In vitro and in vivo studies have associated iron with both the initiation and promotional stages of carcinogenesis. We investigated whether iron was associated with colorectal cancer in a nested case-control study within the a-tocopherol, b-carotene cancer prevention study cohort. Exposure was assessed at baseline, using a 276-item food frequency questionnaire and a fasting serum sample. The study included 130 colorectal cancer cases (73 colon cancers and 57 rectal cancers) and 260 controls. Conditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Supplemental iron intake was only reported for 4 cases and 18 controls; therefore, we were unable to obtain meaningful results for this variable. Comparing the highest to the lowest quartiles, there was an inverse association between serum ferritin and colorectal cancer risk (OR 5 0.4, 95% CI 5 0.2-0.9) and a suggestion of an inverse association between dietary iron and colorectal cancer risk (OR 5 0.4, 95% CI 5 0.1-1.1). In addition, serum ferritin, serum iron and transferrin saturation were all inversely associated with colon cancer risk specifically (OR 5 0.2, 95% CI 5 0.1-0.7, p trend 5 0.02; OR 5 0.2, 95% CI 5 0.1-0.9, p trend 5 0.05; OR 5 0.1, 95% CI 5 0.02-0.5, p trend 5 0.003, respectively), whereas serum unsaturated iron binding capacity was positively associated with colon cancer risk (OR 5 4.7, 95% CI 5 1.4-15.1, p trend 5 0.009). In summary, we found a significant inverse association between several serum iron indices and colon cancer risk. ' 2006 Wiley-Liss, Inc.Key words: red meat; iron; colorectal cancer There is increasing epidemiological evidence implicating red meat as a risk factor for colorectal cancer, whereas white meat has not been associated with this cancer. 1 One of the main differences between red and white meat is the higher iron content in red meat.There are many mechanisms through which iron might influence the carcinogenic process, particularly with respect to colorectal cancer. Iron is able to catalyze the formation of reactive oxygen species, which can induce oxidative DNA damage. 2 In addition, rodent studies have shown that iron is associated with increased crypt cell proliferation in the large intestine 3 and an increased rate of tumor growth in chemically-induced colorectal cancer. 4,5 Heme iron specifically, which is mainly found in meat, has been associated with increased cytotoxicity of fecal water from rodents, 6 increased endogenous formation of carcinogenic N-nitroso compounds 7 and promotion of chemically-induced colorectal cancer in rats. 8 Of the 3 large cohort studies to address the association between iron and colorectal cancer, one examined dietary iron intake and found a significant positive association between iron consumption and cancer of the proximal colon. 9 All 3 cohorts examined iron stores and colorectal cancer risk; one cohort found increased risks for both colon and rectal tumors 9 and one found an increased risk for rectal cancer in women only, 10 but the th...