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©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
Favorable lifestyle before diagnosis associated with lower risk of screen-detected advanced colorectal neoplasia
Markus D Knudsen, Thomas de Lange, Edoardo Botteri, Dung-Hong Nguyen, Helge Evensen, Chloé B Steen, Geir Hoff, Tomm Bernklev, Anette Hjartåker, Paula Berstad
Markus D Knudsen, Thomas de Lange, Edoardo Botteri, Chloé B Steen, Geir Hoff, Paula Berstad, Department of bowel cancer screening, Cancer Registry of Norway, Majorstuen, 0304 Oslo, Norway
Markus D Knudsen, Geir Hoff, Tomm Bernklev, Paula Berstad, Department of Research and Development, Telemark Hospital, 3710 Skien, Norway
Markus D Knudsen, Anette Hjartåker, Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, 0317 Oslo, Norway
Thomas de Lange, Helge Evensen, Department of Medicine, Bærum Hospital, Vestre Viken Hospital Trust, 3004 Drammen, Norway
Edoardo Botteri, Division of Epidemiology and Biostatistics, European Institute of Oncology, 20141 Milan, Italy
Dung-Hong Nguyen, Department of Gastroenterology, Østfold Hospital Trust, 1714 Grålum, Norway
Geir Hoff, Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, 0317 Oslo, Norway
Tomm Bernklev, Institute of Clinical Medicine, University of Oslo, Blindern P.O. Box 1171, 0318 Oslo, Norway
Author contributions: Nguyen DH, Evensen H, Berstad P, Knudsen MD and Steen CB collected the data; Hoff G and Berstad P designed the study; Knudsen MD and Steen CB analyzed the data under supervision of Botteri E (Biostatistician); Knudsen MD wrote the paper under the supervision of de Lange T, Bernklev T, Hjartåker A and Berstad P; all authors have read and revised the manuscript; Knudsen MD, de Lange T, Bernklev T, Hjartåker A and Berstad P bear the primary responsibility for the content.
Institutional review board statement: The Regional Research Ethics Committee of South-East Norway and the Norwegian Data Inspectorate approved the study protocol (approval No. 2011/1272). Clinical Trials.gov: NCT01538550.
Informed consent statement: The participants gave their consent to participate in the lifestyle study by completing and returning the mailed questionnaire.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: Statistical code and dataset available from the corresponding author at (t.d.lange@medisin.uio.no) No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Thomas de Lange, MD, PhD, Department of bowel cancer screening, Cancer Registry of Norway, PO Box 5313, Majorstuen, 0304 Oslo, Norway.
t.d.lange@medisin.uio.no
Telephone: +47-22-928709
Received: April 8, 2016
Peer-review started: April 9, 2016
First decision: May 12, 2016
Revised: May 23, 2016
Accepted: June 13, 2016
Article in press: June 13, 2016
Published online: July 21, 2016
Processing time: 97 Days and 23.4 Hours
AIM: To investigate the association between adherence to health recommendations and detection of advanced colorectal neoplasia (ACN) in colorectal cancer (CRC) screening.
METHODS: A total of 14832 women and men were invited to CRC screening, 6959 in the fecal immunochemical test arm and 7873 in the flexible sigmoidoscopy arm. These were also sent a self-reported lifestyle questionnaire to be completed prior to their first CRC screening. A lifestyle score was created to reflect current adherence to healthy behaviors in regard to smoking, body mass index, physical activity, alcohol consumption and food consumption, and ranged from zero (poorest) to six (best). Odds ratios (ORs) and 95%CIs were calculated using multivariable logistic regression to evaluate the association between the single lifestyle variables and the lifestyle score and the probability of detecting ACN.
RESULTS: In all 6315 women and men completed the lifestyle questionnaire, 3323 (53%) in the FIT arm and 2992 (47%) in the FS arm. This was 89% of those who participated in screening. ACN was diagnosed in 311 (5%) participants of which 25 (8%) were diagnosed with CRC. For individuals with a lifestyle score of two, three, four, and five-six, the ORs (95%CI) for the probability of ACN detection were 0.82 (0.45-1.16), 0.43 (0.28-0.73), 0.41 (0.23-0.64), and 0.41 (0.22-0.73), respectively compared to individuals with a lifestyle score of zero-one. Of the single lifestyle factors, adherence to non-smoking and moderate alcohol intake were associated with a decreased probability of ACN detection compared to being a smoker or having a high alcohol intake 0.53 (0.42-0.68) and 0.63 (0.43-0.93) respectively.
CONCLUSION: Adopted healthy behaviors were inversely associated with the probability of ACN detection. Lifestyle assessment might be useful for risk stratification in CRC screening.
Core tip: Colorectal cancer (CRC) is a highly prevalent disease, developing from adenomas. In primary prevention of CRC, following public health recommendations such as non-smoking, normal body weight, physical activity, limited alcohol consumption and healthy diet is important. In the present study, we showed that adherence to multiple health recommendations was associated with decreased risk of detecting advanced colorectal neoplasia (ACN) in CRC screening. Regarding single health recommendations, non-smoking and moderate alcohol consumption were the most important lifestyle factors associated with low risk of ACN. Lifestyle assessment in CRC screening may therefore be used as a tool in risk stratification of participants.
