{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T21:08:29Z","timestamp":1765832909660,"version":"3.48.0"},"reference-count":72,"publisher":"BMJ","issue":"11","license":[{"start":{"date-parts":[[2024,11,27]],"date-time":"2024-11-27T00:00:00Z","timestamp":1732665600000},"content-version":"unspecified","delay-in-days":26,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,10,25]]},"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>With improvements in cancer treatment and early detection, the number of people living with cancer is increasing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Prospective cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Women residing in Norway, general population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Exposure measures<\/jats:title>\n                    <jats:p>HLI score measured prior to cancer diagnosis. The HLI combines physical activity level, body mass index, smoking behaviour, alcohol consumption and dietary habits.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome measures<\/jats:title>\n                    <jats:p>We estimated HRs and 95% CIs using Cox proportional hazard models for all-cause and site-specific cancer mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2023-083594","type":"journal-article","created":{"date-parts":[[2024,11,28]],"date-time":"2024-11-28T04:30:59Z","timestamp":1732768259000},"page":"e083594","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Combined prediagnostic lifestyle factors and survival of breast, colorectal and lung cancer in the Norwegian Women and Cancer (NOWAC) study: a prospective cohort study"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5774-7058","authenticated-orcid":false,"given":"Sairah Lai Fa","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Community Medicine, UiT The Arctic University of Norway, Troms\u00f8, Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristin Benjaminsen","family":"Borch","sequence":"additional","affiliation":[{"name":"Department of Community Medicine, UiT The Arctic University of Norway, Troms\u00f8, Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Torkjel Manning","family":"Sandanger","sequence":"additional","affiliation":[{"name":"Department of Community Medicine, UiT The Arctic University of Norway, Troms\u00f8, Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jill","family":"Tinmouth","sequence":"additional","affiliation":[{"name":"University of Toronto Institute of Health Policy Management and Evaluation, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tonje","family":"Braaten","sequence":"additional","affiliation":[{"name":"Department of Community Medicine, UiT The Arctic University of Norway, Troms\u00f8, Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Therese Haugdahl","family":"N\u00f8st","sequence":"additional","affiliation":[{"name":"Department of Community Medicine, UiT The Arctic University of Norway, Troms\u00f8, Norway"},{"name":"K.G. 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