Heterogeneity of Colorectal Cancer Risk Factors by Anatomical Subsite in 10 European Countries: A Multinational Cohort Study (original) (raw)
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Body mass index, physical activity, and colorectal cancer by anatomical subsites
European Journal of Cancer Prevention, 2013
Several studies report varying incidence rates of cancer in subsites of the colorectum, as an increasing proportion appears to develop in the proximal colon. Varying incidence trends together with biological differences between the colorectal segments raise questions of whether lifestyle factors impact on the risk of cancer differently at colorectal subsites. We provide an updated overview of the risk of cancer at different colorectal subsites (proximal colon, distal colon, and rectum) according to BMI and physical activity to shed light on this issue. Cohort studies of colorectal cancer, published in English throughout 2010, were identified using PubMed. The risk estimates from 30 eligible studies were summarized for BMI and physical activity. A positive relationship was found between BMI and cancer for all colorectal subsites, but most pronounced for the distal colon [relative risk (RR) 1.59, 95% confidence interval (CI) 1.34-1.89]. For the proximal colon and rectum, the risk estimates were 1.24 (95% CI 1.08-1.42) and 1.23 (95% CI 1.02-1.48), respectively. Physical activity was related inversely to the risk of cancer at the proximal (RR 0.76, 95% CI 0.70-0.83) and distal colon (RR 0.77, 95% CI 0.71-0.83). Such a relationship could not be established for the rectum (RR 0.98, 95% CI 0.88-1.08).
Combined impact of healthy lifestyle factors on colorectal cancer: a large European cohort study
BMC Medicine, 2014
Background: Excess body weight, physical activity, smoking, alcohol consumption and certain dietary factors are individually related to colorectal cancer (CRC) risk; however, little is known about their joint effects. The aim of this study was to develop a healthy lifestyle index (HLI) composed of five potentially modifiable lifestyle factorshealthy weight, physical activity, non-smoking, limited alcohol consumption and a healthy diet, and to explore the association of this index with CRC incidence using data collected within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. Methods: In the EPIC cohort, a total of 347,237 men and women, 25-to 70-years old, provided dietary and lifestyle information at study baseline (1992 to 2000). Over a median follow-up time of 12 years, 3,759 incident CRC cases were identified. The association between a HLI and CRC risk was evaluated using Cox proportional hazards regression models and population attributable risks (PARs) have been calculated. Results: After accounting for study centre, age, sex and education, compared with 0 or 1 healthy lifestyle factors, the hazard ratio (HR) for CRC was 0.87 (95% confidence interval (CI): 0.44 to 0.77) for two factors, 0.79 (95% CI: 0.70 to 0.89) for three factors, 0.66 (95% CI: 0.58 to 0.75) for four factors and 0.63 (95% CI: 0.54 to 0.74) for five factors; P-trend <0.0001. The associations were present for both colon and rectal cancers, HRs, 0.61 (95% CI: 0.50 to 0.74; P for trend <0.0001) for colon cancer and 0.68 (95% CI: 0.53 to 0.88; P-trend <0.0001) for rectal cancer, respectively (P-difference by cancer sub-site = 0.10). Overall, 16% of the new CRC cases (22% in men and 11% in women) were attributable to not adhering to a combination of all five healthy lifestyle behaviours included in the index. Conclusions: Combined lifestyle factors are associated with a lower incidence of CRC in European populations characterized by western lifestyles. Prevention strategies considering complex targeting of multiple lifestyle factors may provide practical means for improved CRC prevention.
Comparison of risk factors for colon and rectal cancer
International Journal of Cancer, 2004
Predictors of colorectal cancer have been extensively studied with some evidence suggesting that risk factors vary by subsite. Using data from 2 prospective cohort studies, we examined established risk factors to determine whether they were differentially associated with colon and rectal cancer. Our study population included 87,733 women from the Nurses' Health Study (NHS) and 46,632 men from the Health Professionals Follow Up Study (HPFS). Exposure information was collected via biennial questionnaires (dietary variables were collected every 4 years). During the follow-up period (NHS, we identified 1,139 cases of colon cancer and 339 cases of rectal cancer. We used pooled logistic regression to estimate multivariate relative risks for the 2 outcomes separately and then used polytomous logistic regression to compare these estimates. In the combined cohort, age, gender, family history of colon or rectal cancer, height, body mass index, physical activity, folate, intake of beef, pork or lamb as a main dish, intake of processed meat and alcohol were significantly associated with colon cancer risk. However, only age and sex were associated with rectal cancer. In a stepwise polytomous logistic regression procedure, family history and physical activity were associated with statistically significant different relative risks of colon and rectal cancer. Our findings support previous suggestions that family history and physical activity are not strong contributors to the etiology of rectal cancer. Future investigations of colon or rectal cancer should take into consideration risk factor differences by subsite.
JNCI: Journal of the National Cancer Institute, 2006
Background: Body weight and body mass index (BMI) are positively related to risk of colon cancer in men, whereas weak or no associations exist in women. This discrepancy may be related to differences in fat distribution between sexes or to the use of hormone replacement therapy (HRT) in women. Methods: We used multivariable adjusted Cox proportional hazards models to examine the association between anthropometric measures and risks of colon and rectal cancer among 368 277 men and women who were free of cancer at baseline from nine countries of the European Prospective Investigation Into Cancer and Nutrition. All statistical tests were two-sided. Results: During 6.1 years of follow-up, we identifi ed 984 and 586 patients with colon and rectal cancer, respectively. Body weight and BMI were statistically signifi cantly associated with colon cancer risk in men (highest versus lowest quintile of BMI, relative risk [RR] = 1.55, 95% confi dence interval [CI] = 1.12 to 2.15; P trend = .006) but not in women. In contrast, comparisons of the highest to the lowest quintile showed that several anthropometric measures, including waist circumference (men, RR = 1.39, 95% CI = 1.01 to 1.93; P trend = .001; women, RR = 1.48, 95% CI = 1.08 to 2.03; P trend = .008), waist-to-hip ratio (WHR; men, RR = 1.51, 95% CI = 1.06 to 2.15; P trend = .006; women, RR = 1.52, 95% CI = 1.12 to 2.05; P trend = .002), and height (men, RR = 1.40, 95% CI = 0.99 to 1.98; P trend = .04; women, RR = 1.79, 95% CI = 1.30 to 2.46; P trend <.001) were related to colon cancer risk in both sexes. The estimated absolute risk of developing colon cancer within 5 years was 203 and 131 cases per 100 000 men and 129 and 86 cases per 100 000 women in the highest and lowest quintiles of WHR, respectively. Upon further stratifi cation, no association of waist circumference and WHR with risk of colon cancer was observed among postmenopausal women who used HRT. None of the anthropometric measures was statistically signifi cantly related to rectal cancer. Conclusions: Waist circumference and WHR, indicators of abdominal obesity, were strongly associated with colon cancer risk in men and women in this population. The association of abdominal obesity with colon cancer risk may vary depending on HRT use in postmenopausal women; however, these fi ndings require confi rmation in future studies. [
International Journal of Cancer, 2009
Colorectal cancer is a major cause of cancer mortality and is considered to be largely attributable to inappropriate lifestyle and behavior patterns. The purpose of this review was to undertake a comparison of the strength of the associations between known and putative risk factors for colorectal cancer by conducting 10 independent meta-analyses of prospective cohort studies. Studies published between 1966 and January 2008 were identified through EMBASE and MEDLINE, using a combined text word and MESH heading search strategy. Studies were eligible if they reported estimates of the relative risk for colorectal cancer with any of the following: alcohol, smoking, diabetes, physical activity, meat, fish, poultry, fruits and vegetables. Studies were excluded if the estimates were not adjusted at least for age. Overall, data from 103 cohort studies were included. The risk of colorectal cancer was significantly associated with alcohol: individuals consuming the most alcohol had 60% greater risk of colorectal cancer compared with non- or light drinkers (relative risk 1.56, 95% CI 1.42–1.70). Smoking, diabetes, obesity and high meat intakes were each associated with a significant 20% increased risk of colorectal cancer (compared with individuals in the lowest categories for each) with little evidence of between-study heterogeneity or publication bias. Physical activity was protective against colorectal cancer. Public-health strategies that promote modest alcohol consumption, smoking cessation, weight loss, increased physical activity and moderate consumption of red and processed meat are likely to have significant benefits at the population level for reducing the incidence of colorectal cancer. © 2009 UICC
Subsite-Specific Dietary Risk Factors for Colorectal Cancer: A Review of Cohort Studies
Journal of Oncology, 2013
Objective. A shift in the total incidence from left-to right-sided colon cancer has been reported and raises the question as to whether lifestyle risk factors are responsible for the changing subsite distribution of colon cancer. The present study provides a review of the subsite-specific risk estimates for the dietary components presently regarded as convincing or probable risk factors for colorectal cancer: red meat, processed meat, fiber, garlic, milk, calcium, and alcohol. Methods. Studies were identified by searching PubMed through October 8, 2012 and by reviewing reference lists. Thirty-two prospective cohort studies are included, and the estimates are compared by sex for each risk factor. Results. For alcohol, there seems to be a stronger association with rectal cancer than with colon cancer, and for meat a somewhat stronger association with distal colon and rectal cancer, relative to proximal colon cancer. For fiber, milk, and calcium, there were only minor differences in relative risk across subsites. No statement could be given regarding garlic. Overall, many of the subsite-specific risk estimates were nonsignificant, irrespective of exposure. Conclusion. For some dietary components the associations with risk of cancer of the rectum and distal colon appear stronger than for proximal colon, but not for all.
Meta-analyses of colorectal cancer risk factors
Cancer Causes & Control, 2013
Purpose-Demographic, behavioral and environmental factors have been associated with increased risk of colorectal cancer (CRC). We reviewed the published evidence and explored associations between risk factors and CRC incidence. Methods-We identified 12 established non-screening CRC risk factors and performed a comprehensive review and meta-analyses to quantify each factor's impact on CRC risk. We used random effects models of the logarithms of risks across studies: inverse variance weighted averages for dichotomous factors and generalized least squares for dose-response for multi-level factors. Results-Significant risk factors include inflammatory bowel disease (RR = 2.93, 95% CI: 1.79-4.81); CRC history in first-degree relative (RR = 1.79, 95% CI: 1.60-2.02); body mass index (BMI) to overall population (RR = 1.10 per 8 kg/m 2 increase, 95% CI: 1.08-1.12); physical activity (RR = 0.88, 95% CI: 0.86-0.91 for 2 standard deviations increased physical activity score); cigarette smoking (RR = 1.06, 95% CI: 1.03-1.08 for 5 pack-years), and consumption of red meat (RR = 1.13, 95% CI: 1.09-1.16 for 5 servings/week), fruit (RR = 0.85, 95% CI: 0.75-0.96 for 3 servings/day), and vegetables (RR = 0.86, 95% CI: 0.78-0.94 for 5 servings/day). Conclusions-We developed a comprehensive risk modeling strategy that incorporates multiple effects to predict an individual's risk of developing colorectal cancer. Inflammatory bowel disease
BMC Cancer
Introduction: Colorectal cancer (CRC) remains the second most common cancer in women worldwide. Physical activity (PA) has been associated with reduced risk of CRC; however, this has been demonstrated more consistently in men, while results of studies in women have been largely equivocal. We aimed to further examine the relationship between PA patterns and the risk of CRC in women, using repeated measurements. Methods: We followed participants of the Norwegian Women and Cancer (NOWAC) Study-a nationally representative cohort. Baseline information was available for 79,184 women, and we used this information in addition to follow-up information collected 6-8 years later, for repeated measurement analysis. At enrollment, participants were cancer-free and aged 30-70 years, with a median age of 51 years. We used Cox proportional hazards regression to compute hazard ratios (HRs) and 95% confidence intervals (CIs). Results: During an average of 14.6 years of follow-up and 1.16 million person-years, 885 cases of colon and 426 cases of rectal cancer were identified through linkage to the Norwegian Cancer Registry (median age at diagnosis: 65 years). We found no association between PA level and the risk of colon cancer in baseline or repeated measurements analyses when comparing women with PA level 1-2 to those with PA level 5-6 (reference) (baseline: HR = 0.90, 95% CI 0.66-1.23, p-trend = 0.76; repeated measurements: HR = 0.78, 95% CI 0.55-1.10, p-trend = 0.27). Results were the same when comparing PA level 9-10 to the reference level (baseline: HR = 0.80, 95% CI 0.56-1.12, p-trend = 0.76; repeated measurements: HR = 0.82, 95% CI 0.58-1.16, p-trend = 0.27). Similarly, we found no association between PA levels and the risk of rectal cancer. Conclusions: Women may need to look beyond PA in order to reduce their risk of CRC.
Lifestyle and Colon Cancer: An Assessment of Factors Associated with Risk
American Journal of Epidemiology, 1999
Studies of the etiology of colon cancer indicate that it is strongly associated with diet and lifestyle factors. The authors use data from a population-based study conducted in northern California, Utah, and Minnesota in 1991-1995 to determine lifestyle patterns and their association with colon cancer. Data obtained from 1,993 cases and 2,410 controls were grouped by using factor analyses to describe various aspects of lifestyle patterns. The first five lifestyle patterns for both men and women loaded heavily on dietary variables and were labeled: "Western," "moderation," "calcium/low-fat dairy," "meat and mutagens," and "nibblers, smoking, and coffee." Other important lifestyle patterns that emerged were labeled "body size," "medication and supplementation," "alcohol," and "physical activity." Among both men and women, the lifestyle characterized by high levels of physical activity was the most marked lifestyle associated with colon cancer (odds ratios = 0.42, 95% confidence interval: 0.32, 0.55 and odds ratio = 0.52, 95% confidence interval: 0.39, 0.69, for men and women, respectively) followed by medication and supplementation (odds ratio = 1.68, 95% confidence interval: 1.29, 2.18 and odds ratio = 1.63, 95% Cl 1.23, 2.16, respectively). Other lifestyles that were associated with colon cancer were the Western lifestyle, the lifestyle characterized by large body size, and the one characterized by calcium and low-fat dairy. Different lifestyle patterns appear to have age-and tumor site-specific associations. Am J Epidemiol 1999;150:869-77. anti-inflammatory agents, nonsteroidal; aspirin; colonic neoplasms; diet; hormone replacement therapy; obesity; physical exercise Colon cancer is multifactorial in its etiology and is thought to result from a composite of host, diet, and other lifestyle factors that occur over many years. It is likely that there are many pathways to disease and that factors that increase risk do not work in isolation from other factors. Because of studies conducted among migrant populations, in which incidence rates of the host country are adopted after migration, it has been hypothesized that components of a Western lifestyle contribute to risk (1, 2). Studies seeking to identify causal factors focused on specific components of a Western lifestyle, such as diet, physical activity, obesity (1), and, in some instances, interactions, have been examined between exposures (3-6). However, an integrated picture of lifestyle on risk of colon cancer is lacking. In this study, we attempt to identify lifestyle
Body Mass Index and Risk of Colorectal Cancer in Women (United States)
Cancer Cause Control, 2004
OBJECTIVES-To examine the association between body mass index (BMI) and incident colorectal cancer across the spectrum of BMI, including underweight, because detailed prospective cohort data on this topic in Asians is scarce, as is data on underweight (BMI < 18.5 kg/m 2 ) in any population RESEARCH DESIGN AND METHODS-Analysis of the Singapore Chinese Health Study included 51,251 men and women ages 45-74 years enrolled in 1993-1998 and followed up through 2007. Incident cancer cases and deaths among cohort members were identified through record linkage and 980 cases were identified. Cox regression models were used to investigate the association of baseline BMI with risk of incident colorectal cancer during mean 11.5 years of follow-up.