Calcium intake and risk of colorectal cancer according to expression status of calcium-sensing receptor (CASR)

Gut. 2018 Aug;67(8):1475-1483. doi: 10.1136/gutjnl-2017-314163. Epub 2017 Jul 4.


Objective: Although evidence suggests an inverse association between calcium intake and the risk of colorectal cancer, the mechanisms remain unclear. The calcium-sensing receptor (CASR) is expressed abundantly in normal colonic epithelium and may influence carcinogenesis. We hypothesized that calcium intake might be associated with lower risk of CASR-positive, but not CASR-negative, colorectal cancer.

Design: We assessed tumour CASR protein expression using immunohistochemistry in 779 incident colon and rectal cancer cases that developed among 136 249 individuals in the Nurses' Health Study and Health Professionals Follow-Up Study. Duplication method Cox proportional hazards regression analysis was used to assess associations of calcium intake with incidence of colorectal adenocarcinoma subtypes by CASR status.

Results: Total calcium intake was inversely associated with the risk of developing colorectal cancer (ptrend=0.01, comparing ≥1200 vs <600 mg/day: multivariable HR=0.75, 95% CI 0.60 to 0.95). For the same comparison, higher total calcium intake was associated with a lower risk of CASR-positive tumours (ptrend=0.003, multivariable HR=0.67, 95% CI 0.51 to 0.86) but not with CASR-negative tumours (ptrend=0.67, multivariable HR=1.15, 95% CI 0.75 to 1.78; pheterogeneity=0.06 between the CASR subtypes). The stronger inverse associations of calcium intake with CASR-positive but not CASR-negative tumours generally appeared consistent regardless of sex, tumour location and source of calcium.

Conclusions: Our molecular pathological epidemiology data suggest a causal relationship between higher calcium intake and lower colorectal cancer risk, and a potential role of CASR in mediating antineoplastic effect of calcium.

Keywords: calcium; calcium-sensing receptor; cancer epidemiology; cancer prevention; cohort study; colon cancer; diet; etiologic heterogeneity; molecular pathological epidemiology; rectal cancer; tumor microenvironment..

MeSH terms

  • Adult
  • Aged
  • Calcium, Dietary / administration & dosage*
  • Cohort Studies
  • Colorectal Neoplasms / diagnosis
  • Colorectal Neoplasms / epidemiology*
  • Colorectal Neoplasms / metabolism*
  • Diet*
  • Female
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Receptors, Calcium-Sensing / metabolism*
  • Risk Factors


  • Calcium, Dietary
  • Receptors, Calcium-Sensing