Abstract
BackgroundColorectal cancer is the 4th common cancer in China. Most colorectal cancers are due to modifiable lifestyle factors, but few studies have provided a systematic evidence-based assessment of the burden of colorectal cancer incidence and mortality attributable to the known risk factors in China.MethodsWe estimated the population attributable faction (PAF) for each selected risk factor in China, based on the prevalence of exposure around 2000 and relative risks from cohort studies and meta-analyses.ResultsAmong 245,000 new cases and 139,000 deaths of colorectal cancer in China in 2012, we found that 115,578 incident cases and 63,102 deaths of colorectal cancer were attributable to smoking, alcohol drinking, overweight and obesity, physical inactivity and dietary factors. Low vegetable intake was the main risk factor for colorectal cancer with a PAF of 17.9%. Physical inactivity was responsible for 8.9% of colorectal cancer incidence and mortality. The remaining factors, including high red and processed meat intake, low fruit intake, alcohol drinking, overweight/obesity and smoking, accounted for 8.6%, 6.4%, 5.4%, 5.3% and 4.9% of colorectal cancer, respectively. Overall, 45.5% of colorectal cancer incidence and mortality were attributable to the joint effects of these seven risk factors.ConclusionsTobacco smoking, alcohol drinking, overweight or obesity, physical inactivity, low vegetable intake, low fruit intake, and high red and processed meat intake were responsible for nearly 46% of colorectal cancer incidence and mortality in China in 2012. Our findings could provide a basis for developing guidelines of colorectal cancer prevention and control in China.
Highlights
IntroductionMost colorectal cancers are due to modifiable lifestyle factors, but few studies have provided a systematic evidence-based assessment of the burden of colorectal cancer incidence and mortality attributable to the known risk factors in China
Colorectal cancer is the 4th common cancer in China
Data on colorectal cancer mortality were collected from the registration system in China, while the incidence data was estimated from the known cancer deaths and Mortality and Incidence (M/I) ratio that was calculated using Poisson regression adjusted for age, gender and regional sites
Summary
Most colorectal cancers are due to modifiable lifestyle factors, but few studies have provided a systematic evidence-based assessment of the burden of colorectal cancer incidence and mortality attributable to the known risk factors in China. Individuals who had higher education level or were non-Hispanic white suffered lower risk of colorectal cancer mortality [5]. Over the past few decades, a number of risk factors for colorectal cancer have been identified, including: family history of colorectal cancer [6], inflammatory bowel disease [7], diabetes [8], obesity [9], excessive alcohol consumption [10], high consumption of red and processed meat [11], low vegetable and fruit intake [12] and tobacco smoking [13]
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