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Exogenous hormones and colorectal cancer risk in Canada: associations stratified by clinically defined familial risk of cancer

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Abstract

Objective

This work assessed associations between colorectal cancer risk and postmenopausal/contraceptive hormones; subgroup analyses included women with a clinically defined family history of cancer.

Methods

A population based case–control study of incident colorectal cancer was conducted among women aged 20–74 years in Ontario and Newfoundland & Labrador, Canada. Incident cases (n = 1,404) were selected from provincial cancer registries and controls (n = 1,203) were identified through property records, and other means, between January 1997 and April 2006. Family history of cancer, exogenous hormone-use, and other risk factors were collected via self-administered questionnaires. Multivariate unconditional logistic regression analyses were used to estimate odds ratios (ORs) and corresponding 95% confidence intervals (CIs).

Results

Decreased risks of colorectal cancer were observed with ever-users of: hormonal contraceptives (OR: 0.77; CI: 0.65–0.91), estrogen-only postmenopausal hormones (OR: 0.60; CI: 0.47–0.75), and estrogen–progestin postmenopausal hormones (OR: 0.70; CI: 0.52–0.95). Risk estimates were similar between women with and without a strong familial history of cancer. Age at initiation of hormonal contraceptives was associated with colorectal cancer risk; women who initiated use at younger ages (age <22 years: OR: 0.60; CI: 0.47–0.77) experienced a greater reduced risk of disease than women who initiated use at later ages (age 30+: OR: 0.92; CI: 0.68–1.24; p trend: 0.0026).

Conclusions

These results indicate that exogenous hormone-use is linked with reduced risk of colorectal cancer among women with a strong familial risk of cancer, consistent with observations on population samples of sporadic colorectal cancer cases. A potential age-effect for use of hormonal contraceptives warrants further attention.

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Acknowledgments

The authors thank Dr Elizabeth Dicks, Dr Darshana Daftary, Teresa Mulvenna, and staff and investigators of the Ontario and Newfoundland Colorectal Cancer Registries for their contributions to this project. PTC thanks Professors Anthony Hanley, Mary Chipman, Loraine Marrett, and Edward Giovannucci for helpful discussions of this work.

This work was supported by the National Cancer Institute, National Institutes of Health under RFA # CA-96-011 and through cooperative agreements with members of the Colon Cancer Family Registry (CFR) and P.I.s. The content of this manuscript does not necessarily reflect the views or policies of the National Cancer Institute or any of the collaborating institutions or investigators in the Colon CFR, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government or the Colon CFR. Data collection in Newfoundland and Labrador was funded by the Canadian Institutes of Health Research (CRT 43821). PTC was partially supported by a National Cancer Institute of Canada Doctoral Fellowship (#13523) with funds from the Canadian Cancer Society.

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Authors and Affiliations

  1. Prosserman Centre for Health Research, Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, ON, Canada

    Peter T. Campbell & John R. McLaughlin

  2. Cancer Prevention Program, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, M4-B402, Seattle, WA, 98109, USA

    Peter T. Campbell & Polly Newcomb

  3. Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada

    Steven Gallinger

  4. Division of Preventive Oncology, Cancer Care Ontario, Toronto, ON, Canada

    Michelle Cotterchio & John R. McLaughlin

  5. Department of Public Health Sciences, University of Toronto, Toronto, ON, Canada

    Michelle Cotterchio & John R. McLaughlin

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  1. Peter T. Campbell
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  4. Michelle Cotterchio
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Correspondence to Peter T. Campbell.

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Appendix 1 Familial risk of cancer criteria
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Campbell, P.T., Newcomb, P., Gallinger, S. et al. Exogenous hormones and colorectal cancer risk in Canada: associations stratified by clinically defined familial risk of cancer. Cancer Causes Control 18, 723–733 (2007). https://doi.org/10.1007/s10552-007-9015-7

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