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@ARTICLE{Botteri:286699,
      author       = {E. Botteri and G. Peveri and P. Berstad and V. Bagnardi and
                      G. Hoff and A. K. Heath and A. J. Cross and P. Vineis and L.
                      Dossus and M. Johansson and H. Freisling and K. Matta and I.
                      Huybrechts and S. L. F. Chen and K. B Borch and T. M.
                      Sandanger and T. H Nøst and C. C. Dahm and C. S.
                      Antoniussen and S. Tin Tin and A. Fournier and C. Marques
                      and F. Artaud and M.-J. Sánchez and M. Guevara and C.
                      Santiuste and A. Agudo and R. Bajracharya$^*$ and V.
                      Katzke$^*$ and F. Ricceri and C. Agnoli and M. M. Bergmann
                      and M. B. Schulze and S. Panico and G. Masala and A.
                      Tjønneland and A. Olsen and T. Stocks and J. Manjer and A.
                      Aizpurua-Atxega and E. Weiderpass and E. Riboli and M. J.
                      Gunter and P. Ferrari},
      title        = {{L}ifestyle changes in middle age and risk of cancer:
                      evidence from the {E}uropean {P}rospective {I}nvestigation
                      into {C}ancer and {N}utrition.},
      journal      = {European journal of epidemiology},
      volume       = {39},
      number       = {2},
      issn         = {0393-2990},
      address      = {Dordrecht [u.a.]},
      publisher    = {Springer Science + Business Media B.V.},
      reportid     = {DKFZ-2024-00039},
      pages        = {147-159},
      year         = {2024},
      note         = {2024 Feb;39(2):147-159},
      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 (Other) / Cohort study (Other) / Healthy
                      lifestyle index (Other) / Lifestyle changes (Other)},
      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:38180593},
      doi          = {10.1007/s10654-023-01059-4},
      url          = {https://inrepo02.dkfz.de/record/286699},
}