Original Paper

Cancer Causes & Control

, Volume 18, Issue 7, pp 723-733

Exogenous hormones and colorectal cancer risk in Canada: associations stratified by clinically defined familial risk of cancer

  • Peter T. CampbellAffiliated withProsserman Centre for Health Research, Samuel Lunenfeld Research Institute, Mount Sinai HospitalCancer Prevention Program, Fred Hutchinson Cancer Research Center Email author 
  • , Polly NewcombAffiliated withCancer Prevention Program, Fred Hutchinson Cancer Research Center
  • , Steven GallingerAffiliated withDepartment of Surgery, Mount Sinai Hospital
  • , Michelle CotterchioAffiliated withDivision of Preventive Oncology, Cancer Care OntarioDepartment of Public Health Sciences, University of Toronto
  • , John R. McLaughlinAffiliated withProsserman Centre for Health Research, Samuel Lunenfeld Research Institute, Mount Sinai HospitalDivision of Preventive Oncology, Cancer Care OntarioDepartment of Public Health Sciences, University of Toronto

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Abstract

Objective

This work assessed associations between colorectal cancer risk and postmenopausal/contraceptive hormones; subgroup analyses included women with a clinically defined family history of cancer.

Methods

A population based case–control study of incident colorectal cancer was conducted among women aged 20–74 years in Ontario and Newfoundland & Labrador, Canada. Incident cases (n = 1,404) were selected from provincial cancer registries and controls (n = 1,203) were identified through property records, and other means, between January 1997 and April 2006. Family history of cancer, exogenous hormone-use, and other risk factors were collected via self-administered questionnaires. Multivariate unconditional logistic regression analyses were used to estimate odds ratios (ORs) and corresponding 95% confidence intervals (CIs).

Results

Decreased risks of colorectal cancer were observed with ever-users of: hormonal contraceptives (OR: 0.77; CI: 0.65–0.91), estrogen-only postmenopausal hormones (OR: 0.60; CI: 0.47–0.75), and estrogen–progestin postmenopausal hormones (OR: 0.70; CI: 0.52–0.95). Risk estimates were similar between women with and without a strong familial history of cancer. Age at initiation of hormonal contraceptives was associated with colorectal cancer risk; women who initiated use at younger ages (age <22 years: OR: 0.60; CI: 0.47–0.77) experienced a greater reduced risk of disease than women who initiated use at later ages (age 30+: OR: 0.92; CI: 0.68–1.24; p trend: 0.0026).

Conclusions

These results indicate that exogenous hormone-use is linked with reduced risk of colorectal cancer among women with a strong familial risk of cancer, consistent with observations on population samples of sporadic colorectal cancer cases. A potential age-effect for use of hormonal contraceptives warrants further attention.

Keywords

Postmenopausal hormones HRT Contraceptives Colorectal cancer Family history of cancer Amsterdam criteria Bethesda criteria