Recent studies have shown a decreased risk of colon cancer with consumption of fish. However, most studies on fish consumption do not distinguish between lean and fatty fish, or between poached and fried fish. The aim of this study was to investigate any association between fish consumption and colon cancer in The Norwegian Women and Cancer (NOWAC) study. We focused mainly on lean fish, which was further divided into poached and fried fish. A total of 63 914 women were included in the analysis, 254 of whom were found to have colon cancer during followup. Since fish consumption was one of the main topics of interest in the NOWAC study, there is a predominance of women from northern Norway due to higher fish intake in this area; hence the study is not representative of the whole of Norway. The participants completed a semi-quantitative FFQ between 1996 and 1999, and were followed-up for incidence of colon cancer until 2004. No association between fish consumption and risk of colon cancer was seen, except for the third tertile of poached lean fish consumption (relative risk (RR) 1·46, 95 % CI 1·04, 2·06). This association disappeared when excluding women with less than 1 year of follow-up. In conclusion, the present study does not support the hypothesis of a protective effect of fish against colon cancer risk.
Fish consumption: Colon cancer: NOWAC: DietColon cancer is the second most common cancer among women in Norway, with 1217 new cases in 2004 (age-adjusted incidence rates per 100 000 women was 23·9), and colorectal cancer is the most common cancer in men and women combined (3482 new cases in 2004) 1 . Norway has the highest incidence of colorectal cancer of the Nordic countries 2 . It is estimated that a third to half of colon cancers may possibly be avoided if different diet-related factors were controlled for 3 .Norway has a long coastline, and thus a long tradition in harvesting fish, and using fish in the diet. Lean, white fish such as cod, haddock and saithe, and fish products made from these, are most commonly eaten 4 . Fish products, such as fish balls, puddings and cakes, are mainly made of minced lean fish, starch, milk and spices. Fish served for dinner is prepared from fresh/frozen, smoked, salted and/or dried fish, and is often served with melted fat or fatty sauces 4 .Recently, results from the European Prospective Investigation into Cancer and Nutrition (EPIC) showed a decrease in colon cancer risk with higher intake of fish 5 . However, like most studies on fish consumption and cancer risk, only total fish consumption was analysed. No distinction was made between lean and fatty fish. It is also quite common in analyses of fish consumption to combine intake of fish and poultry (white meat), or fish and meat 6 . Fatty fish has been analysed in terms of n-3 fatty acids, but lean fish has not been investigated as much 6 .Heterocyclic amines and polycyclic aromatic hydrocarbons formed during preparation of the fish at high temperatures cause cancer in rodents 7 , and may also be harmful for humans. I...