Cancer Causes & Control

, Volume 24, Issue 6, pp 1207–1222 | Cite as

Meta-analyses of colorectal cancer risk factors

  • Constance M. Johnson
  • Caimiao Wei
  • Joe E. Ensor
  • Derek J. Smolenski
  • Christopher I. Amos
  • Bernard Levin
  • Donald A. BerryEmail author
Original paper



Demographic, behavioral, and environmental factors have been associated with increased risk of colorectal cancer (CRC). We reviewed the published evidence and explored associations between risk factors and CRC incidence.


We identified 12 established non-screening CRC risk factors and performed a comprehensive review and meta-analyses to quantify each factor’s impact on CRC risk. We used random-effects models of the logarithms of risks across studies: inverse-variance weighted averages for dichotomous factors and generalized least squares for dose–response for multi-level factors.


Significant risk factors include inflammatory bowel disease (RR = 2.93, 95 % CI 1.79–4.81); CRC history in first-degree relative (RR = 1.80, 95 % CI 1.61–2.02); body mass index (BMI) to overall population (RR = 1.10 per 8 kg/m2 increase, 95 % CI 1.08–1.12); physical activity (RR = 0.88, 95 % CI 0.86–0.91 for 2 standard deviations increased physical activity score); cigarette smoking (RR = 1.06, 95 % CI 1.03–1.08 for 5 pack-years); and consumption of red meat (RR = 1.13, 95 % CI 1.09–1.16 for 5 servings/week), fruit (RR = 0.85, 95 % CI 0.75–0.96 for 3 servings/day), and vegetables (RR = 0.86, 95 % CI 0.78–0.94 for 5 servings/day).


We developed a comprehensive risk modeling strategy that incorporates multiple effects to predict an individual’s risk of developing CRC. Inflammatory bowel disease and history of CRC in first-degree relatives are associated with much higher risk of CRC. Increased BMI, red meat intake, cigarette smoking, low physical activity, low vegetable consumption, and low fruit consumption were associated with moderately increased risk of CRC.


Colorectal cancer Colon neoplasms Colonic neoplasms Colorectal neoplasms Colorectal risk factors Colorectal cancer prevention Meta-analysis 



This project was supported in part by the National Colorectal Cancer Research Alliance; its contents are solely the responsibility of the authors and do not represent the official view of the National Colorectal Cancer Research Alliance.

Conflict of interest

Donald A. Berry is co-owner of Berry Consultants, LLC, a company that designs adaptive clinical trials for pharmaceutical and medical device companies and NIH cooperative groups.


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Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  • Constance M. Johnson
    • 1
  • Caimiao Wei
    • 2
  • Joe E. Ensor
    • 2
  • Derek J. Smolenski
    • 3
  • Christopher I. Amos
    • 4
  • Bernard Levin
    • 5
  • Donald A. Berry
    • 2
    Email author
  1. 1.School of Nursing and Community and Family MedicineDuke UniversityDurhamUSA
  2. 2.Division of Quantitative Sciences, Department of Biostatistics, Unit 1409The University of Texas MD Anderson Cancer CenterHoustonUSA
  3. 3.Research, Outcomes, Surveillance, Evaluations, National Center for Telehealth and TechnologyJoint Base Lewis-McChordTacomaUSA
  4. 4.Department of Community and Family Medicine, Geisel School of MedicineDartmouth CollegeLebanonUSA
  5. 5.Professor Emeritus, Division of Cancer Prevention and Population SciencesThe University of Texas MD Anderson Cancer CenterHoustonUSA

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