Journal
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY
Volume 9, Issue 2, Pages 137-144Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.cgh.2010.10.012
Keywords
Colorectal Cancer; Tumor Location; Tobacco; Risk Factor
Categories
Funding
- European Commission: Public Health and Consumer Protection Directorate
- Research Directorate-General
- Ligue contre le Cancer
- Societe 3M
- Mutuelle Generale de I'Education Nationale
- Institut National de la Sante et de la Recherche Medicale (INSERM) (France)
- German Cancer Aid, German Cancer Research Center
- Federal Ministry of Education and Research (Germany)
- Danish Cancer Society (Denmark)
- Spanish Ministry of Health
- Cancer Research UK
- Medical Research Council
- Stroke Association
- British Heart Foundation
- Department of Health
- Food Standards Agency
- Wellcome Trust (United Kingdom)
- Hellenic Ministry of Health
- Stavros Niarchos Foundation
- Hellenic Health Foundation (Greece)
- Italian Association for Research on Cancer
- National Research Council (Italy)
- Dutch Ministry of Public Health
- Welfare and Sports (VWS)
- Netherlands Cancer Registry (NKR)
- LK Research Funds
- Dutch Prevention Funds
- Dutch ZON (Zorg Onderzoek Nederland)
- World Cancer Research Fund (The Netherlands)
- Statistics Netherlands
- Swedish Cancer Society
- Swedish Scientific Council
- Regional Government of Skane (Sweden)
- Norwegian Research Council
- NordForsk (Norway)
- Medical Research Council [G0401527, G0801056B, MC_U106179471, G1000143] Funding Source: researchfish
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BACKGROUND & AIMS: There has been consistent evidence for a relationship between smoking and colorectal cancer (CRC), although it is not clear whether the colon or rectum is more sensitive to the effects of smoking. We investigated the relationships between cigarette smoking and risk of CRC and tumor location. METHODS: We analyzed data from 465,879 participants in the European Prospective Investigation into Cancer and Nutrition (EPIC) study; 2741 developed CRC during the follow-up period (mean, 8.7 years). Cox proportional hazard regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS: The risk of colon carcinoma was increased among ever smokers (HR, 1.18; 95% CI, 1.06-1.32) and former cigarette smokers (HR, 1.21; 95% CI, 1.08-1.36), compared with never smokers; the increased risk for current smokers was of borderline significance (HR, 1.13; 95% Cl, 0.98-1.31). When stratified for tumor location, the risk of proximal colon cancer was increased for former (HR, 1.25; 95% CI, 1.04-1.50) and current smokers (HR, 1.31; 95% CI, 1.06-1.64), but the risks for cancers in the distal colon or rectum were not. Subsite analyses showed a nonsignificant difference between the proximal and distal colon (P=.45) for former smokers and a significant difference for current smokers (P=.02). For smokers who had stopped smoking for at least 20 years, the risk of developing colon cancer was similar to that of never smokers. CONCLUSIONS: Ever smokers have an increased risk of colon cancer, which appeared to be more pronounced in the proximal than the distal colon location.
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