Proportion of colon cancer attributable to lifestyle in a cohort of US women
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Many modifiable lifestyle factors have been associated with colon cancer risk, but less is known about their effect on disease when considered together. Estimating the proportion of colon cancer cases that could be prevented by the adoption of combined modifiable lifestyle behaviors will provide important insights into disease prevention.
In the Nurses’ Health Study, we defined a low-risk group according to a combination of six factors: body mass index <25 kg/m2, physical activity of ≥21 metabolic equivalent of task per week, alcohol consumption ≤30 g/day, cigarette smoking <10 pack-years before the age of 30, current use of multivitamins for ≥15 years, and total calcium intake ≥700 mg/day. A composite risk score index was created and the population attributable risk (PAR%) was calculated after accounting for other known risk or protective factors.
We documented 1,127 colon cancer cases among 81,092 over 24 years of follow-up. Compared with women in the lowest risk category, the women at all other exposure levels had a hazard ratio of colon cancer of 1.81 (95 % confidence interval 1.15–2.85). The score index was significantly and linearly related to an increasing risk of colon cancer (p value for trend <0.0001). The PAR% of the six risk factors considered together in relation to colon cancer was 0.37 (95 % CI 0.09–0.60). When regular aspirin use (two tablets/week for six or more years) was included with the other low-risk behaviors, the PAR% increased to 0.43 (95 % CI 0.14–0.65).
Beyond the known benefit from colonoscopy/sigmoidoscopy, key behavior modifications and adherence to a healthy lifestyle could avoid approximately 37 % of colon cancer cases among women.
KeywordsObesity Physical activity Smoking Calcium Multivitamin Alcohol Aspirin Screening Population attributable risk Colon cancer Prevention
We would like to thank the participants and staff of the Nurses’ Health Study for their valuable contributions as well as the following state cancer registries for their help: AL, AZ, AR, CA, CO, CT, DE, FL, GA, ID, IL, IN, IA, KY, LA, ME, MD, MA, MI, NE, NH, NJ, NY, NC, ND, OH, OK, OR, PA, RI, SC, TN, TX, VA, WA, and WY. This work was supported by the National Institutes of Health (NIH) grants UM1CA167552 (to W. C. Willett), P01CA87969 (to E. L. Giovannucci), U01CA186107 (to M.J. Stampfer), R03CA176717 (to X Zhang), and R25CA057711 (to, G. C. Sorensen). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
Conflict of interest
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