Journal of the National Cancer Institute Advance Access originally published online on November 13, 2007
JNCI Journal of the National Cancer Institute 2007 99(22):1729-1735; doi:10.1093/jnci/djm176
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© The Author 2007. Published by Oxford University Press.
Association Between Cigarette Smoking and Colorectal Cancer in the Women’s Health Initiative
Affiliations of authors: Division of Population Sciences, Center for Population Health and Health Disparities, Comprehensive Cancer Center and Division of Epidemiology, School of Public Health, The Ohio State University, Columbus, OH (EDP); Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA (KWR); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (TER); Department of Family and Preventive Medicine, University of California, San Diego, CA (MAA); Howard University Cancer Center, Washington, DC (CDW); Department of Preventive Medicine, Stony Brook University, Stony Brook, NY (CRM); Kaiser Permanente Center for Health Research, Portland, OR (EW); Fred Hutchinson Cancer Research Center, Seattle, WA (AS, JRH)
Correspondence to: Electra D. Paskett, PhD, 320 West Tenth Ave, A356 Starling Loving Hall, Columbus, OH 43210 (e-mail: electra.paskett{at}osumc.edu).
The evidence linking cigarette smoking to the risk of colorectal cancer is inconsistent. We investigated the associations between active and passive smoking and colorectal cancer among 146877 Women's Health Initiative participants. Women reported detailed smoking histories at enrollment. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated for the association between smoking and overall and site-specific risk of colorectal cancer. Invasive colorectal cancer was diagnosed in 1242 women over an average of 7.8 years (range = 0.003–11.2 years) of follow-up. In adjusted analyses, statistically significant positive associations were observed between most measures of cigarette smoking and risk of invasive colorectal cancer. Site-specific analyses indicated that current smokers had a statistically significantly increased risk of rectal cancer (HR = 1.95, 95% CI = 1.10 to 3.47) but not colon cancer (HR = 1.03, 95% CI = 0.77 to 1.38), compared with never smokers. Passive smoke exposure was not associated with colorectal cancer in adjusted analyses. Thus, active exposure to cigarette smoking appears to be a risk factor for rectal cancer.
| CONTEXT AND CAVEATS Prior knowledge The evidence for the association between cigarette smoking and the risk of colorectal cancer is inconsistent. Study design Pooled analysis of the association between cigarette smoking and colorectal cancer among participants in the observational study and the three clinical trials of the Women's Health Initiative. Contribution Statistically significant positive associations between most measures of cigarette smoking and colorectal cancer were observed. Current smokers have a statistically significantly increased risk of rectal cancer but not colon cancer, compared with never smokers. Passive smoke exposure was not associated with colorectal cancer in adjusted analyses. Implications Active cigarette smoking appears to be a risk factor for rectal cancer. Limitations Smoking exposure was self-reported and does not account for any change in smoking behavior during follow-up. Because multiple comparisons were performed, the findings of this study might be due to chance. The rate of current smoking in women in this study was lower than US women with similar ages.
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We wish to thank all WHI investigators and participants for their contributions. The following list is a short list of WHI investigators.
Program Office: Elizabeth Nabel, Jacques Rossouw, Shari Ludlam, Linda Pottern, Joan McGowan, Leslie Ford, and Nancy Geller (National Heart, Lung, and Blood Institute, Bethesda, MD).
Clinical Coordinating Centers: Ross Prentice, Garnet Anderson, Andrea LaCroix, Charles L. Kooperberg, Ruth E. Patterson, Anne McTiernan (Fred Hutchinson Cancer Research Center, Seattle, WA); Sally Shumaker (Wake Forest University School of Medicine, Winston-Salem, NC); Evan Stein (Medical Research Labs, Highland Heights, KY); Steven Cummings (University of California at San Francisco, San Francisco, CA).
Clinical Centers: Sylvia Wassertheil-Smoller (Albert Einstein College of Medicine, Bronx, NY); Jennifer Hays (Baylor College of Medicine, Houston, TX); JoAnn Manson (Brigham and Women's Hospital, Harvard Medical School, Boston, MA); Annlouise R. Assaf (Brown University, Providence, RI); Lawrence Phillips (Emory University, Atlanta, GA); Shirley Beresford (Fred Hutchinson Cancer Research Center, Seattle, WA); Judith Hsia (George Washington University Medical Center, Washington, DC); Rowan Chlebowski (Los Angeles Biomedical Research Institute at Harbor–UCLA Medical Center, Torrance, CA); Evelyn Whitlock (Kaiser Permanente Center for Health Research, Portland, OR); Bette Caan (Kaiser Permanente Division of Research, Oakland, CA); Jane Morley Kotchen (Medical College of Wisconsin, Milwaukee, WI); Barbara V. Howard (MedStar Research Institute/Howard University, Washington, DC); Linda Van Horn (Northwestern University, Chicago/Evanston, IL); Henry Black (Rush Medical Center, Chicago, IL); Marcia L. Stefanick (Stanford Prevention Research Center, Stanford, CA); Dorothy Lane (State University of New York at Stony Brook, Stony Brook, NY); Rebecca Jackson (The Ohio State University, Columbus, OH); Cora E. Lewis (University of Alabama at Birmingham, Birmingham, AL); Tamsen Bassford (University of Arizona, Tucson/Phoenix, AZ); Jean Wactawski-Wende (University at Buffalo, Buffalo, NY); John Robbins (University of California at Davis, Sacramento, CA); F. Allan Hubbell (University of California at Irvine, CA); Howard Judd (University of California at Los Angeles, Los Angeles, CA); Robert D. Langer (University of California at San Diego, LaJolla/Chula Vista, CA); Margery Gass (University of Cincinnati, Cincinnati, OH); Marian Limacher (University of Florida, Gainesville/Jacksonville, FL); David Curb (University of Hawaii, Honolulu, HI); Robert Wallace (University of Iowa, Iowa City/Davenport, IA); Judith Ockene (University of Massachusetts/Fallon Clinic, Worcester, MA); Norman Lasser (University of Medicine and Dentistry of New Jersey, Newark, NJ); Mary Jo O’Sullivan (University of Miami, Miami, FL); Karen Margolis (University of Minnesota, Minneapolis, MN); Robert Brunner (University of Nevada, Reno, NV); Gerardo Heiss (University of North Carolina, Chapel Hill, NC); Lewis Kuller (University of Pittsburgh, Pittsburgh, PA); Karen C. Johnson (University of Tennessee, Memphis, TN); Robert Brzyski (University of Texas Health Science Center, San Antonio, TX); Gloria E. Sarto (University of Wisconsin, Madison, WI); Denise Bonds (Wake Forest University School of Medicine, Winston-Salem, NC); Susan Hendrix (Wayne State University School of Medicine/Hutzel Hospital, Detroit, MI).
The sponsor played a role in the design and analysis of the WHI. The authors had full responsibility for the analysis and interpretation of the data and the writing and submission of the manuscript.
Manuscript received May 29, 2007; revised September 4, 2007; accepted September 5, 2007.
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