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Int J Cancer. 2018 Dec 26. doi: 10.1002/ijc.32090. [Epub ahead of print]

Gallstones and incident colorectal cancer in a large pan-European cohort study.

Author information

1
School of Public Health, Imperial College London, London, United Kingdom.
2
International Agency for Research on Cancer, Lyon, France.
3
Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway.
4
Department of Research, Cancer Registry of Norway, Institute of population-based cancer research, Oslo, Norway.
5
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
6
Genetic Epidemiology Group, Folkhälsan Research Centre and Faculty of Medicine, University of Helsinki, Helsinki, Finland.
7
Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany.
8
University Paris-Saclay, University Paris-Sud, UVSQ, CESP, INSERM UMRS, Villejuif, France.
9
Gustave Roussy, Villejuif, France.
10
Department of Gastroenterology, Bicêtre University Hospital, Public Assistance Hospitals of Paris, Le Kremlin Bicêtre, France.
11
Division of Cancer Epidemiology, German Cancer Research Centre (DKFZ), Foundation under Public Law, Heidelberg, Germany.
12
German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Nuthetal, Germany.
13
Danish Cancer Society Research Centre, Copenhagen, Denmark.
14
Department of Public Health, Aarhus University, Aarhus, Denmark.
15
Public Health Directorate, Asturias, Spain.
16
Unit of Nutrition and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO), Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.
17
CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain.
18
Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria, Granada, Spain.
19
Public Health Department of Gipuzkoa, Donostia, Spain.
20
Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia University, Murcia, Spain.
21
Navarra Public Health Institute, Pamplona, Spain.
22
Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.
23
Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
24
Hellenic Health Foundation, Athens, Greece.
25
WHO Collaborating Centre for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
26
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
27
Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for cancer research, prevention and clinical network (ISPRO), Florence, Italy.
28
Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
29
Cancer Registry and Histopathology Department, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy.
30
Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital and Centre for Cancer Prevention (CPO), Turin, Italy.
31
Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Naples, Italy.
32
Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
33
Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands.
34
Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
35
Institute for Risk Assessment Sciences, Utrecht University.
36
Department of Epidemiology, Julius Centre Research Program Cancer, University Medical Center Utrecht, Utrecht, The Netherlands.
37
Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden.
38
Department of Nutrition, Bjørknes University College, Oslo, Norway.

Abstract

Gallstones, a common gastrointestinal condition, can lead to several digestive complications and can result in inflammation. Risk factors for gallstones include obesity, diabetes, smoking and physical inactivity, all of which are known risk factors for colorectal cancer (CRC), as is inflammation. However, it is unclear whether gallstones are a risk factor for CRC. We examined the association between history of gallstones and CRC in the European Prospective Investigation into Cancer and Nutrition (EPIC) study, a prospective cohort of over half a million participants from ten European countries. History of gallstones was assessed at baseline using a self-reported questionnaire. The analytic cohort included 334,986 participants; a history of gallstones was reported by 3,917 men and 19,836 women, and incident CRC was diagnosed among 1,832 men and 2,178 women (mean follow-up: 13.6 years). Hazard ratios (HR) and 95% confidence intervals (CI) for the association between gallstones and CRC were estimated using Cox proportional hazards regression models, stratified by sex, study centre and age at recruitment. The models were adjusted for body mass index, diabetes, alcohol intake and physical activity. A positive, marginally significant association was detected between gallstones and CRC among women in multivariable analyses (HR = 1.14, 95%CI 0.99-1.31, p = 0.077). The relationship between gallstones and CRC among men was inverse but not significant (HR = 0.81, 95%CI 0.63-1.04, p = 0.10). Additional adjustment for details of reproductive history or waist circumference yielded minimal changes to the observed associations. Further research is required to confirm the nature of the association between gallstones and CRC by sex.

KEYWORDS:

EPIC; Gallstones; cohort; colorectal cancer

PMID:
30585640
DOI:
10.1002/ijc.32090

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