Abstract
We investigated the association of colorectal cancer risk factors with different colorectal cancer subsites to assess etiological differences for cancers of the proximal colon, distal colon, and rectum. Included in this study were 869,725 men and 395,501 women who participated in a health examination provided by the Korean National Health System between 1996 and 1997. During up to 7 years of follow-up, 4,144 incident colorectal cancer cases were detected (3,051 men and 1,093 women). Greater height was associated with elevated risk for distal colon cancer and rectal cancer in both men and women. Family history of cancer was associated with higher risk for cancers of the proximal colon in men and distal colon in both men and women. Frequent alcohol consumption and consuming high amounts of alcohol were associated with elevated risk for distal colon cancer in men and higher risk for rectal cancer in women. Frequent meat consumption was associated with risk for proximal colon cancer in men and for rectal cancer in women. Our findings suggest that risk factors for colorectal cancer are different by subsites of colon and rectum, as well as by sex.
Highlights
Colorectal cancer incidence and mortality has been increasing rapidly in Korea during last few decades
After adjusting for age, height was associated with elevated risk for distal colon cancer in men (P-trend = 0.003; Table 3)
Higher BMI was associated with elevated risk for distal colon cancer in men (P-trend,0.001) and with marginally elevated risk for proximal colon cancer in women (P-trend = 0.057)
Summary
Colorectal cancer incidence and mortality has been increasing rapidly in Korea during last few decades. The annual percent changes in colorectal cancer incidence were 6.9% in men and 5.2% in women between 1999 and 2008 [1], and the incidence and mortality rates of colorectal cancer are expected to increase [2]. Recent clinicopathologic and molecular studies of colorectal cancer have suggested that there are subtypes based on tumor methylation status and DNA microsatellite instability (MSI) that exhibit different characteristics in patients, such as differences in tumor locations [5,6]. Classification of colorectal cancer based on anatomical site of origin is too crude to distinguish phenotypically distinct colorectal cancer subgroups, it is still useful especially in large scale cohort studies, in which detailed molecular classification of tumors may not be available for analysis
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