ArticlePLoS medicine2021
Healthy lifestyle, endoscopic screening, and colorectal cancer incidence and mortality in the United States: A nationwide cohort study.
Article in PLoS medicine, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 1 of them a synthesis that pooled it.
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Who cites it
18 citing papers in PubMed, 1 synthesis or guideline pooled it, 36 citations in OpenAlex.
- Comparative Efficacy of Different AI Systems for Polyp Detection by Size During Colonoscopy: Systematic Review and Network Meta-Analysis.Journal of medical Internet research · 2026Pooled it
- Socioeconomic status and long-term health behaviour maintenance after non-communicable disease diagnosis: a multicohort study.BMC medicine · 2025Article
- Global, regional, and national burden of colorectal cancer in the elderly (aged > 60 years): a comprehensive analysis across 204 countries and territories (1990-2021).BMC gastroenterology · 2025Article
- Development and validation of an information-motivation-behavioral skills questionnaire for colorectal cancer prevention in a high-risk population.BMC psychology · 2025Article
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- Investigating the Obesity Paradox in Colorectal Cancer: An Analysis of Prospectively Collected Data in a Diverse Cohort.Cancers · 2024Article
- Nine dietary habits and risk of colorectal cancer: a Mendelian randomization study.BMC medical genomics · 2024Article
- Interplay between oral health and lifestyle factors for cancer risk in rural and urban China: a population-based cohort study.Journal of the National Cancer Center · 2023Article
- Association between antibiotic use during early life and early-onset colorectal cancer risk overall and according to polygenic risk and FUT2 genotypes.International journal of cancer · 2023Article
- Individual and joint effect of socioeconomic status and lifestyle factors on cancer in Korea.Cancer medicine · 2023Article
- Article
- Association of modifiable lifestyle with colorectal cancer incidence and mortality according to metabolic status: prospective cohort study.Frontiers in oncology · 2023Article
- Exposome approach for identifying modifiable factors for the prevention of colorectal cancer.Scientific reports · 2022Article
- Association of sleep duration, sleep apnea, and shift work with risk of colorectal neoplasms: a systematic review and meta-analysis.Journal of gastrointestinal oncology · 2022Article
- Changes in Lifestyle Factors After Endoscopic Screening: A Prospective Study in the United States.Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association · 2022Article
- Methylation ofFrontiers in molecular biosciences · 2021Article
- Combined Lifestyle Behaviors and the Incidence of Common Cancer Types in the Norwegian Women and Cancer Study (NOWAC).Clinical epidemiology · 2021Article
- Cardiovascular Health and Colorectal Cancer Screening in Black Men: A Cross-Sectional Analysis.American journal of men's healthArticle
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Authors and funding
7 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundHealthy lifestyle and screening represent 2 major approaches to colorectal cancer (CRC) prevention. It remains unknown whether the CRC-preventive benefit of healthy lifestyle differs by endoscopic screening status, and how the combination of healthy lifestyle with endoscopic screening can improve CRC prevention. METHODS AND
findingsWe assessed lifestyle and endoscopic screening biennially among 75,873 women (Nurses' Health Study, 1988 to 2014) and 42,875 men (Health Professionals Follow-up Study, 1988 to 2014). We defined a healthy lifestyle score based on body mass index, smoking, physical activity, alcohol consumption, and diet. We calculated hazard ratios (HRs) and population-attributable risks (PARs) for CRC incidence and mortality in relation to healthy lifestyle score according to endoscopic screening. Participants' mean age (standard deviation) at baseline was 54 (8) years. During a median of 26 years (2,827,088 person-years) follow-up, we documented 2,836 incident CRC cases and 1,013 CRC deaths. We found a similar association between healthy lifestyle score and lower CRC incidence among individuals with and without endoscopic screening, with the multivariable HR per one-unit increment of 0.85 (95% CI, 0.80 to 0.90) and 0.85 (95% CI, 0.81 to 0.88), respectively (P-interaction = 0.99). The fraction of CRC cases that might be prevented (PAR) by endoscopic screening alone was 32% (95% CI, 31% to 33%) and increased to 61% (95% CI, 42% to 75%) when combined with healthy lifestyle (score = 5). The corresponding PAR (95% CI) increased from 15% (13% to 16%) to 51% (17% to 74%) for proximal colon cancer and from 47% (45% to 50%) to 75% (61% to 84%) for distal CRC. Results were similar for CRC mortality. A limitation of our study is that our study participants are all health professionals and predominantly whites, which may not be representative of the general population.
conclusionsOur study suggests that healthy lifestyle is associated with lower CRC incidence and mortality independent of endoscopic screening. An integration of healthy lifestyle with endoscopic screening may substantially enhance prevention for CRC, particularly for proximal colon cancer, compared to endoscopic screening alone.
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