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Published in: Cancer Causes & Control 10/2012

01-10-2012 | Original paper

Risk factors for colon cancer in 150,912 postmenopausal women

Authors: Arthur Hartz, Tao He, John Jacob Ross

Published in: Cancer Causes & Control | Issue 10/2012

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Abstract

Background

Prospective data from the Women’s Health Initiative were analyzed to evaluate more than 800 possible risk factors for an association with colon cancer in postmenopausal women.

Methods

Data included 150,912 postmenopausal women between the ages of 50 and 79. The Cox proportional hazard regression analysis was used to identify risk factors independently associated with the development of colon cancer during a median follow-up time of 8 years.

Results

A total of 1,210 women developed colon cancer and 282 developed rectal cancer. Eleven risk factors were independently associated with an increased risk of colon cancer at the p < 0.001 level. In decreasing order of associated χ2 values, they were age, waist girth (especially for subjects without diabetes), use of hormone therapy at baseline (protective), years smoked, arthritis (protective presumably because of medications used for treatment), relatives with colorectal cancer, lower hematocrit levels, fatigue, diabetes, less use of sleep medication, and cholecystectomy. Of the 11 factors, three were significantly associated with an increased risk of rectal cancer: age, waist, and not taking hormone therapy.

Conclusions

The results provide additional support for the importance of waist girth, hormone therapy, smoking, NSAID use, diabetes, and cholecystectomy as risk factors for colon cancer. Some factors previously identified as influencing risk (exercise and black race) did not have a strong independent association with colon cancer in this analysis.
Literature
1.
go back to reference Giovannucci E (2002) Modifiable risk factors for colon cancer. Gastroenterol Clin North Am 31:925–943CrossRefPubMed Giovannucci E (2002) Modifiable risk factors for colon cancer. Gastroenterol Clin North Am 31:925–943CrossRefPubMed
2.
go back to reference Marshall JR (2008) Prevention of colorectal cancer: diet, chemoprevention, and lifestyle. Gastroenterol Clin North Am 37:73–82 viCrossRefPubMed Marshall JR (2008) Prevention of colorectal cancer: diet, chemoprevention, and lifestyle. Gastroenterol Clin North Am 37:73–82 viCrossRefPubMed
3.
go back to reference The Women’s Health Initiative Study Group (1998) Design of the Women’s Health Initiative clinical trial and observational study. Control Clin Trials 19:61–109CrossRef The Women’s Health Initiative Study Group (1998) Design of the Women’s Health Initiative clinical trial and observational study. Control Clin Trials 19:61–109CrossRef
4.
go back to reference Anderson GL, Manson J, Wallace R et al (2003) Implementation of the Women’s Health Initiative study design. Ann Epidemiol 13:S5–S17CrossRefPubMed Anderson GL, Manson J, Wallace R et al (2003) Implementation of the Women’s Health Initiative study design. Ann Epidemiol 13:S5–S17CrossRefPubMed
5.
go back to reference Curb JD, McTiernan A, Heckbert SR et al (2003) Outcomes ascertainment and adjudication methods in the Women’s Health Initiative. Ann Epidemiol 13:S122–S128CrossRefPubMed Curb JD, McTiernan A, Heckbert SR et al (2003) Outcomes ascertainment and adjudication methods in the Women’s Health Initiative. Ann Epidemiol 13:S122–S128CrossRefPubMed
6.
go back to reference Hays J, Hunt JR, Hubbell FA et al (2003) The Women’s Health Initiative recruitment methods and results. Ann Epidemiol 13:S18–S77CrossRefPubMed Hays J, Hunt JR, Hubbell FA et al (2003) The Women’s Health Initiative recruitment methods and results. Ann Epidemiol 13:S18–S77CrossRefPubMed
7.
8.
go back to reference Hartz A, Houts P, Arnold S, Bartholomew M, Fischer M (1988) A method of quantify confounding in regression analyses applied to data on diet and CHD incidence. J Clin Epidemiol 41:331–337CrossRefPubMed Hartz A, Houts P, Arnold S, Bartholomew M, Fischer M (1988) A method of quantify confounding in regression analyses applied to data on diet and CHD incidence. J Clin Epidemiol 41:331–337CrossRefPubMed
9.
go back to reference Wolf LA, Terry PD, Potter JD, Bostick RM (2007) Do factors related to endogenous and exogenous estrogens modify the relationship between obesity and risk of colorectal adenomas in women? Cancer Epidemiol Biomarkers Prev 16:676–683CrossRefPubMed Wolf LA, Terry PD, Potter JD, Bostick RM (2007) Do factors related to endogenous and exogenous estrogens modify the relationship between obesity and risk of colorectal adenomas in women? Cancer Epidemiol Biomarkers Prev 16:676–683CrossRefPubMed
10.
go back to reference Ding EL, Mehta S, Fawzi WW, Giovannucci EL (2008) Interaction of estrogen therapy with calcium and vitamin D supplementation on colorectal cancer risk: reanalysis of Women’s Health Initiative randomized trial. Int J Cancer 122:1690–1694CrossRefPubMed Ding EL, Mehta S, Fawzi WW, Giovannucci EL (2008) Interaction of estrogen therapy with calcium and vitamin D supplementation on colorectal cancer risk: reanalysis of Women’s Health Initiative randomized trial. Int J Cancer 122:1690–1694CrossRefPubMed
12.
go back to reference Freedman AN, Slattery ML, Ballard-Barbash R et al (2009) Colorectal cancer risk prediction tool for white men and women without known susceptibility. J Clin Oncol 27:686–693CrossRefPubMed Freedman AN, Slattery ML, Ballard-Barbash R et al (2009) Colorectal cancer risk prediction tool for white men and women without known susceptibility. J Clin Oncol 27:686–693CrossRefPubMed
13.
go back to reference Moore LL, Bradlee ML, Singer MR et al (2004) BMI and waist circumference as predictors of lifetime colon cancer risk in Framingham Study adults. Int J Obes Relat Metab Disord 28:559–567CrossRefPubMed Moore LL, Bradlee ML, Singer MR et al (2004) BMI and waist circumference as predictors of lifetime colon cancer risk in Framingham Study adults. Int J Obes Relat Metab Disord 28:559–567CrossRefPubMed
14.
go back to reference Beresford SA, Johnson KC, Ritenbaugh C et al (2006) Low-fat dietary pattern and risk of colorectal cancer: the Women’s Health Initiative randomized controlled dietary modification trial. JAMA 295:643–654CrossRefPubMed Beresford SA, Johnson KC, Ritenbaugh C et al (2006) Low-fat dietary pattern and risk of colorectal cancer: the Women’s Health Initiative randomized controlled dietary modification trial. JAMA 295:643–654CrossRefPubMed
15.
go back to reference Kabat GC, Shikany JM, Beresford SA et al (2008) Dietary carbohydrate, glycemic index, and glycemic load in relation to colorectal cancer risk in the Women’s Health Initiative. Cancer Causes Control 19:1291–1298CrossRefPubMed Kabat GC, Shikany JM, Beresford SA et al (2008) Dietary carbohydrate, glycemic index, and glycemic load in relation to colorectal cancer risk in the Women’s Health Initiative. Cancer Causes Control 19:1291–1298CrossRefPubMed
16.
go back to reference Neuhouser ML, Wassertheil-Smoller S, Thomson C et al (2009) Multivitamin use and risk of cancer and cardiovascular disease in the Women’s Health Initiative cohorts. Arch Intern Med 169:294–304CrossRefPubMed Neuhouser ML, Wassertheil-Smoller S, Thomson C et al (2009) Multivitamin use and risk of cancer and cardiovascular disease in the Women’s Health Initiative cohorts. Arch Intern Med 169:294–304CrossRefPubMed
17.
go back to reference Paskett ED, Reeves KW, Rohan TE et al (2007) Association between cigarette smoking and colorectal cancer in the Women’s Health Initiative. J Natl Cancer Inst 99:1729–1735CrossRefPubMed Paskett ED, Reeves KW, Rohan TE et al (2007) Association between cigarette smoking and colorectal cancer in the Women’s Health Initiative. J Natl Cancer Inst 99:1729–1735CrossRefPubMed
18.
go back to reference Prentice RL, Pettinger M, Beresford SA et al (2009) Colorectal cancer in relation to postmenopausal estrogen and estrogen plus progestin in the Women’s Health Initiative clinical trial and observational study. Cancer Epidemiol Biomarkers Prev 18:1531–1537CrossRefPubMed Prentice RL, Pettinger M, Beresford SA et al (2009) Colorectal cancer in relation to postmenopausal estrogen and estrogen plus progestin in the Women’s Health Initiative clinical trial and observational study. Cancer Epidemiol Biomarkers Prev 18:1531–1537CrossRefPubMed
19.
go back to reference Ritenbaugh C, Stanford JL, Wu L et al (2008) Conjugated equine estrogens and colorectal cancer incidence and survival: the Women’s Health Initiative randomized clinical trial. Cancer Epidemiol Biomarkers Prev 17:2609–2618CrossRefPubMed Ritenbaugh C, Stanford JL, Wu L et al (2008) Conjugated equine estrogens and colorectal cancer incidence and survival: the Women’s Health Initiative randomized clinical trial. Cancer Epidemiol Biomarkers Prev 17:2609–2618CrossRefPubMed
20.
go back to reference Hoffmeister M, Raum E, Krtschil A, Chang-Claude J, Brenner H (2009) No evidence for variation in colorectal cancer risk associated with different types of postmenopausal hormone therapy. Clin Pharmacol Ther 86:416–424CrossRefPubMed Hoffmeister M, Raum E, Krtschil A, Chang-Claude J, Brenner H (2009) No evidence for variation in colorectal cancer risk associated with different types of postmenopausal hormone therapy. Clin Pharmacol Ther 86:416–424CrossRefPubMed
21.
go back to reference Reid FD, Mercer PM, Harrison M, Bates T (1996) Cholecystectomy as a risk factor for colorectal cancer: a meta-analysis. Scand J Gastroenterol 31:160–169CrossRefPubMed Reid FD, Mercer PM, Harrison M, Bates T (1996) Cholecystectomy as a risk factor for colorectal cancer: a meta-analysis. Scand J Gastroenterol 31:160–169CrossRefPubMed
22.
go back to reference Zhao C, Ge Z, Wang Y, Qian J (2012) Meta-analysis of observational studies on cholecystectomy and the risk of colorectal adenoma. Eur J Gastroenterol Hepatol 24:375–381PubMed Zhao C, Ge Z, Wang Y, Qian J (2012) Meta-analysis of observational studies on cholecystectomy and the risk of colorectal adenoma. Eur J Gastroenterol Hepatol 24:375–381PubMed
23.
go back to reference Shao T, Yang YX (2005) Cholecystectomy and the risk of colorectal cancer. Am J Gastroenterol 100:1813–1820CrossRefPubMed Shao T, Yang YX (2005) Cholecystectomy and the risk of colorectal cancer. Am J Gastroenterol 100:1813–1820CrossRefPubMed
24.
go back to reference Xu YK, Zhang FL, Feng T, Li J, Wang YH (2009) Meta-analysis on the correlation of cholecystectomy or cholecystolithiasis to risk of colorectal cancer in Chinese population. Chin J Cancer 28:749–755CrossRef Xu YK, Zhang FL, Feng T, Li J, Wang YH (2009) Meta-analysis on the correlation of cholecystectomy or cholecystolithiasis to risk of colorectal cancer in Chinese population. Chin J Cancer 28:749–755CrossRef
25.
go back to reference Giovannucci E, Colditz GA, Stampfer MJ (1993) A meta-analysis of cholecystectomy and risk of colorectal cancer. Gastroenterology 105:130–141PubMed Giovannucci E, Colditz GA, Stampfer MJ (1993) A meta-analysis of cholecystectomy and risk of colorectal cancer. Gastroenterology 105:130–141PubMed
26.
go back to reference Narisawa T, Magadia NE, Weisburger JH, Wynder EL (1974) Promoting effect of bile acids on colon carcinogenesis after intrarectal instillation of N-methyl-N′-nitro-N-nitrosoguanidine in rats. J Natl Cancer Inst 53:1093–1097PubMed Narisawa T, Magadia NE, Weisburger JH, Wynder EL (1974) Promoting effect of bile acids on colon carcinogenesis after intrarectal instillation of N-methyl-N′-nitro-N-nitrosoguanidine in rats. J Natl Cancer Inst 53:1093–1097PubMed
27.
go back to reference Koga S, Kaibara N, Takeda R (1982) Effect of bile acids on 1,2-dimethylhydrazine-induced colon cancer in rats. Cancer 50:543–547CrossRefPubMed Koga S, Kaibara N, Takeda R (1982) Effect of bile acids on 1,2-dimethylhydrazine-induced colon cancer in rats. Cancer 50:543–547CrossRefPubMed
28.
go back to reference Todoroki I, Friedman GD, Slattery ML, Potter JD, Samowitz W (1999) Cholecystectomy and the risk of colon cancer. Am J Gastroenterol 94:41–46CrossRefPubMed Todoroki I, Friedman GD, Slattery ML, Potter JD, Samowitz W (1999) Cholecystectomy and the risk of colon cancer. Am J Gastroenterol 94:41–46CrossRefPubMed
29.
go back to reference Slattery ML, Edwards SL, Ma KN, Friedman GD (2000) Colon cancer screening, lifestyle, and risk of colon cancer. Cancer Causes Control 11:555–563CrossRefPubMed Slattery ML, Edwards SL, Ma KN, Friedman GD (2000) Colon cancer screening, lifestyle, and risk of colon cancer. Cancer Causes Control 11:555–563CrossRefPubMed
30.
go back to reference Winawer SJ, Zauber AG, Ho MN et al (1993) Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med 329:1977–1981CrossRefPubMed Winawer SJ, Zauber AG, Ho MN et al (1993) Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med 329:1977–1981CrossRefPubMed
31.
go back to reference Pischon T, Lahmann PH, Boeing H et al (2006) Body size and risk of colon and rectal cancer in the European Prospective Investigation Into Cancer and Nutrition (EPIC). J Natl Cancer Inst 98:920–931CrossRefPubMed Pischon T, Lahmann PH, Boeing H et al (2006) Body size and risk of colon and rectal cancer in the European Prospective Investigation Into Cancer and Nutrition (EPIC). J Natl Cancer Inst 98:920–931CrossRefPubMed
32.
go back to reference Akhter M, Inoue M, Kurahashi N, Iwasaki M, Sasazuki S, Tsugane S (2008) Reproductive factors, exogenous female hormone use and colorectal cancer risk: the Japan Public Health Center-based Prospective Study. Eur J Cancer Prev 17:515–524CrossRefPubMed Akhter M, Inoue M, Kurahashi N, Iwasaki M, Sasazuki S, Tsugane S (2008) Reproductive factors, exogenous female hormone use and colorectal cancer risk: the Japan Public Health Center-based Prospective Study. Eur J Cancer Prev 17:515–524CrossRefPubMed
33.
go back to reference Martinez ME, Grodstein F, Giovannucci E et al (1997) A prospective study of reproductive factors, oral contraceptive use, and risk of colorectal cancer. Cancer Epidemiol Biomarkers Prev 6:1–5PubMed Martinez ME, Grodstein F, Giovannucci E et al (1997) A prospective study of reproductive factors, oral contraceptive use, and risk of colorectal cancer. Cancer Epidemiol Biomarkers Prev 6:1–5PubMed
34.
go back to reference Zervoudakis A, Strickler HD, Park Y et al (2011) Reproductive history and risk of colorectal cancer in postmenopausal women. J Natl Cancer Inst 103:826–834CrossRefPubMed Zervoudakis A, Strickler HD, Park Y et al (2011) Reproductive history and risk of colorectal cancer in postmenopausal women. J Natl Cancer Inst 103:826–834CrossRefPubMed
35.
go back to reference Chute CG, Willett WC, Colditz GA, Stampfer MJ, Rosner B, Speizer FE (1991) A prospective study of reproductive history and exogenous estrogens on the risk of colorectal cancer in women. Epidemiology 2:201–207CrossRefPubMed Chute CG, Willett WC, Colditz GA, Stampfer MJ, Rosner B, Speizer FE (1991) A prospective study of reproductive history and exogenous estrogens on the risk of colorectal cancer in women. Epidemiology 2:201–207CrossRefPubMed
36.
go back to reference Tamakoshi K, Wakai K, Kojima M et al (2004) A prospective study of reproductive and menstrual factors and colon cancer risk in Japanese women: findings from the JACC study. Cancer Sci 95:602–607CrossRefPubMed Tamakoshi K, Wakai K, Kojima M et al (2004) A prospective study of reproductive and menstrual factors and colon cancer risk in Japanese women: findings from the JACC study. Cancer Sci 95:602–607CrossRefPubMed
37.
go back to reference Taylor ML, Wells BJ, Smolak MJ (2008) Statins and cancer: a meta-analysis of case–control studies. Eur J Cancer Prev 17:259–268CrossRefPubMed Taylor ML, Wells BJ, Smolak MJ (2008) Statins and cancer: a meta-analysis of case–control studies. Eur J Cancer Prev 17:259–268CrossRefPubMed
38.
go back to reference Poynter JN, Gruber SB, Higgins PD et al (2005) Statins and the risk of colorectal cancer. N Engl J Med 352:2184–2192CrossRefPubMed Poynter JN, Gruber SB, Higgins PD et al (2005) Statins and the risk of colorectal cancer. N Engl J Med 352:2184–2192CrossRefPubMed
39.
go back to reference Haukka J, Sankila R, Klaukka T et al (2010) Incidence of cancer and statin usage—record linkage study. Int J Cancer 126:279–284CrossRefPubMed Haukka J, Sankila R, Klaukka T et al (2010) Incidence of cancer and statin usage—record linkage study. Int J Cancer 126:279–284CrossRefPubMed
40.
go back to reference Coogan PF, Smith J, Rosenberg L (2007) Statin use and risk of colorectal cancer. J Natl Cancer Inst 99:32–40CrossRefPubMed Coogan PF, Smith J, Rosenberg L (2007) Statin use and risk of colorectal cancer. J Natl Cancer Inst 99:32–40CrossRefPubMed
41.
go back to reference Kershaw EE, Flier JS (2004) Adipose tissue as an endocrine organ. J Clin Endocrinol Metab 89:2548–2556CrossRefPubMed Kershaw EE, Flier JS (2004) Adipose tissue as an endocrine organ. J Clin Endocrinol Metab 89:2548–2556CrossRefPubMed
42.
go back to reference Rondini EA, Harvey AE, Steibel JP, Hursting SD, Fenton JI (2010) Energy balance modulates colon tumor growth: interactive roles of insulin and estrogen. Mol Carcinog 50:370–382 Rondini EA, Harvey AE, Steibel JP, Hursting SD, Fenton JI (2010) Energy balance modulates colon tumor growth: interactive roles of insulin and estrogen. Mol Carcinog 50:370–382
43.
go back to reference Delellis Henderson K, Duan L, Sullivan-Halley J et al (2010) Menopausal hormone therapy use and risk of invasive colon cancer: the California Teachers Study. Am J Epidemiol 171:415–425CrossRefPubMed Delellis Henderson K, Duan L, Sullivan-Halley J et al (2010) Menopausal hormone therapy use and risk of invasive colon cancer: the California Teachers Study. Am J Epidemiol 171:415–425CrossRefPubMed
44.
Metadata
Title
Risk factors for colon cancer in 150,912 postmenopausal women
Authors
Arthur Hartz
Tao He
John Jacob Ross
Publication date
01-10-2012
Publisher
Springer Netherlands
Published in
Cancer Causes & Control / Issue 10/2012
Print ISSN: 0957-5243
Electronic ISSN: 1573-7225
DOI
https://doi.org/10.1007/s10552-012-0037-4

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