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000182342 1001_ $$00000-0002-0287-7979$$aMacciotta, Alessandra$$b0
000182342 245__ $$aMediating role of lifestyle behaviours in the association between education and cancer: results from the European Prospective Investigation into Cancer and Nutrition.
000182342 260__ $$aPhiladelphia, Pa.$$bAACR$$c2023
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000182342 500__ $$a2023 Jan 9;32(1):132-140
000182342 520__ $$aMany studies have shown that socioeconomic position (SEP) is associated with the incidence of malignant tumors at different sites. This study aims to estimate the association between educational level (as proxy for SEP) and cancer incidence and to understand if the observed associations might be partially explained by lifestyle behaviors.The analyses were performed on data from the European Prospective Investigation into Cancer and Nutrition (EPIC) study, globally and by sex. We used Cox proportional hazards models together with mediation analysis to disentangle the total effect (TE) of educational level (measured through the Relative Index of Inequality (RII)) on cancer incidence into pure direct (PDE) and total indirect (TIE) effect, unexplained and explained by mediators, respectively. PDE and TIE were then combined to compute the proportions mediated (PM).After an average of 14 years of follow-up, 52,422 malignant tumors were ascertained. Low educated participants showed higher risk of developing stomach, lung, kidney (in women), and bladder (in men) cancers, and, conversely, lower risk of melanoma and breast cancer (in post-menopausal women), when compared to more educated participants. Mediation analyses showed that portions of the total effect of RII on cancer could be explained by site-specific related lifestyle behaviors for stomach, lung, and breast (in women).Cancer incidence in Europe is determined at least in part by a socioeconomically stratified distribution of risk factors.These observational findings support policies to reduce cancer occurrence by altering mediators, such as lifestyle behaviors, particularly focusing on underprivileged strata of the population.
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000182342 7001_ $$00000-0003-2597-2060$$aCatalano, Alberto$$b1
000182342 7001_ $$00000-0002-7152-6902$$aGiraudo, Maria Teresa$$b2
000182342 7001_ $$00000-0003-2237-0128$$aWeiderpass, Elisabete$$b3
000182342 7001_ $$00000-0001-9358-7338$$aFerrari, Pietro$$b4
000182342 7001_ $$00000-0001-8648-4998$$aFreisling, Heinz$$b5
000182342 7001_ $$00000-0002-6700-0780$$aColorado-Yohar, Sandra M$$b6
000182342 7001_ $$00000-0003-3463-2869$$aSantiuste, Carmen$$b7
000182342 7001_ $$00000-0003-3986-7026$$aAmiano, Pilar$$b8
000182342 7001_ $$00000-0001-6517-1300$$aHeath, Alicia K$$b9
000182342 7001_ $$00000-0002-2721-2404$$aWard, Heather A$$b10
000182342 7001_ $$00000-0001-9219-4436$$aChristakoudi, Sofia$$b11
000182342 7001_ $$00000-0001-8935-4566$$aVineis, Paolo$$b12
000182342 7001_ $$00000-0002-9533-9183$$aSingh, Deependra$$b13
000182342 7001_ $$00000-0002-2516-2167$$aVaccarella, Salvatore$$b14
000182342 7001_ $$00000-0002-0830-5277$$aSchulze, Matthias B$$b15
000182342 7001_ $$00000-0002-6216-2609$$aHiensch, Anouk E$$b16
000182342 7001_ $$00000-0002-6641-7605$$aMonninkhof, Evelyn M$$b17
000182342 7001_ $$0P:(DE-He78)fb68a9386399d72d84f7f34cfc6048b4$$aKatzke, Verena$$b18$$udkfz
000182342 7001_ $$0P:(DE-He78)4b2dc91c9d1ac33a1c0e0777d0c1697a$$aKaaks, Rudolf$$b19$$udkfz
000182342 7001_ $$00000-0003-2666-414X$$aTumino, Rosario$$b20
000182342 7001_ $$00000-0002-6698-5944$$aLazzarato, Fulvio$$b21
000182342 7001_ $$00000-0002-2185-2179$$aMilani, Lorenzo$$b22
000182342 7001_ $$00000-0001-9900-5677$$aAgudo, Antonio$$b23
000182342 7001_ $$00000-0003-0481-2893$$aDahm, Christina C$$b24
000182342 7001_ $$00000-0002-8193-7529$$aBaglietto, Laura$$b25
000182342 7001_ $$00000-0003-0339-0473$$aPerduca, Vittorio$$b26
000182342 7001_ $$00000-0001-7157-419X$$aSeveri, Gianluca$$b27
000182342 7001_ $$00000-0002-5891-8426$$aGrioni, Sara$$b28
000182342 7001_ $$00000-0002-5498-8312$$aPanico, Salvatore$$b29
000182342 7001_ $$00000-0001-8434-2013$$aArdanaz, Eva$$b30
000182342 7001_ $$00000-0002-1741-2322$$aBenjaminsen Borch, Kristin$$b31
000182342 7001_ $$00000-0003-2729-7417$$aBenebo, Faith O$$b32
000182342 7001_ $$00000-0003-4394-6149$$aBraaten, Tonje$$b33
000182342 7001_ $$00000-0003-4817-0757$$aSánchez, Maria-Jose$$b34
000182342 7001_ $$00000-0001-7957-3925$$aGiachino, Claudia$$b35
000182342 7001_ $$00000-0002-8008-5096$$aSacerdote, Carlotta$$b36
000182342 7001_ $$00000-0001-8749-9737$$aRicceri, Fulvio$$b37
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