Objectives Although overweight body mass is an established risk factor for colorectal cancer incidence, few studies have examined the association between body mass index (BMI) and mortality after colorectal cancer diagnosis. We examined survival in a group of postmenopausal women according to BMI.
Methods Using the Wisconsin Cancer Reporting System we identified and enrolled 633 postmenopausal women aged 38–74 years who were diagnosed with colorectal cancer in 1988–1991. These women were interviewed by telephone; vital status was ascertained via Wisconsin death certificates. Cox proportional hazards regression was used to estimate multivariate risks of colorectal cancer-specific and all-cause mortality.
Results Both underweight (BMI <20.0 kg/m2) (Hazard Ratio (HR) 2.3, 95% Confidence Interval (CI) 1.0–5.4) and obese (BMI ≥ 30.0 kg/m2) women (HR 2.1, 95% CI 1.1–3.8) were at increased risk of colon cancer death, as compared to normal weight women (BMI 20.0–24.9 kg/m2). No association was observed for those with rectal cancer. Approximately 50% increases in all-cause mortality were observed among underweight and obese women with colorectal cancer. Postmenopausal hormone use did not appear to modify these associations.
Conclusions Underweight and obese postmenopausal women with colon cancer were at increased risk of death, though comorbidities may partially account for this risk.
Body mass index Colorectal cancer Mortality
The authors wish to acknowledge Drs. Henry Anderson and Patrick Remington for their advice and support throughout this study; Laura Stephenson and the staff of the Wisconsin Cancer Reporting System for assistance with data; and the participants and study staff of the Wisconsin Women’s Health Study for their commitment.
Lin, J, Zhang, SM, Cook, NR, et al. 2004Body mass index and risk of colorectal cancer in women (United States)Cancer Causes Control15581589PubMedCrossRefGoogle Scholar
Shimizu, N, Nagata, C, Shimizu, H, et al. 2003Height, weight, and alcohol consumption in relation to the risk of colorectal cancer in Japan: a prospective studyBr J Cancer8810381043PubMedCrossRefGoogle Scholar
Slattery, ML, Ballard-Barbash, R, Edwards, S, Caan, BJ, Potter, JD 2003Body mass index and colon cancer: an evaluation of the modifying effects of estrogen (United States)Cancer Causes Control147584PubMedGoogle Scholar
Terry, P, Giovannucci, E, Bergkvist, L, Holmberg, L, Wolk, A 2001Body weight and colorectal cancer risk in a cohort of Swedish women: relation varies by age and cancer siteBr J Cancer85346349PubMedGoogle Scholar
Ford, ES 1999Body mass index and colon cancer in a national sample of adult US men and womenAm J Epidemiol150390398PubMedGoogle Scholar
Le Marchand, L, Wilkens, LR, Kolonel, LN, Hankin, JH, Lyu, LC 1997Associations of sedentary lifestyle, obesity, smoking, alcohol use, and diabetes with the risk of colorectal cancerCancer Res5747874794PubMedGoogle Scholar
Martinez, ME, Giovannucci, E, Spiegelman, D, et al. 1997Leisure-time physical activity, body size, and colon cancer in women. Nurses’ Health Study Research GroupJ Natl Cancer Inst89948955PubMedCrossRefGoogle Scholar
Giovannucci, E, Ascherio, A, Rimm, EB, et al. 1995Physical activity, obesity, and risk for colon cancer and adenoma in menAnn Intern Med122327334PubMedGoogle Scholar
Dietz, AT, Newcomb, PA, Marcus, PM, Storer, BE 1995The association of body size and large bowel cancer risk in Wisconsin (United States) womenCancer Causes Control63036PubMedCrossRefGoogle Scholar
Bostick, RM, Potter, JD, Kushi, LH, et al. 1994Sugar, meat, and fat intake, and non-dietary risk factors for colon cancer incidence in Iowa women (United States)Cancer Causes Control53852PubMedCrossRefGoogle Scholar
Lee, IM, Paffenbarger, RS,Jr.1992Quetelet’s index and risk of colon cancer in college alumniJ Natl Cancer Inst8413261331PubMedGoogle Scholar
Le Marchand, L, Wilkens, LR, Mi, MP 1992Obesity in youth and middle age and risk of colorectal cancer in menCancer Causes Control3349354PubMedGoogle Scholar
Gerhardsson de Verdier, M, Hagman, U, Steineck, G, Rieger, A, Norell, SE 1990Diet, body mass and colorectal cancer: a case-referent study in StockholmInt J Cancer46832838PubMedGoogle Scholar
Kune, GA, Kune, S, Watson, LF 1990Body weight and physical activity as predictors of colorectal cancer riskNutr Cancer13917PubMedGoogle Scholar
West, DW, Slattery, ML, Robison, LM, et al. 1989Dietary intake and colon cancer: sex- and anatomic site-specific associationsAm J Epidemiol130883894PubMedGoogle Scholar
Graham, S, Marshall, J, Haughey, B, et al. 1988Dietary epidemiology of cancer of the colon in western New YorkAm J Epidemiol128490503PubMedGoogle Scholar
Klatsky, AL, Armstrong, MA, Friedman, GD, Hiatt, RA 1988The relations of alcoholic beverage use to colon and rectal cancerAm J Epidemiol12810071015PubMedGoogle Scholar
Wu, AH, Paganini-Hill, A, Ross, RK, Henderson, BE 1987Alcohol, physical activity and other risk factors for colorectal cancer: a prospective studyBr J Cancer55687694PubMedGoogle Scholar
Nomura, A, Heilbrun, LK, Stemmermann, GN 1985Body mass index as a predictor of cancer in menJ Natl Cancer Inst74319323PubMedGoogle Scholar
Calle, EE, Rodriguez, C, Walker-Thurmond, K, Thun, MJ 2003Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adultsN Engl J Med34816251638PubMedCrossRefGoogle Scholar
Phillips, RL, Snowdon, DA 1985Dietary relationships with fatal colorectal cancer among Seventh-Day AdventistsJ Natl Cancer Inst74307317PubMedGoogle Scholar
Key, TJ, Allen, NE, Verkasalo, PK, Banks, E 2001Energy balance and cancer: the role of sex hormonesProc Nutr Soc608189PubMedCrossRefGoogle Scholar
Chlebowski, RT, Wactawski-Wende, J, Ritenbaugh, C, et al. 2004Estrogen plus progestin and colorectal cancer in postmenopausal womenN Engl J Med3509911004PubMedCrossRefGoogle Scholar
Grodstein, F, Newcomb, PA, Stampfer, MJ 1999Postmenopausal hormone therapy and the risk of colorectal cancer: a review and meta-analysisAm J Med106574582PubMedCrossRefGoogle Scholar
Newcomb, PA, Storer, BE 1995Postmenopausal hormone use and risk of large-bowel cancerJ Natl Cancer Inst8710671071PubMedGoogle Scholar
Meyerhardt, JA, Catalano, PJ, Haller, DG, et al. 2003Influence of body mass index on outcomes and treatment-related toxicity in patients with colon carcinomaCancer98484495PubMedCrossRefGoogle Scholar
Meyerhardt, JA, Tepper, JE, Niedzwiecki, D, et al. 2004Impact of body mass index on outcomes and treatment-related toxicity in patients with stage II and III rectal cancer: findings from Intergroup Trial 0114J Clin Oncol22648657PubMedGoogle Scholar
Slattery, ML, French, TK, Egger, MJ, Lyon, JL 1989Diet and survival of patients with colon cancer in Utah: is there an association?Int J Epidemiol18792797PubMedGoogle Scholar
Ederer, F, Geisser, MS, Mongin, SJ, Church, TR, Mandel, JS 1999Colorectal cancer deaths as determined by expert committee and from death certificate: a comparison. The Minnesota StudyJ Clin Epidemiol52447452PubMedCrossRefGoogle Scholar
Tartter, PI, Slater, G, Papatestas, AE, Aufses, AH,Jr.1984Cholesterol, weight, height, Quetelet’s index, and colon cancer recurrenceJ Surg Oncol27232235PubMedGoogle Scholar
Giovannucci, E 2003Diet, body weight, and colorectal cancer: a summary of the epidemiologic evidenceJ Womens Health (Larchmt)12173182CrossRefGoogle Scholar