.)
| | - Penny Buykx
- From the International Agency for Research on Cancer, Lyon, France (S.M.G., V.B., S.T.N., B.L.-S.); the School of Public Health and Health Professions, University at Buffalo, Buffalo (J.L.F.), and the Mailman School of Public Health and the Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, Columbia University, New York (M.B.T.) - both in New York; the Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (C.C.A., K.A.M.); Cancer Council Victoria and Melbourne School of Population and Global Health, University of Melbourne, Melbourne (D.R.E.), and the University of Newcastle, Callaghan, NSW (P.B.) - both in Australia; the Centre for Addiction and Mental Health, Toronto (J.R.); the School of Public Health, University of Minnesota, Minneapolis (S.B.); Eskenazi Health and Indiana University School of Medicine, Indianapolis (D.C.); the School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow, United Kingdom (D.I.C.); American Cancer Society, Atlanta (F.I.); Chemical and Veterinary Investigation Agency Karlsruhe, Karlsruhe, Germany (D.W.L.); University of Helsinki, Helsinki (M.S.); the Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo (N.S.); and the School of Public Health, Universidade de São Paulo, São Paulo (T.T.)
| | - David Crabb
- From the International Agency for Research on Cancer, Lyon, France (S.M.G., V.B., S.T.N., B.L.-S.); the School of Public Health and Health Professions, University at Buffalo, Buffalo (J.L.F.), and the Mailman School of Public Health and the Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, Columbia University, New York (M.B.T.) - both in New York; the Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (C.C.A., K.A.M.); Cancer Council Victoria and Melbourne School of Population and Global Health, University of Melbourne, Melbourne (D.R.E.), and the University of Newcastle, Callaghan, NSW (P.B.) - both in Australia; the Centre for Addiction and Mental Health, Toronto (J.R.); the School of Public Health, University of Minnesota, Minneapolis (S.B.); Eskenazi Health and Indiana University School of Medicine, Indianapolis (D.C.); the School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow, United Kingdom (D.I.C.); American Cancer Society, Atlanta (F.I.); Chemical and Veterinary Investigation Agency Karlsruhe, Karlsruhe, Germany (D.W.L.); University of Helsinki, Helsinki (M.S.); the Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo (N.S.); and the School of Public Health, Universidade de São Paulo, São Paulo (T.T.)
| | - David I Conway
- From the International Agency for Research on Cancer, Lyon, France (S.M.G., V.B., S.T.N., B.L.-S.); the School of Public Health and Health Professions, University at Buffalo, Buffalo (J.L.F.), and the Mailman School of Public Health and the Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, Columbia University, New York (M.B.T.) - both in New York; the Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (C.C.A., K.A.M.); Cancer Council Victoria and Melbourne School of Population and Global Health, University of Melbourne, Melbourne (D.R.E.), and the University of Newcastle, Callaghan, NSW (P.B.) - both in Australia; the Centre for Addiction and Mental Health, Toronto (J.R.); the School of Public Health, University of Minnesota, Minneapolis (S.B.); Eskenazi Health and Indiana University School of Medicine, Indianapolis (D.C.); the School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow, United Kingdom (D.I.C.); American Cancer Society, Atlanta (F.I.); Chemical and Veterinary Investigation Agency Karlsruhe, Karlsruhe, Germany (D.W.L.); University of Helsinki, Helsinki (M.S.); the Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo (N.S.); and the School of Public Health, Universidade de São Paulo, São Paulo (T.T.)
| | - Farhad Islami
- From the International Agency for Research on Cancer, Lyon, France (S.M.G., V.B., S.T.N., B.L.-S.); the School of Public Health and Health Professions, University at Buffalo, Buffalo (J.L.F.), and the Mailman School of Public Health and the Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, Columbia University, New York (M.B.T.) - both in New York; the Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (C.C.A., K.A.M.); Cancer Council Victoria and Melbourne School of Population and Global Health, University of Melbourne, Melbourne (D.R.E.), and the University of Newcastle, Callaghan, NSW (P.B.) - both in Australia; the Centre for Addiction and Mental Health, Toronto (J.R.); the School of Public Health, University of Minnesota, Minneapolis (S.B.); Eskenazi Health and Indiana University School of Medicine, Indianapolis (D.C.); the School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow, United Kingdom (D.I.C.); American Cancer Society, Atlanta (F.I.); Chemical and Veterinary Investigation Agency Karlsruhe, Karlsruhe, Germany (D.W.L.); University of Helsinki, Helsinki (M.S.); the Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo (N.S.); and the School of Public Health, Universidade de São Paulo, São Paulo (T.T.)
| | - Dirk W Lachenmeier
- From the International Agency for Research on Cancer, Lyon, France (S.M.G., V.B., S.T.N., B.L.-S.); the School of Public Health and Health Professions, University at Buffalo, Buffalo (J.L.F.), and the Mailman School of Public Health and the Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, Columbia University, New York (M.B.T.) - both in New York; the Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (C.C.A., K.A.M.); Cancer Council Victoria and Melbourne School of Population and Global Health, University of Melbourne, Melbourne (D.R.E.), and the University of Newcastle, Callaghan, NSW (P.B.) - both in Australia; the Centre for Addiction and Mental Health, Toronto (J.R.); the School of Public Health, University of Minnesota, Minneapolis (S.B.); Eskenazi Health and Indiana University School of Medicine, Indianapolis (D.C.); the School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow, United Kingdom (D.I.C.); American Cancer Society, Atlanta (F.I.); Chemical and Veterinary Investigation Agency Karlsruhe, Karlsruhe, Germany (D.W.L.); University of Helsinki, Helsinki (M.S.); the Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo (N.S.); and the School of Public Health, Universidade de São Paulo, São Paulo (T.T.)
| | - Katherine A McGlynn
- From the International Agency for Research on Cancer, Lyon, France (S.M.G., V.B., S.T.N., B.L.-S.); the School of Public Health and Health Professions, University at Buffalo, Buffalo (J.L.F.), and the Mailman School of Public Health and the Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, Columbia University, New York (M.B.T.) - both in New York; the Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (C.C.A., K.A.M.); Cancer Council Victoria and Melbourne School of Population and Global Health, University of Melbourne, Melbourne (D.R.E.), and the University of Newcastle, Callaghan, NSW (P.B.) - both in Australia; the Centre for Addiction and Mental Health, Toronto (J.R.); the School of Public Health, University of Minnesota, Minneapolis (S.B.); Eskenazi Health and Indiana University School of Medicine, Indianapolis (D.C.); the School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow, United Kingdom (D.I.C.); American Cancer Society, Atlanta (F.I.); Chemical and Veterinary Investigation Agency Karlsruhe, Karlsruhe, Germany (D.W.L.); University of Helsinki, Helsinki (M.S.); the Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo (N.S.); and the School of Public Health, Universidade de São Paulo, São Paulo (T.T.)
| | - Mikko Salaspuro
- From the International Agency for Research on Cancer, Lyon, France (S.M.G., V.B., S.T.N., B.L.-S.); the School of Public Health and Health Professions, University at Buffalo, Buffalo (J.L.F.), and the Mailman School of Public Health and the Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, Columbia University, New York (M.B.T.) - both in New York; the Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (C.C.A., K.A.M.); Cancer Council Victoria and Melbourne School of Population and Global Health, University of Melbourne, Melbourne (D.R.E.), and the University of Newcastle, Callaghan, NSW (P.B.) - both in Australia; the Centre for Addiction and Mental Health, Toronto (J.R.); the School of Public Health, University of Minnesota, Minneapolis (S.B.); Eskenazi Health and Indiana University School of Medicine, Indianapolis (D.C.); the School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow, United Kingdom (D.I.C.); American Cancer Society, Atlanta (F.I.); Chemical and Veterinary Investigation Agency Karlsruhe, Karlsruhe, Germany (D.W.L.); University of Helsinki, Helsinki (M.S.); the Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo (N.S.); and the School of Public Health, Universidade de São Paulo, São Paulo (T.T.)
| | - Norie Sawada
- From the International Agency for Research on Cancer, Lyon, France (S.M.G., V.B., S.T.N., B.L.-S.); the School of Public Health and Health Professions, University at Buffalo, Buffalo (J.L.F.), and the Mailman School of Public Health and the Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, Columbia University, New York (M.B.T.) - both in New York; the Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (C.C.A., K.A.M.); Cancer Council Victoria and Melbourne School of Population and Global Health, University of Melbourne, Melbourne (D.R.E.), and the University of Newcastle, Callaghan, NSW (P.B.) - both in Australia; the Centre for Addiction and Mental Health, Toronto (J.R.); the School of Public Health, University of Minnesota, Minneapolis (S.B.); Eskenazi Health and Indiana University School of Medicine, Indianapolis (D.C.); the School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow, United Kingdom (D.I.C.); American Cancer Society, Atlanta (F.I.); Chemical and Veterinary Investigation Agency Karlsruhe, Karlsruhe, Germany (D.W.L.); University of Helsinki, Helsinki (M.S.); the Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo (N.S.); and the School of Public Health, Universidade de São Paulo, São Paulo (T.T.)
| | - Mary B Terry
- From the International Agency for Research on Cancer, Lyon, France (S.M.G., V.B., S.T.N., B.L.-S.); the School of Public Health and Health Professions, University at Buffalo, Buffalo (J.L.F.), and the Mailman School of Public Health and the Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, Columbia University, New York (M.B.T.) - both in New York; the Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (C.C.A., K.A.M.); Cancer Council Victoria and Melbourne School of Population and Global Health, University of Melbourne, Melbourne (D.R.E.), and the University of Newcastle, Callaghan, NSW (P.B.) - both in Australia; the Centre for Addiction and Mental Health, Toronto (J.R.); the School of Public Health, University of Minnesota, Minneapolis (S.B.); Eskenazi Health and Indiana University School of Medicine, Indianapolis (D.C.); the School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow, United Kingdom (D.I.C.); American Cancer Society, Atlanta (F.I.); Chemical and Veterinary Investigation Agency Karlsruhe, Karlsruhe, Germany (D.W.L.); University of Helsinki, Helsinki (M.S.); the Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo (N.S.); and the School of Public Health, Universidade de São Paulo, São Paulo (T.T.)
| | - Tatiana Toporcov
- From the International Agency for Research on Cancer, Lyon, France (S.M.G., V.B., S.T.N., B.L.-S.); the School of Public Health and Health Professions, University at Buffalo, Buffalo (J.L.F.), and the Mailman School of Public Health and the Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, Columbia University, New York (M.B.T.) - both in New York; the Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (C.C.A., K.A.M.); Cancer Council Victoria and Melbourne School of Population and Global Health, University of Melbourne, Melbourne (D.R.E.), and the University of Newcastle, Callaghan, NSW (P.B.) - both in Australia; the Centre for Addiction and Mental Health, Toronto (J.R.); the School of Public Health, University of Minnesota, Minneapolis (S.B.); Eskenazi Health and Indiana University School of Medicine, Indianapolis (D.C.); the School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow, United Kingdom (D.I.C.); American Cancer Society, Atlanta (F.I.); Chemical and Veterinary Investigation Agency Karlsruhe, Karlsruhe, Germany (D.W.L.); University of Helsinki, Helsinki (M.S.); the Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo (N.S.); and the School of Public Health, Universidade de São Paulo, São Paulo (T.T.)
| | - Béatrice Lauby-Secretan
- From the International Agency for Research on Cancer, Lyon, France (S.M.G., V.B., S.T.N., B.L.-S.); the School of Public Health and Health Professions, University at Buffalo, Buffalo (J.L.F.), and the Mailman School of Public Health and the Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, Columbia University, New York (M.B.T.) - both in New York; the Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD (C.C.A., K.A.M.); Cancer Council Victoria and Melbourne School of Population and Global Health, University of Melbourne, Melbourne (D.R.E.), and the University of Newcastle, Callaghan, NSW (P.B.) - both in Australia; the Centre for Addiction and Mental Health, Toronto (J.R.); the School of Public Health, University of Minnesota, Minneapolis (S.B.); Eskenazi Health and Indiana University School of Medicine, Indianapolis (D.C.); the School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow, United Kingdom (D.I.C.); American Cancer Society, Atlanta (F.I.); Chemical and Veterinary Investigation Agency Karlsruhe, Karlsruhe, Germany (D.W.L.); University of Helsinki, Helsinki (M.S.); the Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo (N.S.); and the School of Public Health, Universidade de São Paulo, São Paulo (T.T.)
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5
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Botteri E, Peveri G, Berstad P, Bagnardi V, Chen SLF, Sandanger TM, Hoff G, Dahm CC, Antoniussen CS, Tjønneland A, Eriksen AK, Skeie G, Perez-Cornago A, Huerta JM, Jakszyn P, Harlid S, Sundström B, Barricarte A, Monninkhof EM, Derksen JWG, Schulze MB, Bueno-de-Mesquita B, Sánchez MJ, Cross AJ, Tsilidis KK, De Magistris MS, Kaaks R, Katzke V, Rothwell JA, Laouali N, Severi G, Amiano P, Contiero P, Sacerdote C, Goldberg M, Touvier M, Freisling H, Viallon V, Weiderpass E, Riboli E, Gunter MJ, Jenab M, Ferrari P. Changes in Lifestyle and Risk of Colorectal Cancer in the European Prospective Investigation Into Cancer and Nutrition. Am J Gastroenterol 2023; 118:702-711. [PMID: 36227801 DOI: 10.14309/ajg.0000000000002065] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 09/09/2022] [Indexed: 12/04/2022]
Abstract
INTRODUCTION We investigated the impact of changes in lifestyle habits on colorectal cancer (CRC) risk in a multicountry European cohort. METHODS We used baseline and follow-up questionnaire data from the European Prospective Investigation into Cancer cohort to assess changes in lifestyle habits and their associations with CRC development. We calculated a healthy lifestyle index (HLI) score based on smoking status, alcohol consumption, body mass index, and physical activity collected at the 2 time points. HLI ranged from 0 (most unfavorable) to 16 (most favorable). We estimated the association between HLI changes and CRC risk using Cox regression models and reported hazard ratios (HR) with 95% confidence intervals (CI). RESULTS Among 295,865 participants, 2,799 CRC cases were observed over a median of 7.8 years. The median time between questionnaires was 5.7 years. Each unit increase in HLI from the baseline to the follow-up assessment was associated with a statistically significant 3% lower CRC risk. Among participants in the top tertile at baseline (HLI > 11), those in the bottom tertile at follow-up (HLI ≤ 9) had a higher CRC risk (HR 1.34; 95% CI 1.02-1.75) than those remaining in the top tertile. Among individuals in the bottom tertile at baseline, those in the top tertile at follow-up had a lower risk (HR 0.77; 95% CI 0.59-1.00) than those remaining in the bottom tertile. DISCUSSION Improving adherence to a healthy lifestyle was inversely associated with CRC risk, while worsening adherence was positively associated with CRC risk. These results justify and support recommendations for healthy lifestyle changes and healthy lifestyle maintenance for CRC prevention.
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Affiliation(s)
- Edoardo Botteri
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
- Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - Giulia Peveri
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Paula Berstad
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Sairah L F Chen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Torkjel M Sandanger
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Geir Hoff
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
- Department of Research, Telemark Hospital, Skien, Norway
| | | | | | | | | | - Guri Skeie
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Aurora Perez-Cornago
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - José María Huerta
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Paula Jakszyn
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain
| | - Sophia Harlid
- Department of Radiation Sciences, Oncology Unit, Umeå University, Umeå, Sweden
| | - Björn Sundström
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Aurelio Barricarte
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Navarra Public Health Institute, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA) Pamplona, Spain
| | - Evelyn M Monninkhof
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Jeroen W G Derksen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Matthias B Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
- Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany
| | - Bas Bueno-de-Mesquita
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Maria-Jose Sánchez
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Escuela Andaluza de Salud Pública (EASP), Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
| | - Amanda J Cross
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Konstantinos K Tsilidis
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | | | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Verena Katzke
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Joseph A Rothwell
- Université Paris-Saclay, UVSQ, Inserm, CESP U1018, "Exposome, Heredity, Cancer and Health" Team, Gustave Roussy, Villejuif, France
| | - Nasser Laouali
- Université Paris-Saclay, UVSQ, Inserm, CESP U1018, "Exposome, Heredity, Cancer and Health" Team, Gustave Roussy, Villejuif, France
| | - Gianluca Severi
- Université Paris-Saclay, UVSQ, Inserm, CESP U1018, "Exposome, Heredity, Cancer and Health" Team, Gustave Roussy, Villejuif, France
- Department of Statistics, Computer Science, Applications "G. Parenti" (DISIA), University of Florence, Florence, Italy
| | - Pilar Amiano
- Ministry of Health of the Basque Government, Sub Directorate for Public Health and Addictions of Gipuzkoa, San Sebastian, Spain
- Biodonostia Health Research Institute, Epidemiology of Chronic and Communicable Diseases Group, San Sebastián, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Paolo Contiero
- Environmental Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Carlotta Sacerdote
- Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital, Turin, Italy
| | - Marcel Goldberg
- Population-based Epidemiologic Cohorts Unit, Inserrm UMS 11, Villejuif, France
| | - Mathilde Touvier
- Nutritional Epidemiology Research Team (EREN), Sorbonne Paris Nord University, Inserm U1153, Inrae U1125, Cnam, Epidemiology and Statistics Research Center-University of Paris (CRESS), Bobigny, France
- Public Health Department, Avicenne Hospital, AP-HP, Bobigny, France
| | - Heinz Freisling
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Vivian Viallon
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Elisabete Weiderpass
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Marc J Gunter
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Mazda Jenab
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Pietro Ferrari
- International Agency for Research on Cancer, World Health Organization, Lyon, France
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