Cancer Epidemiology最新文献

{"title":"Uncovering the possible link between dietary advanced glycation end products and mortality risk: A systematic review and meta-analysis","authors":"Hamid Ahmadirad ,&nbsp;Hossein Farhadnejad ,&nbsp;Mostafa Norouzzadeh ,&nbsp;Mitra Kazemi Jahromi ,&nbsp;Ebrahim Mokhtari ,&nbsp;Morteza Omrani ,&nbsp;Farshad Teymoori ,&nbsp;Reza Sadeghi ,&nbsp;Parvin Mirmiran ,&nbsp;Maryam Bagherian","doi":"10.1016/j.canep.2025.102807","DOIUrl":"10.1016/j.canep.2025.102807","url":null,"abstract":"<div><h3>Background</h3><div>Recently, observational studies have focused on dietary advanced glycation end products (dAGEs) as predictive risk factors for chronic diseases and their related mortality. The current systematic review and meta-analysis aimed to synthesize the available evidence and quantify the possible association of dAGEs and risk of all-cause or cause-specific mortality.</div></div><div><h3>Methods</h3><div>A comprehensive and systematic search was conducted in online literature databases, including PubMed, Scopus and Web of Science until January 2025 without any language limitation. The hazard ratio (HR) with 95 % confidence interval (CI) for the included studies were extracted and converted into log HR. Also, we used a random-effects model with inverse variance weighting method to compute the pooled effect size.</div></div><div><h3>Results</h3><div>Six eligible studies (including 18 reports) were included in the current meta-analysis. 111,543 participants, aged 45.6–79 years old, participated in these observational studies, and the duration of follow-up varied from 3.8 to 16 years. According to the pooled results of our analysis, no significant association was observed between dAGEs and its components with the risk of all-cause mortality (HR=1.02; 95 %CI=0.92, 1.13; I²= 73.2 %), cancer mortality (HR=1.00; 95 %CI=0.88, 1.13; I²= 41.0 %) and CVDs mortality (HR=1.16; 95 %CI=0.86, 1.55; I²=86.1 %). Sex, target population, dAGEs components, region, dAGEs assessment method, and dietary data collection methods were the sources of heterogeneity.</div></div><div><h3>Conclusions</h3><div>In conclusion, our study suggested that there was no significant association between dAGEs intake and all-cause or cause-specific mortality.</div></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"96 ","pages":"Article 102807"},"PeriodicalIF":2.4,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143698016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges of cancer registration and epidemiology in Italy","authors":"Fabrizio Stracci ,&nbsp;Margherita Ferrante ,&nbsp;Adele Caldarella ,&nbsp;Silvia Francisci ,&nbsp;Mario Fusco ,&nbsp;Gemma Gatta ,&nbsp;Diego Serraino ,&nbsp;William Mantovani ,&nbsp;Walter Mazzucco","doi":"10.1016/j.canep.2025.102804","DOIUrl":"10.1016/j.canep.2025.102804","url":null,"abstract":"<div><div>We outline the history and role of cancer registration in Italy. Since the ‘70s, local population-based registries were established, representing up to nowadays a valuable national surveillance network. In this framework, the Italian Association of Cancer Registries (AIRTUM) has been playing a central role, ensuring high data quality standards and supporting cancer registry-based research. Over the years, difficulties for cancer registration arose due to a strict and non-uniform application of data protection rules, to the gap in digitalization of health data primary sources, which feed population-based cancer registries (PBCRs), and, more recently, to the impact of COVID-19 pandemic. Indeed, the COVID-19 pandemic in Italy affected not only cancer surveillance but also cancer screening and access to care. Despite the above-mentioned limitations, an unprecedented coverage of cancer surveillance on the Italian population (about 80 %) was reached for the present study, representing a substantial contribution in the perspective of the long-lasting establishment of a national cancer registry. This commentary introduces a series of manuscripts updating the landscape of descriptive cancer epidemiology, highlighting at the same time the challenges of cancer registration, in Italy.</div></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"96 ","pages":"Article 102804"},"PeriodicalIF":2.4,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143686513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Depressive disorder among gynecologic cancer survivors in the US: Evidence from the 2020 Behavioral Risk Factor Surveillance Survey","authors":"Marlo M. Vernon,&nbsp;Biplab Datta,&nbsp;Steven S Coughlin","doi":"10.1016/j.canep.2025.102795","DOIUrl":"10.1016/j.canep.2025.102795","url":null,"abstract":"<div><h3>Objective</h3><div>Patients with gynecologic cancers demonstrate different psychosocial outcomes based on their cancer site, which may affect treatment effectiveness and survivorship. Demographic differences and the relation with depression (DP) among women who have a gynecologic cancer diagnosis are not well understood.</div></div><div><h3>Methods</h3><div>To assess whether survivors of gynecologic cancer had a greater risk of DP compared with women with and without a history of cancer, 2020 BRFSS data was utilized. Pearson chi-square and multivariable logistic regression were conducted to obtain adjusted odds ratios.</div></div><div><h3>Results</h3><div>Prevalence of DP was 20 % higher among survivors of gynecologic cancer; this was consistent across race/ethnic and urban/rural categories. Odds of DP among gynecologic cancer survivors were 2.5xs those without any history of cancer. Among Black and Hispanic gynecologic cancer survivors, the adjusted odds of DP were 4.5 and 3.2 times those with no cancer or a history of any cancer.</div></div><div><h3>Conclusions</h3><div>The odds of having DP were significantly higher among gynecologic cancer survivors compared to women without any history of cancer, breast cancer survivors, or survivors of other cancers.</div></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"96 ","pages":"Article 102795"},"PeriodicalIF":2.4,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143686516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age period cohort analysis of cancer incidence from 1990 to 2019 in Türkiye","authors":"Buşra Tozduman,&nbsp;Ahmet Naci Emecen","doi":"10.1016/j.canep.2025.102803","DOIUrl":"10.1016/j.canep.2025.102803","url":null,"abstract":"<div><h3>Background</h3><div>Cancer is a major public health concern worldwide and in Türkiye, as it is one of the leading causes of disability-adjusted life years (DALYs) and mortality. This study aims to analyze long-term cancer trends in Türkiye from 1990 to 2019 using the Age-Period-Cohort (APC) model to determine the independent effects of aging, time periods, and birth cohorts on cancer incidence.</div></div><div><h3>Methods</h3><div>Cancer incidence data for all cancers and the most common site-specific cancers in men and women were obtained from the Global Burden of Disease 2021 study. The analysis included 14 five-year age groups (20–94 years) and 6 five-year time periods (1990–2019). Age-standardized incidence rates (ASIR) per 100,000 persons were calculated using the world standard population. The APC analysis estimated net drift, local drifts, period rate ratios, and cohort rate ratios. The 2000–2004 period and 1945 birth cohort were set as reference points. Statistical analyses were conducted using the APC R-based Web Tool provided by the National Cancer Institute.</div></div><div><h3>Results</h3><div>The ASIR for all cancers in men exhibited a fluctuating pattern over the study period, without a consistent annual increase or decrease; while in women, the ASIR exhibited an upward trend, increasing by 1.32 % annually, reaching its peak in 2016. Lung and stomach cancer incidence declined in males, whereas prostate, colon and rectum and bladder cancers increased. Incidence rates were higher in the periods 1990–2000 and 2010–2019 compared to the reference period (2000–2004), with similar rates in both periods. In females, breast, uterine and thyroid cancers showed substantial increases. The increase in incidence rates became particularly noticeable from the 2005–2009 period onwards. The cohort effect revealed increasing risks in recent birth cohorts, particularly for breast, uterine, thyroid, prostate and bladder cancers.</div></div><div><h3>Conclusion</h3><div>The findings highlight the dynamic nature of cancer epidemiology in Türkiye, with variations across age groups, time periods, and birth cohorts. While Türkiye’s cancer incidence remains lower than in many developed countries, specific cancers, such as lung and stomach cancers, remain more prevalent. The rising burden of breast, uterine, prostate, bladder and colon and rectum cancers suggests an impact of aging, lifestyle changes, and screening programs. Continuous monitoring, preventive strategies, and early detection programs are crucial to mitigate future cancer trends.</div></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"96 ","pages":"Article 102803"},"PeriodicalIF":2.4,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143686515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical trial participation for vulnerable cancer patients in Denmark and England","authors":"Lars Hernández Nielsen ,&nbsp;Jakob Bruhn Krøjgaard Skelmose ,&nbsp;Laurids Østergaard Poulsen ,&nbsp;Marianne Tang Severinsen ,&nbsp;Martin Bøgsted ,&nbsp;Rasmus Froberg Brøndum","doi":"10.1016/j.canep.2025.102793","DOIUrl":"10.1016/j.canep.2025.102793","url":null,"abstract":"<div><h3>Background</h3><div>New cancer therapies are introduced through clinical trials. However, eligibility criteria can pose a barrier to vulnerable patients, limiting access to potentially improved treatments and reducing generalizability of the results. The aim of this study was to investigate participation in clinical trials for vulnerable cancer patients in Denmark and compare results to England.</div></div><div><h3>Patients and methods</h3><div>We utilized population-based registries of systemic anti-cancer therapy from the North Denmark Region and England covering, respectively, 2008–2021 and 2016–2019. We included adult patients (≥18 years) who received SACT in relation to a solid cancer. Vulnerability was defined as the lowest quintile in relation to socioeconomic position. We estimated odds ratios (OR) for participation in a clinical trial.</div></div><div><h3>Results</h3><div>We included 15,173 patients in the Danish cohort and 336,218 in the English. From these 1107 (7.3 %) and 12,502 (3.7 %) participated in a clinical trial, respectively. The adjusted OR for participating in a trial for vulnerable patients was 0.81 (95 % CI 0.68–0.96) in Denmark and 0.80 (95 % CI 0.76–0.84) in England. The strongest associations were found within gynaecological cancers.</div></div><div><h3>Conclusion</h3><div>We found associations of reduced trial participation for vulnerable individuals in both countries and consistent associations within gynaecological cancers.</div></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"96 ","pages":"Article 102793"},"PeriodicalIF":2.4,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143644692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"It is never too late to stop smoking. Applying working estimates of smoking cessation on five-year overall survival gains after a cancer diagnosis","authors":"Nouhad El-Haddad ,&nbsp;Yang Li ,&nbsp;Geoff P. Delaney ,&nbsp;Heewon Kang ,&nbsp;Shalini Vinod ,&nbsp;Margo Barr ,&nbsp;Takahiro Tabuchi ,&nbsp;Michael Kidd ,&nbsp;Freddy Sitas","doi":"10.1016/j.canep.2025.102775","DOIUrl":"10.1016/j.canep.2025.102775","url":null,"abstract":"<div><h3>Background</h3><div>Detailed data on five-year overall survival (5Y-OS) in relation to smoking cessation after a cancer diagnosis are sparse. Implementation of smoking cessation in cancer treatment centres is also sub-optimal. The aim is to provide working, numeric estimates of 5Y-OS outcomes in relation to quitting smoking to help inform patients with cancer.</div></div><div><h3>Methods</h3><div>5Y-OS data and hazard ratios (HR) from a moderately sized cohort study from Japan were used to derive survival benefits on Australian cancer survival scenarios ranging from 10 % to 90 % 5Y survival, using standard epidemiological formulas comparing survival in those who recently quit around the time of their cancer diagnosis in comparison to those who continued to smoke.</div></div><div><h3>Results</h3><div>In a scenario of a cancer type with 90 % 5 y survival e.g. breast, prostate cancer, or melanoma, quitting smoking shows a gain in 5Y-OS of 10 %, and a gain in median survival of 2.1 years. In a scenario of 20 % 5 y survival (e.g. lung, liver, brain, or oesophageal cancer) recent quitting shows a 5Y-OS gain of 2 %, and a median survival gain of three months.</div></div><div><h3>Conclusion</h3><div>The greater the survival at presentation, the greater the gain by quitting smoking. Future research should aim to produce estimates based on real-world data.</div></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"96 ","pages":"Article 102775"},"PeriodicalIF":2.4,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143644693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Eribulin efficacy in long responder patients with metastatic breast cancer: A multicentric observational study","authors":"J. Passildas ,&nbsp;MJ Paillard ,&nbsp;L. Uwer ,&nbsp;I. Molnar ,&nbsp;N. Dohollou ,&nbsp;T. Petit ,&nbsp;N. Hajjaji ,&nbsp;L. Boudin ,&nbsp;V. Lorgis ,&nbsp;JP Jacquin ,&nbsp;C. Abrial ,&nbsp;MA Mouret-Reynier","doi":"10.1016/j.canep.2025.102800","DOIUrl":"10.1016/j.canep.2025.102800","url":null,"abstract":"<div><h3>Background</h3><div>Eribulin can represent a therapeutic alternative for patients with advanced breast cancer who have received at least one or two lines of anthracyclines-based chemotherapy and taxane therapy. In this observational study, we focused on long-responder patients, i.e. with an objective response or stability ≥ 6 months under eribulin to better characterize them.</div></div><div><h3>Methods</h3><div>Metastatic breast cancer (MBC) patients treated by eribulin in 2nd, 3rd or 4th line between September 2011 and June-2018 were included. The following parameters were assessed: primary tumor and metastasis characteristics, type of response and duration, disease progression, treatment received, toxicities, progression free survival (PFS), overall survival (OS), and prognostic factors of OS and PFS. Special attention was paid to patients with hepatic disease (HD).</div></div><div><h3>Results</h3><div>Among the 98 patients included, an analysis was conducted on 84 patients (median age 62). Median duration of response was 25.6 weeks (95 IC 22–27.7) with a median number of infusions of 6. Response was similar, irrespective of ERI line number. HD was observed in 70.2 % of patients. Median PFS was 9 months (95 %CI 8–10). Subgroup analysis showed similar PFS, irrespective of HD (p = 0.21) and treatment line (p = 0.46). Median OS was 24 months. (95 % IC 20–31). The main prognostic factors of OS were duration of response (p &lt; 0.001) and, progesterone receptor positiveness was associated to PFS (p = 0.006).</div></div><div><h3>Conclusion</h3><div>This multicentric, retrospective study highlights eribulin as a potential second-line therapy for MBC with a median response duration of 25 weeks after 6 infusions. The safety and efficacy profiles align with previous studies, supporting its role as a viable treatment option. Notably, the response and PFS were independent of hepatic metastasis, suggesting benefit across various MBC subtypes, including those with liver involvement. However, the retrospective design warrants cautious interpretation, and further prospective studies are needed to confirm these findings and optimize eribulin’s use, potentially through molecular profiling for personalized treatment strategies.</div></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"96 ","pages":"Article 102800"},"PeriodicalIF":2.4,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143629581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The association of different body weight classes and survival outcomes in patients with cervical cancer","authors":"Szu-Ying Tsai ,&nbsp;Ming-Chieh Tsai ,&nbsp;Min-Shu Hsu ,&nbsp;Li-Wei Tsai ,&nbsp;Heng-Cheng Hsu ,&nbsp;Jing-Rong Jhuang ,&nbsp;Chun-Ju Chiang ,&nbsp;Wen-Chung Lee ,&nbsp;Kuo-Liong Chien ,&nbsp;Hsin-Yin Hsu ,&nbsp;Tzu-Lin Yeh","doi":"10.1016/j.canep.2025.102801","DOIUrl":"10.1016/j.canep.2025.102801","url":null,"abstract":"<div><h3>Background</h3><div>The relationship between different weight class and mortality risk remained uncertain in cervical cancer patients. Thus, we conducted the study to assess the association between different body weight classes and survival outcomes in patients with cervical cancer.</div></div><div><h3>Methods</h3><div>This was a retrospective cohort study including 6908 cervical cancer patients from the Taiwan Cancer Registry database. A COX regression model was used to evaluate the relationship between different weight classes and time-to-event outcomes of overall survival and cancer-specific survival at three years.</div></div><div><h3>Results</h3><div>The median follow-up time was 4.64 ± 2.55 years. Our study revealed that the underweight group had a significantly higher risk of overall death [hazard ratio (HR) = 1.65, 95 % confidence interval (CI) = 1.37, 1.99] than the normal-weight group. Overweight patients had a significantly lower risk of overall death (HR = 0.81, 95 % CI = 0.71, 0.93), whereas the obesity group had an insignificant lower risk of overall death (HR = 0.92, 95 % CI = 0.75, 1.13) compared with the reference group.</div></div><div><h3>Conclusion</h3><div>After controlling for confounding factors, underweight patients with cervical cancer had a higher risk of overall death than normal-weight patients with cervical cancer. Our study indicates that underweight cervical cancer patients had a higher risk of overall death compared with normal-weight cervical cancer patients. Furthermore, the overweight patients had a significantly lower risk of overall death. More strategies are needed to be addressed especially in public health field regarding women’s weight class and cancer mortality issues.</div></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"96 ","pages":"Article 102801"},"PeriodicalIF":2.4,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143629582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A systematic review and meta-analysis of the association of human papilloma virus infections with ocular surface squamous neoplasia","authors":"Leanne Hall ,&nbsp;Clare Heal","doi":"10.1016/j.canep.2025.102799","DOIUrl":"10.1016/j.canep.2025.102799","url":null,"abstract":"<div><div>The incidence of Ocular Squamous Surface Neoplasia (OSSN) is increasing, particularly in populations with high HIV prevalence and higher solar irradiance. Human Papilloma Virus (HPV) is considered a precursor/co-factor to OSSN. We aimed to quantify the association between HPV and OSSN and analyse co-factors in this association, including geographical differences and pathology of the comparator group. We used the DerSimonian and Laird method to compute summary odds risk estimates in a random effects model. The <em>I</em>² statistic was used to quantify heterogenicity. Subgroup analyses, sensitivity analyses and meta-regression were used to explore sources of heterogeneity. Twenty-one studies were included. The odds of HPV was significantly higher in OSSN lesions than benign lesions. The pooled odds ratio was 9.2 (95 % CI: 5.0–16.9) ((<em>I</em>² = 56.1 % (95 % CI: 26 %-74 %)). In subgroup analysis, the odds ratio was lower in studies from African countries (with high HIV prevalences) and countries closer to the equator. The effect size was lower when ocular surface diseases such as pterygium were used as the comparator group rather than healthy tissues. We report a strong association between HPV and OSSN. The odds of HPV was 9.2 times higher in conjunctival cancers than benign tissues. This association was muted in African countries and countries closer to the equator, highlighting the role of UV radiation and HIV as co-factors in OSSN development. Muting of the association may also signal a role of pterygium as precursor lesions to OSSN, or that HPV may be involved in their development.</div></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"96 ","pages":"Article 102799"},"PeriodicalIF":2.4,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143629191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Healthy lifestyle and the risk of endometrial cancer","authors":"Eveline Coemans ,&nbsp;Piet A. van den Brandt ,&nbsp;Leo J. Schouten","doi":"10.1016/j.canep.2025.102798","DOIUrl":"10.1016/j.canep.2025.102798","url":null,"abstract":"<div><h3>Background</h3><div>The incidence and mortality rate of endometrial cancer (EC) is increasing worldwide. Modifiable lifestyle factors associated with an increased or decreased risk of cancer typically cluster. Therefore, this study aimed to investigate the association between a healthy lifestyle, measured with a Healthy Lifestyle Index (HLI), based on diet, smoking, alcohol consumption, physical activity and Body Mass Index (BMI), and the risk of EC.</div></div><div><h3>Methods</h3><div>A case-cohort analysis was conducted using data from the prospective Netherlands Cohort Study on Diet and Cancer (n = 62,573). At baseline in 1986, participants (aged 55–69) completed a questionnaire on potential cancer determinants. Data on aforementioned risk factors were used to calculate an HLI-score, ranging 0–20, with higher scores reflecting a healthier lifestyle. Cox regression analyses were used to estimate hazard ratios (HR’s) and 95 % confidence intervals (CI’s) for the association between HLI-score and EC risk in 414 cases and 1593 subcohort women, after 20.3 years of follow-up. After stratification by smoking status, Cox regression was applied using an HLI-score without smoking.</div></div><div><h3>Results</h3><div>The HR for the total HLI score was 0.86 (95 %CI 0.78–0.94) per 1 standard deviation (SD) increment. The HR for the HLI score without smoking component was 0.75 (95 %CI 0.67–0.83) for non-smokers (never smoked or former smoker &gt;10 years ago) and 0.85 (95 %CI 0.70–1.02) for recent smokers (current or former smoker &lt;10 years ago), all per 1 SD increment. Sensitivity analyses excluding each HLI component show that BMI and physical activity are the main drivers of the inverse association between HLI-score and EC.</div></div><div><h3>Conclusion</h3><div>A healthier lifestyle, measured with an HLI based on diet, alcohol consumption, physical activity, BMI and smoking is associated with a reduced EC risk. The association is stronger for non-smokers.</div></div>","PeriodicalId":56322,"journal":{"name":"Cancer Epidemiology","volume":"96 ","pages":"Article 102798"},"PeriodicalIF":2.4,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143609949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}