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@ARTICLE{Macciotta:182342,
      author       = {A. Macciotta and A. Catalano and M. T. Giraudo and E.
                      Weiderpass and P. Ferrari and H. Freisling and S. M.
                      Colorado-Yohar and C. Santiuste and P. Amiano and A. K.
                      Heath and H. A. Ward and S. Christakoudi and P. Vineis and
                      D. Singh and S. Vaccarella and M. B. Schulze and A. E.
                      Hiensch and E. M. Monninkhof and V. Katzke$^*$ and R.
                      Kaaks$^*$ and R. Tumino and F. Lazzarato and L. Milani and
                      A. Agudo and C. C. Dahm and L. Baglietto and V. Perduca and
                      G. Severi and S. Grioni and S. Panico and E. Ardanaz and K.
                      Benjaminsen Borch and F. O. Benebo and T. Braaten and M.-J.
                      Sánchez and C. Giachino and C. Sacerdote and F. Ricceri},
      title        = {{M}ediating role of lifestyle behaviours in the association
                      between education and cancer: results from the {E}uropean
                      {P}rospective {I}nvestigation into {C}ancer and
                      {N}utrition.},
      journal      = {Cancer epidemiology, biomarkers $\&$ prevention},
      volume       = {32},
      number       = {1},
      issn         = {1055-9965},
      address      = {Philadelphia, Pa.},
      publisher    = {AACR},
      reportid     = {DKFZ-2022-02585},
      pages        = {132-140},
      year         = {2023},
      note         = {2023 Jan 9;32(1):132-140},
      abstract     = {Many 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.},
      cin          = {C020},
      ddc          = {610},
      cid          = {I:(DE-He78)C020-20160331},
      pnm          = {313 - Krebsrisikofaktoren und Prävention (POF4-313)},
      pid          = {G:(DE-HGF)POF4-313},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:36306379},
      doi          = {10.1158/1055-9965.EPI-22-0777},
      url          = {https://inrepo02.dkfz.de/record/182342},
}