Publication:
Heterogeneity of Colorectal Cancer Risk Factors by Anatomical Subsite in 10 European Countries: A Multinational Cohort Study.

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Date

2018-07-26

Authors

Murphy, Neil
Ward, Heather A
Jenab, Mazda
Rothwell, Joseph A
Boutron-Ruault, Marie-Christine
Carbonnel, Franck
Kvaskoff, Marina
Kaaks, Rudolf
Kühn, Tilman
Boeing, Heiner

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Abstract

Colorectal cancer located at different anatomical subsites may have distinct etiologies and risk factors. Previous studies that have examined this hypothesis have yielded inconsistent results, possibly because most studies have been of insufficient size to identify heterogeneous associations with precision. In the European Prospective Investigation into Cancer and Nutrition study, we used multivariable joint Cox proportional hazards models, which accounted for tumors at different anatomical sites (proximal colon, distal colon, and rectum) as competing risks, to examine the relationships between 14 established/suspected lifestyle, anthropometric, and reproductive/menstrual risk factors with colorectal cancer risk. Heterogeneity across sites was tested using Wald tests. After a median of 14.9 years of follow-up of 521,330 men and women, 6291 colorectal cancer cases occurred. Physical activity was related inversely to proximal colon and distal colon cancer, but not to rectal cancer (P heterogeneity = .03). Height was associated positively with proximal and distal colon cancer only, but not rectal cancer (P heterogeneity = .0001). For men, but not women, heterogeneous relationships were observed for body mass index (P heterogeneity = .008) and waist circumference (P heterogeneity = .03), with weaker positive associations found for rectal cancer, compared with proximal and distal colon cancer. Current smoking was associated with a greater risk of rectal and proximal colon cancer, but not distal colon cancer (P heterogeneity = .05). No heterogeneity by anatomical site was found for alcohol consumption, diabetes, nonsteroidal anti-inflammatory drug use, and reproductive/menstrual factors. The relationships between physical activity, anthropometry, and smoking with colorectal cancer risk differed by subsite, supporting the hypothesis that tumors in different anatomical regions may have distinct etiologies.

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MeSH Terms

Adult
Alcohol Drinking
Colon
Colonoscopy
Colorectal Neoplasms
Europe
Exercise
Female
Follow-Up Studies
Humans
Incidence
Life Style
Male
Middle Aged
Prospective Studies
Rectum
Risk Factors
Smoking

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Neoplasias Colorrectales
Factores de Riesgo
Estilo de Vida

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Keywords

Anatomic Subsite, Colorectal Cancer, Distal Colon, Heterogeneity, Proximal Colon, Rectum, Risk Factors

Citation

Murphy N, Ward HA, Jenab M, Rothwell JA, Boutron-Ruault MC, Carbonnel F, et al. Heterogeneity of Colorectal Cancer Risk Factors by Anatomical Subsite in 10 European Countries: A Multinational Cohort Study. Clin Gastroenterol Hepatol. 2019 Jun;17(7):1323-1331.e6.