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

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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.

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Data availability

Access to the EPIC data is governed by the EPIC access policy, as detailed in https://epic.iarc.fr/docs/EPIC-Europe_AccessPolicy_01Feb2023.pdf. Please contact the corresponding author, Dr Pietro Ferrari, for more information.

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Acknowledgements

We acknowledge the use of data from the following EPIC cohorts: Copenhagen, Aarhus, France, Heidelberg, Potsdam, Milan, Florence, Naples, Turin, Ragusa, Norway, Asturias Granada, Murcia, Navarra, San Sebastian, Malmö, Bilthoven, Oxford, Norfolk. The authors thank the EPIC study participants and staff for their valuable contribution to this research. The authors further thank the National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands, for the contribution and ongoing support to the EPIC Study.

Funding

The study was supported by the grant LIBERTY (AAP SHS-E-SP 2020, PI: P Ferrari), from the French Institut National du Cancer (INCa). The coordination of EPIC is financially supported by the International Agency for Research on Cancer (IARC) and also by the Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London which has additional infrastructure support provided by the NIHR Imperial Biomedical Research Centre (BRC). The national cohorts are supported by: Danish Cancer Society (Denmark); Ligue Contre le Cancer, Institut Gustave Roussy, Mutuelle Générale de l’Education Nationale, Institut National de la Santé et de la Recherche Médicale (INSERM) (France); German Cancer Aid, German Cancer Research Center (DKFZ), German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Federal Ministry of Education and Research (BMBF) (Germany); Associazione Italiana per la Ricerca sul Cancro-AIRC-Italy, Compagnia di SanPaolo and National Research Council (Italy); Dutch Ministry of Public Health, Welfare and Sports (VWS), Netherlands Cancer Registry (NKR), LK Research Funds, Dutch Prevention Funds, Dutch ZON (Zorg Onderzoek Nederland), World Cancer Research Fund (WCRF), Statistics Netherlands (The Netherlands); Health Research Fund (FIS)—Instituto de Salud Carlos III (ISCIII), Regional Governments of Andalucía, Asturias, Basque Country, Murcia and Navarra, and the Catalan Institute of Oncology—ICO (Spain); Swedish Cancer Society, Swedish Research Council and County Councils of Skåne and Västerbotten (Sweden); Cancer Research UK (14136 to EPIC-Norfolk; C8221/A29017 to EPIC-Oxford), Medical Research Council (1000143 to EPIC-Norfolk; MR/M012190/1 to EPIC-Oxford) (United Kingdom).

Author information

Author notes

  1. Marc J. Gunter and Pietro Ferrari are joint senior authors.

Authors and Affiliations

  1. Department of Research, Cancer Registry of Norway, Oslo, Norway

    Edoardo Botteri

  2. Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway

    Edoardo Botteri, Paula Berstad & Geir Hoff

  3. Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy

    Giulia Peveri

  4. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden

    Giulia Peveri

  5. Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy

    Vincenzo Bagnardi

  6. Department of Research, Telemark Hospital, Skien, Norway

    Geir Hoff

  7. Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK

    Alicia K. Heath, Amanda J. Cross, Paolo Vineis, Elio Riboli & Marc J. Gunter

  8. International Agency for Research On Cancer (IARC-WHO), World Health Organization, 25, Avenue Tony Garnier, CS 90627, 69366, Lyon Cedex 07, France

    Laure Dossus, Mattias Johansson, Heinz Freisling, Komodo Matta, Inge Huybrechts, Elisabete Weiderpass, Marc J. Gunter & Pietro Ferrari

  9. Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway

    Sairah L. F. Chen, Kristin B. Borch, Torkjel M. Sandanger & Therese H. Nøst

  10. Department of Public Health, Aarhus University, Aarhus, Denmark

    Christina C. Dahm, Christian S. Antoniussen & Anja Olsen

  11. Cancer Epidemiology Unit, Oxford Population Health, University of Oxford, Oxford, UK

    Sandar Tin Tin

  12. Université Paris-Saclay, UVSQ, Inserm “Exposome, Heredity, Cancer and Health” Team, CESP U1018, Gustave Roussy, Villejuif, France

    Agnès Fournier, Chloé Marques & Fanny Artaud

  13. Escuela Andaluza de Salud Pública (EASP), Granada, Spain

    Maria-José Sánchez

  14. Instituto de Investigación Biosanitaria Ibs.GRANADA, Granada, Spain

    Maria-José Sánchez

  15. Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain

    Maria-José Sánchez, Marcela Guevara & Carmen Santiuste

  16. Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain

    Maria-José Sánchez

  17. Instituto de Salud Pública y Laboral de Navarra, 31003, Pamplona, Spain

    Marcela Guevara

  18. Navarre Institute for Health Research (IdiSNA), 31008, Pamplona, Spain

    Marcela Guevara

  19. Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain

    Carmen Santiuste

  20. Unit of Nutrition and Cancer, Catalan Institute of Oncology - ICO, L’Hospitalet de Llobregat, Spain

    Antonio Agudo

  21. Nutrition and Cancer Group; Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Bellvitge Biomedical Research Institute - IDIBELL, L’Hospitalet de Llobregat, Spain

    Antonio Agudo

  22. Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany

    Rashmita Bajracharya & Verena Katzke

  23. Department of Clinical and Biological Sciences, Centre for Biostatistics, Epidemiology, and Public Health, University of Turin, Turin, Italy

    Fulvio Ricceri

  24. Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133, Milan, Italy

    Claudia Agnoli

  25. German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany

    Manuela M. Bergmann

  26. Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany

    Matthias B. Schulze

  27. Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany

    Matthias B. Schulze

  28. Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Naples, Italy

    Salvatore Panico

  29. Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy

    Giovanna Masala

  30. Danish Cancer Society Research Center, Copenhagen, Denmark

    Anne Tjønneland & Anja Olsen

  31. Department of Public Health, University of Copenhagen, Copenhagen, Denmark

    Anne Tjønneland

  32. Department of Translational Medicine, Lund University, Malmö, Sweden

    Tanja Stocks

  33. Department of Surgery, Skåne University Hospital Malmö, Lund University, Malmö, Sweden

    Jonas Manjer

  34. Epidemiology of Chronic and Communicable Diseases Group, Biodonostia Health Research Institute, San Sebastián, Spain

    Amaia Aizpurua-Atxega

  35. Sub Directorate for Public Health and Addictions of Gipuzkoa, Ministry of Health of the Basque Government, San Sebastián, Spain

    Amaia Aizpurua-Atxega

  36. HUNT Center for Molecular and Clinical Epidemiology, Department of Public Health and Nursing , NTNU - Norwegian University of Science and Technology , Trondheim, Norway

    Therese H. Nøst

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  1. Edoardo Botteri
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  2. Giulia Peveri
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  3. Paula Berstad
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  4. Vincenzo Bagnardi
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  5. Geir Hoff
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  14. Sairah L. F. Chen
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  16. Torkjel M. Sandanger
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  17. Therese H. Nøst
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  18. Christina C. Dahm
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  19. Christian S. Antoniussen
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  20. Sandar Tin Tin
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  21. Agnès Fournier
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  22. Chloé Marques
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  24. Maria-José Sánchez
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  25. Marcela Guevara
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  26. Carmen Santiuste
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  27. Antonio Agudo
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  28. Rashmita Bajracharya
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  29. Verena Katzke
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  30. Fulvio Ricceri
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  31. Claudia Agnoli
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  32. Manuela M. Bergmann
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  33. Matthias B. Schulze
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  34. Salvatore Panico
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  35. Giovanna Masala
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  36. Anne Tjønneland
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Correspondence to Pietro Ferrari.

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Botteri, E., Peveri, G., Berstad, P. et al. Lifestyle changes in middle age and risk of cancer: evidence from the European Prospective Investigation into Cancer and Nutrition. Eur J Epidemiol 39, 147–159 (2024). https://doi.org/10.1007/s10654-023-01059-4

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