Carcinoma of the large bowel is common in developed countries with a North-West European culture.' Diets rich in fat2 or meat3 and low in fibre4 may account for the higher incidence in developed nations when compared with underdeveloped societies.Faecal bile acid concentrations are quantitatively related to the amount of fat eaten5 and were reported to be raised in populations with a high incidence of large bowel carcinoma.6 Subsequent studies on healthy subjects in Scandinavia only partially confirmed the association between faecal bile acid concentration and the risk of cancer.7In previous studies, patients with established carcinoma of the large bowel had raised levels of bile acids in the faeces8 9 suggesting either a causal relationship or, alternatively, the effect of an obstructing lesion. In other studies patients with adenomatous polyps" had raised faecal bile acid concentrations, while those with familial polyposis10 and ulcerative colitis"1 did not.We report here the faecal bile acid concentrations of normal subjects and compare them with patients at increased risk of large bowel carcinoma and with cancer patients before and after excision of the tumour. Methods PATIENTSPatients at increased risk of large bowel cancer were *Address for correspondence and requests for reprints: D G Mudd
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