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Risk of colorectal cancer associated with active smoking among female teachers

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Abstract

Purpose

The objective of this study was to examine the risk of colorectal cancer associated with active smoking among members of the California Teachers Study (CTS), a large cohort of female public school employees for whom highly detailed smoking information is available.

Methods

The analysis was conducted among the 122,264 CTS participants who lived in California at cohort entry in 1995/1996, had no prior history of colorectal cancer, and provided detailed smoking information. 1,205 cases of invasive colorectal cancer prospectively diagnosed in 1995–2009 were identified from the California Cancer Registry, including 650 in the proximal colon, 267 in the distal colon, and 288 in the rectum. Hazard ratios and 95 % confidence intervals were estimated using Cox proportional hazards models, stratified by age at cohort entry, and adjusted for race/ethnicity.

Results

Compared to never smokers, current smokers had an approximately 30 % increased risk of colorectal cancer. Overall, a slightly elevated risk was also noted for former smokers. Among former smokers, risks appeared to remain elevated for up to 20 years following cessation. Risks among former and current smokers increased with greater intensity and duration of smoking. Little evidence for heterogeneity in risk was noted for colon versus rectal cancer or for different subsites within the colon.

Conclusions

These results provide convincing evidence that heavy and/or long-term smoking is a risk factor for cancers of the colon and rectum. Such evidence should be considered when updating screening guidelines to include targeting people with long active smoking histories.

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Acknowledgments

This research was funded by grant 18XT-0108 from the California Tobacco-Related Disease Research Program and National Cancer Institute grants R01 CA77398 and K05 CA136967. The collection of cancer incidence data used in this study was supported by the California Department of Public Health as part of the statewide cancer reporting program mandated by California Health and Safety Code Section 103885; the National Cancer Institute’s Surveillance, Epidemiology and End Results Program under contract HHSN261201000036C awarded to the Cancer Prevention Institute of California, contract HHSN261201000035C awarded to the University of Southern California, and contract HHSN261201000034C awarded to the Public Health Institute; and the Centers for Disease Control and Prevention’s National Program of Cancer Registries, under agreement #1U58 DP000807-01 awarded to the Public Health Institute. The ideas and opinions expressed herein are those of the author(s) and endorsement by the State of California Department of Public Health, the National Cancer Institute, and the Centers for Disease Control and Prevention or their Contractors and Subcontractors is not intended nor should be inferred. We express our appreciation to all the participants in the California Teachers Study and to the researchers, analysts and staff who have contributed so much for the success of this research project. We also thank Pam Horn-Ross and Alison Canchola for technical support with the dietary data and Ha Van for administrative support. The authors would like to thank the CTS Steering Committee members who are responsible for the formation and maintenance of the cohort within which this study was conducted but who did not directly contribute to the current paper: Hoda Anton-Culver, Christina A. Clarke, Dennis Deapen, James V. Lacey Jr, Huiyan Ma, Susan L. Neuhausen, Fredrick Schumacher, Sophia S. Wang, and Argyrios Ziogas.

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The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Cancer Prevention Institute of California, 2001 Center Street, Suite 700, Berkeley, CA, 94704, USA

    Susan Hurley, Debbie Goldberg, David O. Nelson & Peggy Reynolds

  2. Department of Population Sciences, Beckman Research Institute, City of Hope, 1500 East Duarte Road, Duarte, CA, 91010, USA

    Yani Lu, Katherine Henderson & Leslie Bernstein

  3. Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, 94305, USA

    Peggy Reynolds

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  1. Susan Hurley
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Correspondence to Susan Hurley.

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Hurley, S., Goldberg, D., Nelson, D.O. et al. Risk of colorectal cancer associated with active smoking among female teachers. Cancer Causes Control 24, 1291–1304 (2013). https://doi.org/10.1007/s10552-013-0207-z

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