Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
BMJ Open. 2024 Nov 27;14(11):e083594. doi: 10.1136/bmjopen-2023-083594.
With improvements in cancer treatment and early detection, the number of people living with cancer is increasing.
This study aimed to investigate the association between combined prediagnostic lifestyle factors, assessed by a Healthy Lifestyle Index (HLI) score, and mortality among women diagnosed with breast cancer (BC), colorectal cancer (CRC) and lung cancer (LC).
Prospective cohort.
Women residing in Norway, general population.
Our analysis included 5032, 2468 and 1594 women from the Norwegian Women and Cancer study diagnosed with BC, CRC and LC, respectively, who responded to a questionnaire between 1996 and 2014.
HLI score measured prior to cancer diagnosis. The HLI combines physical activity level, body mass index, smoking behaviour, alcohol consumption and dietary habits.
We estimated HRs and 95% CIs using Cox proportional hazard models for all-cause and site-specific cancer mortality.
After median follow-up times of 9.8, 7.1 and 5.9 years for BC, CRC and LC cases, respectively, there were 912, 902 and 1094 all-cause deaths; and 509 BC deaths, 679 CRC deaths and 961 LC deaths. For women diagnosed with BC, a 1-point HLI score increment was associated with a 6% lower all-cause mortality rate (HR: 0.94, 95% CI: 0.92 to 0.97). The data were compatible with no association for the estimated 3% lower BC mortality rate (HR: 0.97, 95% CI: 0.94 to 1.00) among women diagnosed with BC, and for the estimated 3% lower all-cause (HR: 0.97, 95% CI: 0.95 to 1.00) and 2% lower CRC mortality rates (HR: 0.98, 95% CI: 0.95 to 1.01) among women diagnosed with CRC. For women diagnosed with LC, prediagnostic HLI score was not associated with all-cause (HR: 1.00, 95% CI: 0.98 to 1.02) or LC mortality rates (HR: 1.00, 95% CI: 0.98 to 1.03).
We observed that a higher HLI score measured before cancer diagnosis was associated with lower all-cause and, possibly, lower BC mortality among Norwegian women diagnosed with BC; and a possible lower all-cause and CRC mortality among those diagnosed with CRC. Smoking was likely responsible for the observed associations.
随着癌症治疗和早期检测的进步，癌症患者的数量正在增加。
本研究旨在探讨在诊断前通过健康生活方式指数（HLI）评分评估的综合生活方式因素与女性乳腺癌（BC）、结直肠癌（CRC）和肺癌（LC）患者的死亡率之间的关系。
前瞻性队列研究。
挪威，普通人群。
我们的分析包括 5032 名、2468 名和 1594 名分别来自挪威女性与癌症研究的女性，她们在 1996 年至 2014 年间回答了一份问卷，这些女性被诊断为 BC、CRC 和 LC。
在癌症诊断前测量 HLI 评分。HLI 结合了身体活动水平、体重指数、吸烟行为、饮酒和饮食习惯。
我们使用 Cox 比例风险模型估计了所有原因和特定部位癌症死亡率的 HRs 和 95%CI。
在分别为 BC、CRC 和 LC 病例的中位随访时间 9.8、7.1 和 5.9 年后，分别发生了 912、902 和 1094 例全因死亡；以及 509 例 BC 死亡、679 例 CRC 死亡和 961 例 LC 死亡。对于被诊断为 BC 的女性，HLI 评分每增加 1 分，全因死亡率降低 6%（HR：0.94，95%CI：0.92 至 0.97）。数据表明，被诊断为 BC 的女性的 BC 死亡率降低 3%（HR：0.97，95%CI：0.94 至 1.00）和全因死亡率降低 3%（HR：0.97，95%CI：0.95 至 1.00）的估计值没有关联，被诊断为 CRC 的女性的全因（HR：0.97，95%CI：0.95 至 1.00）和 CRC 死亡率降低 2%（HR：0.98，95%CI：0.95 至 1.01）的估计值没有关联。对于被诊断为 LC 的女性，诊断前的 HLI 评分与全因（HR：1.00，95%CI：0.98 至 1.02）或 LC 死亡率（HR：1.00，95%CI：0.98 至 1.03）无关。
我们观察到，在诊断为 BC 的挪威女性中，癌症诊断前测量的较高 HLI 评分与全因死亡率降低有关，并且可能与 BC 死亡率降低有关；并且在被诊断为 CRC 的女性中，全因死亡率和 CRC 死亡率可能降低。吸烟可能是造成这些关联的原因。
