© 1992 by Oxford University Press
Journal of the National Cancer Institute, Vol. 84, No. 19, 1491-1500,
October 7, 1992
© 1992 Oxford University Press
Risk Factors for Fatal Colon Cancer in a Large Prospective Study
1American Cancer Society Atlanta, Ga
2Epidemiology Division, Emory University School of Public Health Atlanta, Ga
3National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control Atlanta, Ga
4International Agency for Research on Cancer Lyon, France
*Correspondence to: Michael J. Thun, M.D., M.S., American Cancer Society, 1599 Clifton Rd., N.E., Atlanta, GA 30329
Background: Diet, physical activity, obesity, aspirin use, and family history may all modify the risk of colon cancer, but few epidemiologic studies are large enough to examine these factors simultaneously. Purpose: We prospectively assessed the relationship of diet and other factors to risk of fatal colon cancer. Methods: Using data from Cancer Prevention Study II—an ongoing prospective mortality study—we studied 764343 adults who, in 1982, completed a questionnaire on diet and other risk factors and did not report cancer or other major illness. We assessed mortality through August 1988 and identified 1150 deaths from colon cancer (611 men and 539 women). Multivariate analyses were used to compare these case patients with 5746 matched control subjects drawn from the cohort. Results: Risk of fatal colon cancer decreased with more frequent consumption of vegetables and high-fiber grains (P for trend = .031 in men and .0012 in women). The relative risk (RR) for the highest versus lowest quintile of vegetable intake was 0.76 in men (95% confidence interval [CI] = 0.57–1.02) and 0.62 in women (95% CI = 0.45–0.86). Dietary consumption of vegetables and grains and regular use of aspirin were the only factors having an independent and statistically significant association with fatal colon cancer. Participants who consumed the least vegetables and grains and no aspirin had a higher risk compared with those who consumed the most vegetables and used aspirin 16 or more times per month. For men in the former category, the RR was 2.4 (95% CI = 1.1–5.3); for women, it was 2.9 (95% CI = 1.3–6.7). Weaker associations were seen for physical inactivity, obesity, total dietary fat, and family history. No associations were seen with consumption of red meat or total or saturated fat in either sex, but this finding must be interpreted cautiously. Conclusions: These findings support recommendations that increased consumption of vegetables and grains may reduce the risk of fatal colon cancer. Regular use of low doses of aspirin may prove to be an important supplemental measure. [J Natl Cancer Inst 84:1491—1500, 1992]
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