BACKGROUND Colonoscopy and sigmoidoscopy provide protection against colorectal cancer, but the magnitude and duration of protection, particularly against cancer of the proximal colon, remain uncertain. METHODS We examined the association of the use of lower endoscopy (updated biennially from 1988 through 2008) with colorectal-cancer incidence (through June 2010) and colorectal-cancer mortality (through June 2012) among participants in the Nurses’ Health Study and the Health Professionals Follow-up Study. RESULTS Among 88,902 participants followed over a period of 22 years, we documented 1815 incident colorectal cancers and 474 deaths from colorectal cancer. With endoscopy as compared with no endoscopy, multivariate hazard ratios for colorectal cancer were 0.57 (95% confidence interval [CI], 0.45 to 0.72) after polypectomy, 0.60 (95% CI, 0.53 to 0.68) after negative sigmoidoscopy, and 0.44 (95% CI, 0.38 to 0.52) after negative colonoscopy. Negative colonoscopy was associated with a reduced incidence of proximal colon cancer (multivariate hazard ratio, 0.73; 95% CI, 0.57 to 0.92). Multivariate hazard ratios for death from colorectal cancer were 0.59 (95% CI, 0.45 to 0.76) after screening sigmoidoscopy and 0.32 (95% CI, 0.24 to 0.45) after screening colonoscopy. Reduced mortality from proximal colon cancer was observed after screening colonoscopy (multivariate hazard ratio, 0.47; 95% CI, 0.29 to 0.76) but not after sigmoidoscopy. As compared with colorectal cancers diagnosed in patients more than 5 years after colonoscopy or without any prior endoscopy, those diagnosed in patients within 5 years after colonoscopy were more likely to be characterized by the CpG island methylator phenotype (CIMP) (multivariate odds ratio, 2.19; 95% CI, 1.14 to 4.21) and microsatellite instability (multivariate odds ratio, 2.10; 95% CI, 1.10 to 4.02). CONCLUSIONS Colonoscopy and sigmoidoscopy were associated with a reduced incidence of cancer of the distal colorectum; colonoscopy was also associated with a modest reduction in the incidence of proximal colon cancer. Screening colonoscopy and sigmoidoscopy were associated with reduced colorectal-cancer mortality; only colonoscopy was associated with reduced mortality from proximal colon cancer. Colorectal cancer diagnosed within 5 years after colonoscopy was more likely than cancer diagnosed after that period or without prior endoscopy to have CIMP and microsatellite instability. (Funded by the National Institutes of Health and others.)

Predictors of colorectal cancer have been extensively studied with some evidence suggesting that risk factors vary by subsite. Using data from 2 prospective cohort studies, we examined established risk factors to determine whether they were differentially associated with colon and rectal cancer. Our study population included 87,733 women from the Nurses' Health Study (NHS) and 46,632 men from the Health Professionals Follow Up Study (HPFS). Exposure information was collected via biennial questionnaires (dietary variables were collected every 4 years). During the follow-up period (NHS: 1980 to May 31, 2000; HPFS: 1986 to January 31, 2000), we identified 1,139 cases of colon cancer and 339 cases of rectal cancer. We used pooled logistic regression to estimate multivariate relative risks for the 2 outcomes separately and then used polytomous logistic regression to compare these estimates. In the combined cohort, age, gender, family history of colon or rectal cancer, height, body mass index, physical activity, folate, intake of beef, pork or lamb as a main dish, intake of processed meat and alcohol were significantly associated with colon cancer risk. However, only age and sex were associated with rectal cancer. In a stepwise polytomous logistic regression procedure, family history and physical activity were associated with statistically significant different relative risks of colon and rectal cancer. Our findings support previous suggestions that family history and physical activity are not strong contributors to the etiology of rectal cancer. Future investigations of colon or rectal cancer should take into consideration risk factor differences by subsite. © 2003 Wiley-Liss, Inc. Key words: colon cancer; rectal cancer; cohort studies; risk factorsMany etiologic factors have been established as contributing to the risk of colorectal cancer. However, the statistical models that evaluate the endpoint of colorectal cancer assume constancy of the relative risks for colon cancer and rectal cancer, or ignore if heterogeneity exists between them. If colon cancer and rectal cancer have distinct etiologies, these assumptions may be inappropriate and established risk factors for colorectal cancer may or may not be risk factors for colon or rectal cancer if considered separately.Recently, several investigators have studied associations between exposures and subsites in the large bowel. These studies suggest etiologic distinctions by anatomic location within the colon. [1][2][3][4][5][6] For example, physical inactivity and body mass index have been associated with colon cancer but not with rectal cancer. 7 Because rectal cancers make up approximately 30% of all large bowel cancers in developed countries, analyses of rectal cancer as a distinct endpoint have often been inconclusive as a result of limited statistical power. To our knowledge, no study has formally compared risk factors for colon cancer and rectal cancer. To further our understanding of etiologic similarities and differences between colon cancer and rectal cancer,...

The EDII represents, to our knowledge, a novel, hypothesis-driven, empirically derived dietary pattern that assesses diet quality based on its inflammatory potential. Its strong construct validity in independent samples of women and men indicates its usefulness in assessing the inflammatory potential of whole diets. Additionally, the EDII may be calculated in a standardized and reproducible manner across different populations thus circumventing a major limitation of dietary patterns derived from the same study in which they are applied.

Higher consumption of milk and calcium is associated with a lower risk of colorectal cancer.

We found no association between intake of dairy products and breast cancer in postmenopausal women. Among premenopausal women, high intake of low-fat dairy foods, especially skim/low-fat milk, was associated with reduced risk of breast cancer. Similar inverse associations were seen with components (calcium and vitamin D) of dairy foods, but their independent associations with breast cancer are difficult to distinguish.

Importance: Colorectal cancer incidence and mortality among individuals under age 50 (young-onset CRC) are rising. The reasons for such increase are largely unknown, although the surging prevalence of obesity may be partially responsible. Objective: To investigate prospectively the association between obesity and weight gain since early adulthood with risk of young-onset CRC. Design: Prospective cohort. Setting: U.S.-based Nurses’ Health Study II. Participants: 85,256 women aged 25 to 44 years free of cancer and inflammatory bowel disease at enrollment were followed from 1989 to 2011. Validated anthropomorphic measures and lifestyle information were self-reported biennially. Exposures: Current body mass index (BMI), BMI at age 18, and weight gain since age 18. Main Outcomes and Measures: Relative risk (RR) for incident young-onset CRC. Results: We documented 114 cases of young-onset CRC during 1,196,452 person-years of follow-up. Compared to women with BMI 18.5–22.9 kg/m2, the multivariable RR was 1.37 [95% confidence interval (CI): 0.81–2.30] for overweight women (BMI 25–29.9 kg/m2) and 1.93 (95% CI: 1.15–3.25) for obese women (BMI ≥ 30 kg/m2). The RR for each 5 kg/m2 increment in BMI was 1.20 (95% CI: 1.05–1.38, P-trend=0.01). Similar associations were observed among women without a family history of CRC and without lower endoscopy within the past 10 years. Both BMI at age 18 and weight gain since age 18 contributed to this observation. Compared to women with BMI 18.5–20.9 kg/m2 at age 18, the RR of young-onset CRC was 1.63 (95% CI: 1.01–2.61) for women with BMI ≥ 23 kg/m2 at age 18 (P-trend=0.66). Similarly, compared to women who had gained < 5 kg or had lost weight, the RR of young-onset CRC was 2.15 (95% CI: 1.01–4.55) for women with ≥ 40 kg weight gain since age 18 (P-trend=0.007). Conclusion and Relevance: Obesity was associated with an increased risk of young-onset CRC among women. Further investigations among men and to elucidate underlying biological mechanisms are warranted.

all of which are described at www.genenames.org. Gene symbols are italicized whereas symbols for gene products are not italicized.

Higher calcium intake is associated with a reduced risk of distal colon cancer. The observed risk pattern was consistent with a threshold effect, suggesting that calcium intake beyond moderate levels may not be associated with a further risk reduction. Future investigations on this association should concentrate on specific cancer subsites and on the dose-response relationship.