Exogenous hormones and colorectal cancer risk in Canada: associations stratified by clinically defined familial risk of cancer

Campbell, Peter T.; Newcomb, Polly A.; Gallinger, Steven; Cotterchio, Michelle; McLaughlin, John

doi:10.1007/s10552-007-9015-7

Cited by 39 publications

(38 citation statements)

References 65 publications

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“…Incorporation of these interactions is challenging. Studies have observed that the strengths of associations between environmental risk factors and CRC for those with a family history differs compared with those randomly selected from the population (90)(91)(92), which is consistent with the existence of gene-environment interactions. However to date, there have been few studies directly comparing strengths of associations for carriers with that for noncarriers.…”

Section: Environmental Factorsmentioning

confidence: 57%

Risk Prediction Models for Colorectal Cancer: A Review

Win

MacInnis

Hopper

et al. 2012

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Risk prediction models are important to identify individuals at high risk of developing the disease who can then be offered individually tailored clinical management, targeted screening and interventions to reduce the burden of disease. They are also useful for research purposes when attempting to identify new risk factors for the disease. In this article, we review the risk prediction models that have been developed for colorectal cancer and appraise their applicability, strengths, and weaknesses. We also discuss the factors to be considered for future development and improvement of models for colorectal cancer risk prediction. We conclude that there is no model that sufficiently covers the known risk factors for colorectal cancer that is suitable for assessment of people from across the full range of risk and that a new comprehensive model is needed. Cancer Epidemiol Biomarkers Prev; 21(3); 398-410. Ó2011 AACR.

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Section: Environmental Factorsmentioning

confidence: 57%

Risk Prediction Models for Colorectal Cancer: A Review

Win

MacInnis

Hopper

et al. 2012

Cancer Epidemiology, Biomarkers &Amp; Prevention

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“…1). 4,5,13,[16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] Figure 2 shows the RR estimates reported by individual studies as well as the random effects pooled estimates for both ET and EPT. The pooled RRs of CRC were 0.79 (0.69-0.91) for ET ever use and 0.74 (0.68-0.81) for EPT ever use.…”

Section: Resultsmentioning

confidence: 99%

The effect of estrogen vs. combined estrogen‐progestogen therapy on the risk of colorectal cancer

Lin

Cheung

Lai

et al. 2011

Intl Journal of Cancer

148

104

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Studies suggest that estrogen therapy (ET) and combined estrogen-progestogen therapy (EPT) may have different associations with colorectal cancer (CRC) risk, but data are conflicting. Prior meta-analyses did not distinguish between ET and EPT. We conducted a meta-analysis to summarize the relative risks (RR) of CRC due to ET versus EPT among peri-or postmenopausal women. From a total of 2,661 articles, four randomized controlled trials, eight cohort and eight case-control studies were included. Variables assessed included study characteristics, duration and recency of menopausal hormone therapy (HT) use, method of assessment of HT use, outcome definition and its ascertainment method. RRs were synthesized by random-effects models. We found that EPT ever use was associated with a decreased risk of CRC (RR 0.74, 95% CI 0.68-0.81), and so was ET ever use (RR 0.79, 95% CI 0.69-0.91). While current use of ET was associated with a significantly reduced risk of CRC (RR 0.70, 95% CI 0.57-0.85), former use was not (RR 0.86, 95%CI 0.67-1.11). Recency did not significantly modify the association between EPT and CRC risk. EPT former use was associated with a lower RR of CRC compared to ET former use (p 5 0.008) but no such difference was observed between EPT and ET current use (p 5 0.12). Overall, we found consistent evidence supporting the association between EPT and CRC risk reduction, regardless of recency. While literature for the association between ET and CRC risk is heterogeneous, our analyses suggest only current use of ET is associated with a decreased CRC risk.Menopausal hormone therapy (HT) is indicated for shortterm control of intolerable menopausal symptoms and it has a limited role in the treatment of osteoporosis for selected woman. While HT was found to increase the risks of venous thromboembolism, breast cancer and stroke, studies have also suggested that it may be associated with a reduced risk of colorectal cancer (CRC).1 Grodstein et al. conducted a meta-analysis of 18 observational studies that summarized the effect of HT on CRC risk, and showed an overall inverse association, with a pooled relative risk (RR) of 0.80 (95% CI 0.74-0.86).2 Another meta-analysis published by Nanda et al. revealed similar results.3 The explanation for the observed association has been controversial, however, because selective prescribing of HT to healthier subjects (i.e., healthy user bias) may have accounted for superior outcomes in the HT group. This concern was partly settled by the Women's Health Initiative (WHI) study, a large-scale randomized controlled trial (RCT), which found that the use of conjugated equine estrogens plus medroxyprogesterone acetate was associated with a reduction in CRC risk. 4 In contrast, one study did not find a significant association between the use of conjugated equine estrogen alone and CRC risk, although the small number of CRC cases may have limited its interpretation and generalizability. 5 In fact, the WHI study results were not directly comparable with previous observational studies an...

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“…A statistically significant reduction in colorectal cancer risk with E-only, but not E + P, was observed in the Breast Cancer Detection Demonstration Project cohort (13), but the opposite result was observed in a population-based U.K. cohort (32,33). Results of case-control studies are also conflicting (2,15,16,22), with two supporting a stronger colorectal cancer risk reduction for E-only than E + P (2,22). A nonsignificant 20% reduction in risk for E-only was found in the WHI observational study, but none was found for E + P (31).…”

Section: Discussionmentioning

confidence: 98%

“…This research includes >27 observational studies, conducted since the 1980s, on the association of postmenopausal hormone use with the risk of colorectal cancer and adenomatous polyps (24)(25)(26)(27). Based on findings from these observational studies, "ever" use of postmenopausal hormones is associated with a 20% to 40% reduced relative risk (RR) of colorectal cancer (1-3, 6, 8, 9, 11, 13-15, 18, 21, 22), whereas current or recent use is associated with a 30% to 40% reduced risk (1,2,7,10,11,14,15,17,18,22). Importantly, several studies (11,16,22,28) observed a statistically significant reduction in risk only after 5 years of hormone use.…”

Section: Introductionmentioning

confidence: 99%

“…To date, a small number of observational studies have examined the associations of E + P and E-only with colorectal cancer risk, and results from these studies are inconsistent (2,4,13,15,16,19,22,32,33). The Breast Cancer Detection Demonstration Project, the largest prospective study to examine colorectal cancer risk by hormone type, found a nonstatistically significant reduction in risk of colorectal cancer with ever use of E + P and a significant reduction in risk associated with ever use of E-only (13).…”

Section: Introductionmentioning

confidence: 99%

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Colorectal Cancer Incidence and Postmenopausal Hormone Use by Type, Recency, and Duration in Cancer Prevention Study II

Hildebrand

Jacobs

Campbell

et al. 2009

Cancer Epidemiology, Biomarkers &Amp; Prevention

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The Women's Health Initiative randomized trials showed a reduction in colorectal cancer risk with the use of estrogen plus progesterone (E + P), but not with estrogen alone (E-only), after intervention periods <7 years. Using data from the Cancer Prevention Study II Nutrition Cohort, we examined associations of colorectal cancer risk with E-only and E + P, including analyses by recency and duration of hormone use. During 13.2 years of follow-up, 776 cases of invasive colorectal cancer occurred among 67,412 postmenopausal women participants. Cox proportional hazards models were used to estimate multivariate-adjusted relative risks (RR) and 95% confidence intervals (95% CI) of colorectal cancer for current and former hormone users according to hormone type and duration of use. Relative to women who never used postmenopausal hormones, current, but not former, use of E-only was associated with a reduced risk of colorectal cancer (RR 0.76; 95% CI, 0.59-0.97). Among current E-only users, duration of use was inversely and linearly associated with risk (P trend = 0.01). Use of E-only for <5 years was not associated with reduced risk, whereas use for ≥20 years was associated with a 45% reduction in risk (RR, 0.55; 95% CI, 0.36-0.86). There were no statistically significant associations between E + P and colorectal cancer risk. Our results suggest a strong inverse association of long-term use of E-only with colorectal cancer risk, underscoring the importance of collecting data on duration of hormone use in epidemiologic studies of postmenopausal hormones and risk of disease. (Cancer Epidemiol Biomarkers Prev 2009;18(11):2835-41)

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Exogenous hormones and colorectal cancer risk in Canada: associations stratified by clinically defined familial risk of cancer

Cited by 39 publications

References 65 publications

Risk Prediction Models for Colorectal Cancer: A Review

Risk Prediction Models for Colorectal Cancer: A Review

The effect of estrogen vs. combined estrogen‐progestogen therapy on the risk of colorectal cancer

Colorectal Cancer Incidence and Postmenopausal Hormone Use by Type, Recency, and Duration in Cancer Prevention Study II

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