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@ARTICLE{Vasson:305587,
      author       = {F. Vasson and K. Matta and C. Biessy and C. S Antoniussen
                      and A. Fournier and C. Marques and C. Cadeau and C. Le
                      Cornet$^*$ and R. T Fortner$^*$ and M. B. Schulze and S.
                      Sieri and S. Panico and R. Tumino and F. Ricceri and G.
                      Masala and A. E. Hiensch and E. M. Monninkhof and A. Agudo
                      and M. Guevara and S. M. Colorado-Yohar and M.-J. Sánchez
                      and A. Llorente and S. Tin Tin and I. G. Jackson and M. J.
                      Gunter and E. Botteri and P. Ferrari and L. Dossus},
      title        = {{L}ifestyle changes and postmenopausal breast cancer risk
                      in women from the {E}uropean {P}rospective {I}nvestigation
                      into {C}ancer and {N}utrition.},
      journal      = {Breast cancer research},
      volume       = {27},
      number       = {1},
      issn         = {1465-5411},
      address      = {London},
      publisher    = {BioMed Central},
      reportid     = {DKFZ-2025-02246},
      pages        = {192},
      year         = {2025},
      abstract     = {The risk of breast cancer has been associated with various
                      lifestyle factors, yet the evidence regarding how lifestyle
                      modifications affect this risk remains limited. This study
                      examines the relationship between changes in the Healthy
                      Lifestyle Index (HLI) and postmenopausal breast cancer risk
                      in women participating in the European Prospective
                      Investigation into Cancer (EPIC).HLI scores (ranging from 0
                      to 16) were computed based on smoking habits, alcohol
                      consumption, body mass index (BMI), and physical activity
                      levels, using data from baseline and follow-up
                      questionnaires, which were separated by a median interval of
                      10 (IQR: 5.2-12.0) years. Among the 125,746 women included
                      in the analyses, 2,175 developed breast cancer over a median
                      follow-up period of nearly 4 (IQR: 2.9-8.4) years starting
                      from the date of the second lifestyle questionnaire. Cox
                      proportional hazards models were employed to estimate hazard
                      ratios (HRs) and confidence intervals (CIs) for the
                      relationship between changes in HLI and postmenopausal
                      breast cancer risk, analysed both overall and by estrogen
                      receptor (ER) status. Individual components of the HLI were
                      also analysed, with sensitivity analyses addressing
                      potential reverse causation by delaying the start of
                      follow-up by 1 to 3 years.Each unit increase in the
                      HLI-reflecting a healthier lifestyle-was not associated with
                      the overall risk of postmenopausal breast cancer. Among
                      individual components, only a one-unit increase in the BMI
                      score, corresponding to a shift towards a healthier BMI, was
                      inversely associated with overall (HR = 0.936; $95\%$ CI
                      0.880-0.996) and ER-positive (HR = 0.930; $95\%$ CI
                      0.865-1.000) postmenopausal breast cancer risks.Lifestyle
                      changes, as measured by the HLI, during mid-adulthood were
                      not significantly associated with the risk of postmenopausal
                      breast cancer. More specifically, the results of this study
                      suggested that a shift towards a healthier BMI may
                      contribute to breast cancer prevention. Further research
                      involving diverse and larger study populations and lifestyle
                      assessments at earlier life stages could provide deeper
                      insights.},
      keywords     = {Humans / Female / Breast Neoplasms: epidemiology / Breast
                      Neoplasms: etiology / Postmenopause / Middle Aged / Europe:
                      epidemiology / Life Style / Risk Factors / Prospective
                      Studies / Aged / Body Mass Index / Surveys and
                      Questionnaires / Proportional Hazards Models / Exercise /
                      Receptors, Estrogen: metabolism / Follow-Up Studies / Breast
                      cancer (Other) / Healthy lifestyle index (Other) / Lifestyle
                      changes (Other) / Longitudinal (Other) / Prospective cohort
                      (Other) / Risk (Other) / Receptors, Estrogen (NLM
                      Chemicals)},
      cin          = {C180},
      ddc          = {610},
      cid          = {I:(DE-He78)C180-20160331},
      pnm          = {313 - Krebsrisikofaktoren und Prävention (POF4-313)},
      pid          = {G:(DE-HGF)POF4-313},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:41163053},
      pmc          = {pmc:PMC12574052},
      doi          = {10.1186/s13058-025-02148-w},
      url          = {https://inrepo02.dkfz.de/record/305587},
}