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Meta-analyses of colorectal cancer risk factors

Abstract

Purpose

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.

Methods

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.

Results

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).

Conclusions

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.

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Acknowledgments

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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Johnson, C.M., Wei, C., Ensor, J.E. et al. Meta-analyses of colorectal cancer risk factors. Cancer Causes Control 24, 1207–1222 (2013). https://doi.org/10.1007/s10552-013-0201-5

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Keywords

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