title: Favorable lifestyle before diagnosis associated with lower risk of screen-detected advanced colorectal neoplasia.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  Adopted healthy behaviors were inversely associated with the probability of ACN detection. Lifestyle assessment might be useful for risk stratification in CRC screening.
authors.affiliation: 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.
authors.forename: Markus D
authors.initials: MD
authors.lastname: Knudsen
authors.affiliation: 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.
authors.forename: Thomas
authors.initials: T
authors.lastname: de Lange
authors.affiliation: 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.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Botteri
authors.affiliation: 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.
authors.forename: Dung-Hong
authors.initials: DH
authors.lastname: Nguyen
authors.affiliation: 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.
authors.forename: Helge
authors.initials: H
authors.lastname: Evensen
authors.affiliation: 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.
authors.forename: Chloé B
authors.initials: CB
authors.lastname: Steen
authors.affiliation: 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.
authors.forename: Geir
authors.initials: G
authors.lastname: Hoff
authors.affiliation: 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.
authors.forename: Tomm
authors.initials: T
authors.lastname: Bernklev
authors.affiliation: 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.
authors.forename: Anette
authors.initials: A
authors.lastname: Hjartåker
authors.affiliation: 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.
authors.forename: Paula
authors.initials: P
authors.lastname: Berstad
mesh_terms: D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology*; D015992:Body Mass Index; D002277:Carcinoma / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology; D000072001:Diet, Healthy; D055088:Early Detection of Cancer; D015444:Exercise; D005260:Female; D015438:Health Behavior; D000070497:Healthy Lifestyle; D006801:Humans; D008019:Life Style; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D009780:Occult Blood; D016017:Odds Ratio; D050177:Overweight / Q000453:epidemiology*; D012307:Risk Factors; D012812:Sigmoidoscopy; D012907:Smoking / Q000453:epidemiology*; D011795:Surveys and Questionnaires
keywords: Colorectal neoplasia; Health recommendations; Lifestyle; Prevention; Screening