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Epidemiology
Combined effect of modifiable and non-modifiable risk factors for colorectal cancer risk in a pooled analysis of 11 population-based studies
  1. Xiaoliang Wang1,2,
  2. Kelli O'Connell3,
  3. Jihyoun Jeon4,
  4. Mingyang Song5,6,
  5. David Hunter7,8,
  6. Michael Hoffmeister9,
  7. Yi Lin1,
  8. Sonja Berndt10,
  9. Hermann Brenner9,
  10. Andrew T Chan11,12,
  11. Jenny Chang-Claude13,
  12. Jian Gong1,
  13. Marc J Gunter14,
  14. Tabitha A Harrison1,
  15. Richard B Hayes15,
  16. Amit Joshi7,16,
  17. Polly Newcomb1,2,
  18. Robert Schoen17,
  19. Martha L Slattery18,
  20. Ashley Vargas19,
  21. John D Potter1,2,
  22. Loic Le Marchand20,
  23. Edward Giovannucci5,6,
  24. Emily White1,2,
  25. Li Hsu1,
  26. Ulrike Peters1,2,
  27. Mengmeng Du3
  1. 1Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
  2. 2Epidemiology, University of Washington, Seattle, Washington, USA
  3. 3Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
  4. 4Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
  5. 5Channing Division of Network Medicine, Harvard Medical School, Boston, Massachusetts, USA
  6. 6Nutrition, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
  7. 7Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
  8. 8Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK
  9. 9Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
  10. 10Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
  11. 11Gastrointestinal Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
  12. 12Harvard Medical School, Boston, Massachusetts, USA
  13. 13Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
  14. 14Section of Nutrition and Metabolism, International Agency for Research on Cancer, Lyon, France
  15. 15Epidemiology, New York University School of Medicine, New York, New York, USA
  16. 16Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
  17. 17Medicine and Epidemiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
  18. 18Department of Internal Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
  19. 19Office of Disease Prevention, National Institutes of Health, Bethesda, Maryland, USA
  20. 20Epidemiology Program, University of Hawai'i Cancer Center, Honolulu, Hawaii, USA
  1. Correspondence to Dr Xiaoliang Wang; xwang23{at}fredhutch.org

Abstract

Objective ‘Environmental’ factors associated with colorectal cancer (CRC) risk include modifiable and non-modifiable variables. Whether those with different non-modifiable baseline risks will benefit similarly from reducing their modifiable CRC risks remains unclear.

Design Using 7945 cases and 8893 controls from 11 population-based studies, we combined 17 risk factors to characterise the overall environmental predisposition to CRC (environmental risk score (E-score)). We estimated the absolute risks (ARs) of CRC of 10 and 30 years across E-score using incidence-rate data from the Surveillance, Epidemiology, and End Results programme. We then combined the modifiable risk factors and estimated ARs across the modifiable risk score, stratified by non-modifiable risk profile based on genetic predisposition, family history and height.

Results Higher E-score was associated with increased CRC risk (ORquartile, 1.33; 95% CI 1.30 to 1.37). Across E-scores, 30-year ARs of CRC increased from 2.5% in the lowest quartile (Q1) to 5.9% in the highest (Q4) quartile for men, and from 2.1% to 4.5% for women. The modifiable risk score had a stronger association in those with high non-modifiable risk (relative excess risk due to interaction=1.2, 95% CI 0.5 to 1.9). For those in Q4 of non-modifiable risk, a decrease in modifiable risk reduced 30-year ARs from 8.9% to 3.4% for men and from 6.0% to 3.2% for women, a level lower or comparable to the average population risk.

Conclusions Changes in modifiable risk factors may result in a substantial decline in CRC risk in both sexes. Those with high inherited risk may reap greater benefit from lifestyle modifications. Our results suggested comprehensive evaluation of environmental factors may facilitate CRC risk stratification.

  • colorectal cancer
  • epidemiology
  • cancer prevention

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjgast-2019-000339

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    Footnotes

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    • Contributors MD and JG planned the study proposal; KOC, JJ and YL conducted the analyses; XW and MD led the study, manuscript preparation and manuscript revision; EW, LH and UP oversaw the study plan and manuscript preparation and revision; MS, DH, MH, YL, SB, HB, ATC, JC-C, JG, MJG, TAH, RBH, AJ, PN, RS, MLS, AV, JDP, LLM, EG and EW supported the proposal review, data curation, manuscript submission and revision.

    • Funding Genetics and Epidemiology of Colorectal Cancer Consortium: National Cancer Institute, National Institutes of Health, US Department of Health and Human Services (R01 CA059045, U01 CA164930 and R01 201407). This research was funded in part through the NIH/NCI Cancer Center Support Grant P30 CA015704. COLO2&3: National Institutes of Health (R01 CA60987). DACHS: This work was supported by the German Research Council (BR 1704/6-1, BR 1704/3, BR 1704/6-4, CH 117/1-1, HO 5117/2-1, HE 5998/2-1, KL 2354/3-1, RO 2270/8-1 and BR 1704/17-1), the Interdisciplinary Research Program of the National Center for Tumor Diseases (NCT), Germany, and the German Federal Ministry of Education and Research (01KH0404, 01ER0814, 01ER0815, 01ER1505A and 01ER1505B). DALS: National Institutes of Health (R01 CA48998 to M. L. Slattery). Harvard cohorts (HPFS, NHS and PHS): HPFS is supported by the National Institutes of Health (P01 CA055075, UM1 CA167552, U01 CA167552, R01 CA137178, R01 CA151993, R35 CA197735, K07 CA190673, and P50 CA127003), NHS by the National Institutes of Health (R01 CA137178, P01 CA087969, UM1 CA186107, R01 CA151993, R35 CA197735, K07 CA190673, and P50 CA127003) and PHS by the National Institutes of Health (R01 CA042182). MEC: National Institutes of Health (R37 CA54281, P01 CA033619 and R01 CA063464). PLCO: Intramural Research Program of the Division of Cancer Epidemiology and Genetics and supported by contracts from the Division of Cancer Prevention, National Cancer Institute, NIH,PMH: National Institutes of Health (R01 CA076366 to PN). Vitamins and Lifestyle Study: National Institutes of Health (K05 CA154337). Women's Health Initiative (WHI): The WHI program is funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, US Department of Health and Human Services through contracts HHSN268201100046C, HHSN268201100001C, HHSN268201100002C, HHSN268201100003C, HHSN268201100004C and HHSN271201100004C.

    • Competing interests MJG: where authors are identified as personnel of the International Agency for Research on Cancer/World Health Organization, the authors alone are responsible for the views expressed in this article and they do not necessarily represent the decisions, policy or views of the International Agency for Research on Cancer/World Health Organization.

    • Patient consent for publication Not required.

    • Ethics approval Informed consent was given by all participants. Studies were approved by their respective institutional review boards.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request.