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Am J Epidemiol. 2009 Oct 1;170(7):863-72. doi: 10.1093/aje/kwp210. Epub 2009 Sep 1.

Cumulative risk of colon cancer up to age 70 years by risk factor status using data from the Nurses' Health Study.

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  • 1Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.


The authors developed a comprehensive model of colon cancer incidence that allows for nonproportional hazards and accounts for the temporal nature of risk factors. They estimated relative risk based on cumulative incidence of colon cancer by age 70 years. Using multivariate, nonlinear Poisson regression, they determined colon cancer risk among 83,767 participants in the Nurses' Health Study. The authors observed 701 cases of colon cancer between 1980 and June 1, 2004. There was increased risk for a positive family history of colon or rectal cancer (55%), 10 or more pack-years of cigarette smoking before age 30 years (16%), and tallness (67 inches (170 cm) vs. 61 inches (155 cm): 19%). Reduced risk was observed for current postmenopausal hormone use (-23%), being physically active (21 metabolic equivalent (MET)-hours/week vs. 2 MET-hours/week: -49%), taking aspirin (7 tablets/week vs. none: -29%), and being screened (-24%). Women who smoked, had a consistently high relative weight, had a low physical activity level, consumed red or processed meat daily, were never screened, and consumed low daily amounts of folate had almost a 4-fold higher cumulative risk of colon cancer by age 70 years. For women with a high risk factor profile, adopting a healthier lifestyle could dramatically reduce colon cancer risk.

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