© The Author 2006. Published by Oxford University Press.
ARTICLE |
Body Size and Risk of Colon and Rectal Cancer in the European Prospective Investigation Into Cancer and Nutrition (EPIC)
Affiliations of authors: Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbruecke, Germany (TP, PHL, HB, MMB); Division of Population Health and Information, Alberta Cancer Board, Calgary, Alberta, Canada (CF); International Agency for Research on Cancer, Lyon, France (TN, PF, RK, NS, ER); Danish Cancer Society, Institute of Cancer Epidemiology, Copenhagen, Denmark (A. Tjønneland, JH); Department of Clinical Epidemiology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark (KO); INSERM U 521, Institut Gustave Roussy, Villejuif, France (FCC, MCBR, GG); Division of Clinical Epidemiology, German Cancer Research Center, Heidelberg, Germany (JL, NB); Department of Hygiene and Epidemiology, School of Medicine, University of Athens, Athens, Greece (A. Trichopoulou, DT); Epidemiology Unit, National Cancer Institute, Milan, Italy (SS); Molecular and Nutritional Epidemiology Unit, CSPO-Scientific Institute of Tuscany, Florence, Italy (DP); Cancer Registry, Azienda Ospedaliera "Civile M.P. Arezzo," Ragusa, Italy (RT); Imperial College London, UK, and University of Torino, Turin, Italy (PV); Dipartimento di Medicina Clinica e Sperimentale, Università di Napoli, Naples, Italy (SP); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands (PHMP); Center for Nutrition and Health (HBBdM), Center for Information Technology and Informatics (HCB), National Institute of Public Health and the Environment, Bilthoven, The Netherlands; Department of Medical Biosciences, Pathology, Umeå University, Umeå, Sweden (BVG, RP); Department of Medicine, Lund University, Malmö, Sweden (GB); Department of Epidemiology, Catalan Institute of Oncology, IDIBELL, Barcelona, Spain (CAG); Department of Public Health of Guipuzkoa, San Sebastian, Spain (MD); Public Health Institute of Navarra, Pamplona, Spain (AB); Epidemiology Department, Murcia Health Council, Murcia, Spain (CN); Escuela Andaluza de Salud Publica, Granada, Spain (CM); Health Information Unit, Public Health and Health Planning Directorate, Asturias, Spain (JRQ); Cancer Research UK Epidemiology Unit, University of Oxford, Oxford, UK (AR, NA); Dunn Human Nutrition Unit, Medical Research Council, Cambridge, UK (SB); Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, UK (KTK)
Correspondence to: Tobias Pischon, MD, MPH, Department of Epidemiology, German Institute of Human Nutrition (DIfE), Potsdam-Rehbruecke, Arthur-Scheunert-Allee 114–116, 14558 Nuthetal, Germany (e-mail: pischon{at}mail.dife.de).
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 identified 984 and 586 patients with colon and rectal cancer, respectively. Body weight and BMI were statistically significantly associated with colon cancer risk in men (highest versus lowest quintile of BMI, relative risk [RR] = 1.55, 95% confidence interval [CI] = 1.12 to 2.15; Ptrend = .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; Ptrend = .001; women, RR = 1.48, 95% CI = 1.08 to 2.03; Ptrend = .008), waist-to-hip ratio (WHR; men, RR = 1.51, 95% CI = 1.06 to 2.15; Ptrend = .006; women, RR = 1.52, 95% CI = 1.12 to 2.05; Ptrend = .002), and height (men, RR = 1.40, 95% CI = 0.99 to 1.98; Ptrend = .04; women, RR = 1.79, 95% CI = 1.30 to 2.46; Ptrend<.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 stratification, 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 significantly 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 findings require confirmation in future studies.
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