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. 2024 Feb;39(2):147-159.
doi: 10.1007/s10654-023-01059-4. Epub 2024 Jan 5.

Lifestyle changes in middle age and risk of cancer: evidence from the European Prospective Investigation into Cancer and Nutrition

Edoardo Botteri  1   2 , Giulia Peveri  3   4 , Paula Berstad  2 , Vincenzo Bagnardi  5 , Geir Hoff  2   6 , Alicia K Heath  7 , Amanda J Cross  7 , Paolo Vineis  7 , Laure Dossus  8 , Mattias Johansson  8 , Heinz Freisling  8 , Komodo Matta  8 , Inge Huybrechts  8 , Sairah L F Chen  9 , Kristin B Borch  9 , Torkjel M Sandanger  9 , Therese H Nøst  9   10 , Christina C Dahm  11 , Christian S Antoniussen  11 , Sandar Tin Tin  12 , Agnès Fournier  13 , Chloé Marques  13 , Fanny Artaud  13 , Maria-José Sánchez  14   15   16   17 , Marcela Guevara  16   18   19 , Carmen Santiuste  16   20 , Antonio Agudo  21   22 , Rashmita Bajracharya  23 , Verena Katzke  23 , Fulvio Ricceri  24 , Claudia Agnoli  25 , Manuela M Bergmann  26 , Matthias B Schulze  27   28 , Salvatore Panico  29 , Giovanna Masala  30 , Anne Tjønneland  31   32 , Anja Olsen  11   31 , Tanja Stocks  33 , Jonas Manjer  34 , Amaia Aizpurua-Atxega  35   36 , Elisabete Weiderpass  8 , Elio Riboli  7 , Marc J Gunter #  7   8 , Pietro Ferrari #  37
Affiliations

Lifestyle changes in middle age and risk of cancer: evidence from the European Prospective Investigation into Cancer and Nutrition

Edoardo Botteri et al. Eur J Epidemiol. 2024 Feb.

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.

Keywords: Cancer risk; Cohort study; Healthy lifestyle index; Lifestyle changes.

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