title: Long-term lifestyle changes after colorectal cancer screening: randomised controlled trial.
abstract: OBJECTIVE
  There is uncertainty whether cancer screening affects participant incentives for favourable lifestyle. The present study investigates long-term effects of colorectal cancer (CRC) screening on lifestyle changes.
  
  
  METHODS
  In 1999-2001, men and women drawn from the population registry were randomised to screening for CRC by flexible sigmoidoscopy ('invited-to-screening' arm) or to no-screening (control arm) in the Norwegian Colorectal Cancer Prevention trial. A subgroup of 3043 individuals in the 'invited-to-screening' and 2819 in the control arm, aged 50-55 years, randomised during 2001 had their lifestyle assessed by a questionnaire at inclusion and after 11 years (42% of cohort). The outcome was 11-year changes in lifestyle factors (body weight, smoking status, physical exercise, selected dietary habits) and in total lifestyle score (0-4 points, translating to the number of lifestyle recommendations adhered to). We compared outcomes in the two randomisation arms and attendees with positive versus negative findings.
  
  
  RESULTS
  Total lifestyle scores improved in both arms. The improvement was smaller in the 'invited-to-screening' arm (score 1.43 at inclusion; 1.58 after 11 years) compared with the control arm (score 1.49 at inclusion; 1.67 after 11 years); adjusted difference -0.05 (95% CI -0.09 to -0.01; p=0.03). The change in the score was less favourable in screening attendees with a positive compared with negative screening result; adjusted difference -0.16 (95% CI -0.25 to -0.08; p<0.001).
  
  
  CONCLUSIONS
  The present study suggests that possible unfavourable lifestyle changes after CRC screening are modest. Lifestyle counselling may be considered as part of cancer screening programmes.
  
  
  BACKGROUND
  NCT00119912.
authors.affiliation: Department of Research and Development, Telemark Hospital, Skien, Norway Cancer Registry of Norway, Oslo, Norway.
authors.forename: Paula
authors.initials: P
authors.lastname: Berstad
authors.affiliation: Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA Department of Gastroenterology, Division of Cancer Medicine, Surgery and Transplantation, Oslo University Hospital, Oslo, Norway.
authors.forename: Magnus
authors.initials: M
authors.lastname: Løberg
authors.affiliation: Cancer Registry of Norway, Oslo, Norway.
authors.forename: Inger Kristin
authors.initials: IK
authors.lastname: Larsen
authors.affiliation: Department of Research and Development, Telemark Hospital, Skien, Norway Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA.
authors.forename: Mette
authors.initials: M
authors.lastname: Kalager
authors.affiliation: Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA Department of Medicine, Sørlandet Hospital, Kristiansand, Norway.
authors.forename: Øyvind
authors.initials: Ø
authors.lastname: Holme
authors.affiliation: Cancer Registry of Norway, Oslo, Norway Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Botteri
authors.affiliation: Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA Department of Gastroenterology, Division of Cancer Medicine, Surgery and Transplantation, Oslo University Hospital, Oslo, Norway.
authors.forename: Michael
authors.initials: M
authors.lastname: Bretthauer
authors.affiliation: Department of Research and Development, Telemark Hospital, Skien, Norway Cancer Registry of Norway, Oslo, Norway Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway.
authors.forename: Geir
authors.initials: G
authors.lastname: Hoff
mesh_terms: D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D055088:Early Detection of Cancer; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008019:Life Style; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D012189:Retrospective Studies; D012812:Sigmoidoscopy / Q000379:methods*; D011795:Surveys and Questionnaires; D013997:Time Factors
keywords: COLORECTAL CANCER SCREENING; EPIDEMIOLOGY; NUTRITION; SCREENING