Changes in Lifestyle Factors After Endoscopic Screening: A Prospective Study in the United States

Background: Endoscopic screening and adherence to a healthy lifestyle are major avenues for colorectal cancer (CRC) prevention. We investigated changes in lifestyles after endoscopic screening. Methods: We drew data from 76,303 pairs of time- and age-matched individuals who had and had not, respectively, reported first time endoscopic screening, in the 3 cohorts (Nurses’ Health Study I and II and the Health Professionals Follow-up Study). Detailed information was collected every 2–4 years on endoscopy screening, 12 lifestyle factors (including smoking, physical activity, regular use of aspirin/nonsteroidal anti-inflammatory drugs, body weight, and 8 dietary factors), and adherence to a healthy lifestyle based on a score defined by 5 major lifestyle factors (smoking, alcohol, body weight, physical activity, and diet). We assessed changes in lifestyle from pre- to post-screening periods for the matched pairs. We also conducted subgroup analysis according to screening findings (negative, low- and high-risk polyps, and CRC). Results: Endoscopic screening was associated with higher prevalence of adherence to a healthy lifestyle (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.04–1.16). The association strengthened with the severity of the screening findings, with an OR of 1.09 (95% CI, 1.03–1.15) for negative screening, 1.19 (95% CI, 1.07–1.33) for low-risk polyps, 1.42 (95% CI, 1.14–1.77) for high-risk polyps, and 1.55 (95% CI, 1.17–2.05) for CRC. The individual lifestyle factors and diet showed modest change. Conclusions: Endoscopic screening was associated with a modest improvement in healthy lifestyles, particularly in individuals with more severe endoscopic findings. Further efforts of integrating lifestyle medicine into the screening setting are needed, to better leverage the teachable moment in improving CRC prevention.