A Comprehensive Model of Colorectal Cancer by Risk Factor Status and Subsite Using Data From the Nurses' Health Study

Am J Epidemiol. 2017 Feb 1;185(3):224-237. doi: 10.1093/aje/kww183.

Abstract

We expanded and updated our colon cancer risk model to evaluate colorectal cancer (CRC) and whether subsite-specific risk models are warranted. Using data from 1980-2010 for 90,286 women enrolled in the Nurses' Health Study, we performed competing-risks regression and tests for subsite heterogeneity (proximal colon: n = 821; distal colon: n = 521; rectum: n = 376). Risk factors for CRC were consistent with those in our colon cancer model. Processed meat consumption was associated with a higher risk of distal (hazard ratio (HR) = 1.45; P = 0.02) but not proximal (HR = 0.95; P = 0.72) colon cancer. Smoking was associated with both colon (HR = 1.21) and rectal (HR = 1.27) cancer and was more strongly associated with proximal (HR = 1.31) than with distal (HR = 1.04) colon cancer (P = 0.029). We observed a significant trend of cancer risk for smoking in subsites from the cecum (HR = 1.41) to the proximal colon (excluding the cecum; HR = 1.27) to the distal colon (HR = 1.04; P for trend = 0.040). The C statistics for colorectal (C = 0.607), colon (C = 0.603), and rectal (C = 0.639) cancer were similar, although C was slightly higher for rectal cancer. Despite evidence for site-specific differences for several risk factors, overall our findings support the application of risk prediction models for colon cancer to CRC.

Keywords: colorectal cancer; incidence; rectal cancer; risk; risk factors; risk prediction model; women.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Alcohol Drinking
  • Colorectal Neoplasms / epidemiology
  • Colorectal Neoplasms / etiology*
  • Colorectal Neoplasms / mortality
  • Diet
  • Exercise
  • Female
  • Humans
  • Incidence
  • Meat / adverse effects
  • Middle Aged
  • Proportional Hazards Models
  • Prospective Studies
  • Rectal Neoplasms / epidemiology
  • Rectal Neoplasms / etiology
  • Risk Assessment*
  • Risk Factors
  • Smoking / adverse effects
  • Surveys and Questionnaires
  • Survival Analysis