Abstract
We expanded and updated our colon cancer risk model to evaluate colorectal cancer (CRC) and whether subsite-specific risk models are warranted. Using data from 1980-2010 for 90,286 women enrolled in the Nurses' Health Study, we performed competing-risks regression and tests for subsite heterogeneity (proximal colon: n=821; distal colon: n=521; rectum: n=376). Risk factors for CRC were consistent with those in our colon cancer model. Processed meat consumption was associated with a higher risk of distal (hazard ratio (HR)=1.45; P=0.02) but not proximal (HR=0.95; P=0.72) colon cancer. Smoking was associated with both colon (HR=1.21) and rectal (HR=1.27) cancer and was more strongly associated with proximal (HR=1.31) than with distal (HR=1.04) colon cancer (P=0.029). We observed a significant trend of cancer risk for smoking in subsites from the cecum (HR=1.41) to the proximal colon (excluding the cecum; HR =1.27) to the distal colon (HR=1.04; P for trend =0.040). The C statistics for colorectal (C =0.607), colon (C = 0.603), and rectal (C =0.639) cancer were similar, although C was slightly higher for rectal cancer. Despite evidence for site-specific differences for several risk factors, overall our findings support the application of risk prediction models for colon cancer to CRC.
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