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Winkels RM, Botma A, Van Duijnhoven FJB, Nagengast FM, Kleibeuker JH, Vasen HFA, Kampman E. Smoking increases the risk for colorectal adenomas in patients with Lynch syndrome. Gastroenterology 2012; 142:241-7. [PMID: 22062356 DOI: 10.1053/j.gastro.2011.10.033] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Revised: 09/21/2011] [Accepted: 10/24/2011] [Indexed: 12/22/2022]
Abstract
BACKGROUND & AIMS Individuals with Lynch syndrome have a high risk of developing colorectal carcinomas and adenomas at a young age, due to inherited mutations in mismatch repair genes. We investigated whether modifiable lifestyle factors, such as smoking and alcohol intake, increase this risk. METHODS Using data from the GeoLynch cohort study, a prospective analysis of 386 subjects with Lynch syndrome, we calculated hazard ratios for the association between smoking and alcohol intake and development of colorectal adenoma. We used robust variance estimates in the calculation of 95% confidence intervals to account for dependency within families and adjusted for confounding by age, sex, smoking (in the analyses of alcohol intake), number of colonoscopies during the follow-up, colonic resection, and body mass index. RESULTS During a median follow-up of 10 months, 58 subjects developed a histologically confirmed colorectal adenoma. The hazard ratio for current smokers was 6.13 (95% confidence interval, 2.84-13.22) and for former smokers was 3.03 (95% confidence interval, 1.49-6.16) compared with never smokers. Among ever smokers, a higher number of pack-years was associated with an increased risk for colorectal adenoma (P for trend = .03). There was a trend of alcohol intake increasing the risk of colorectal adenomas, although this was not statistically significant; the hazard ratio for the highest tertile of intake (median, 22 g/day) vs the lowest tertile (median, 0.4 g/day) was 1.56 (95% confidence interval, 0.71-3.43). CONCLUSIONS Among people with Lynch syndrome, current smokers have an increased risk of colorectal adenomas. Former smokers have a lower risk than current smokers, but greater risk than never smokers. Individuals with Lynch syndrome should be encouraged to avoid smoking.
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Affiliation(s)
- Renate M Winkels
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
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Ricciardiello L, Bazzoli F, Fogliano V. Phytochemicals and colorectal cancer prevention--myth or reality? Nat Rev Gastroenterol Hepatol 2011; 8:592-6. [PMID: 21894197 DOI: 10.1038/nrgastro.2011.149] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Chemoprevention of colorectal cancer has been the focus of intensive research for more than two decades. Epidemiological evidence has shown a small, but significant association between fruit and vegetable intake and a reduction in colorectal cancer risk. In vitro and animal data have also demonstrated that many dietary phytochemicals have potent chemopreventive activities. However, in humans, single-agent compounds have yielded conflicting results. A key concept is that dietary phytochemicals exert beneficial effects at low concentrations when working in synergy with each other. As the gut microflora evolved in an environment rich in dietary fiber and phytochemicals, the rapid shift towards a Western diet creates an environment in which the gut is more vulnerable to carcinogens, genetic alterations and inflammation. As enforcing dietary interventions on large populations is not realistic, we believe future chemopreventive work should focus on delivering phytochemical mixtures that target the multiple molecular events involved in colorectal carcinogenesis.
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Affiliation(s)
- Luigi Ricciardiello
- Department of Clinical Medicine, University of Bologna, Via Massarenti 9, Bologna 40138, Italy.
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Win AK, Dowty JG, English DR, Campbell PT, Young JP, Winship I, Macrae FA, Lipton L, Parry S, Young GP, Buchanan DD, Martínez ME, Jacobs ET, Ahnen DJ, Haile RW, Casey G, Baron JA, Lindor NM, Thibodeau SN, Newcomb PA, Potter JD, Le Marchand L, Gallinger S, Hopper JL, Jenkins MA. Body mass index in early adulthood and colorectal cancer risk for carriers and non-carriers of germline mutations in DNA mismatch repair genes. Br J Cancer 2011; 105:162-9. [PMID: 21559014 PMCID: PMC3137400 DOI: 10.1038/bjc.2011.172] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Revised: 04/15/2011] [Accepted: 04/20/2011] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Carriers of germline mutations in DNA mismatch repair (MMR) genes have a high risk of colorectal cancer (CRC), but the modifiers of this risk are not well established. We estimated an association between body mass index (BMI) in early adulthood and subsequent risk of CRC for carriers and, as a comparison, estimated the association for non-carriers. METHODS A weighted Cox regression was used to analyse height and weight at 20 years reported by 1324 carriers of MMR gene mutations (500 MLH1, 648 MSH2, 117 MSH6 and 59 PMS2) and 1219 non-carriers from the Colon Cancer Family Registry. RESULTS During 122,304 person-years of observation, we observed diagnoses of CRC for 659 carriers (50%) and 36 non-carriers (3%). For carriers, the risk of CRC increased by 30% for each 5 kg m(-2) increment in BMI in early adulthood (hazard ratio, HR: 1.30; 95% confidence interval, CI: 1.08-1.58; P=0.01), and increased by 64% for non-carriers (HR: 1.64; 95% CI: 1.02-2.64; P=0.04) after adjusting for sex, country, cigarette smoking and alcohol drinking (and the MMR gene that was mutated in carriers). The difference in HRs for carriers and non-carriers was not statistically significant (P=0.50). For MLH1 and PMS2 (MutLα heterodimer) mutation carriers combined, the corresponding increase was 36% (HR: 1.36; 95% CI: 1.05-1.76; P=0.02). For MSH2 and MSH6 (MutSα heterodimer) mutation carriers combined, the HR was 1.26 (95% CI: 0.96-1.65; P=0.09). There was no significant difference between the HRs for MutLα and MutSα heterodimer carriers (P=0.56). CONCLUSION Body mass index in early adulthood is positively associated with risk of CRC for MMR gene mutation carriers and non-carriers.
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Affiliation(s)
- A K Win
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, The University of Melbourne, Melbourne School of Population Health, Level 3, 207 Bouverie Street, Parkville, Victoria 3010, Australia
| | - J G Dowty
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, The University of Melbourne, Melbourne School of Population Health, Level 3, 207 Bouverie Street, Parkville, Victoria 3010, Australia
| | - D R English
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, The University of Melbourne, Melbourne School of Population Health, Level 3, 207 Bouverie Street, Parkville, Victoria 3010, Australia
- Cancer Epidemiology Centre, Cancer Council Victoria, Carlton South, Victoria, Australia
| | - P T Campbell
- Epidemiology Research Program, American Cancer Society, Atlanta, GA, USA
- Cancer Prevention Program, Fred Hutchinson Cancer Research Centre, Seattle, WA, USA
| | - J P Young
- Familial Cancer Laboratory, Queensland Institute of Medical Research, Herston, Queensland, Australia
| | - I Winship
- Adult Clinical Genetics, The University of Melbourne, Parkville, Victoria, Australia
| | - F A Macrae
- Department of Colorectal Medicine and Genetics, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - L Lipton
- Ludwig Institute for Cancer Research, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - S Parry
- New Zealand Familial Gastrointestinal Cancer Registry, Auckland City Hospital, Auckland, New Zealand
- Department of Gastroenterology, Middlemore Hospital, Auckland, New Zealand
| | - G P Young
- Flinders Centre for Cancer Prevention and Control, Flinders University, Adelaide, South Australia, Australia
| | - D D Buchanan
- Familial Cancer Laboratory, Queensland Institute of Medical Research, Herston, Queensland, Australia
| | - M E Martínez
- Arizona Cancer Centre, University of Arizona, Tucson, AZ, USA
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - E T Jacobs
- Arizona Cancer Centre, University of Arizona, Tucson, AZ, USA
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - D J Ahnen
- Denver VA Medical Center and University of Colorado Denver School of Medicine, Denver, CO, USA
| | - R W Haile
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - G Casey
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - J A Baron
- Department of Medicine and Department of Community and Family Medicine, Dartmouth Medical School, Lebanon, NH, USA
| | - N M Lindor
- Department of Medical Genetics, Mayo Clinic, Rochester, MN, USA
| | - S N Thibodeau
- Department of Medical Genetics, Mayo Clinic, Rochester, MN, USA
| | - P A Newcomb
- Cancer Prevention Program, Fred Hutchinson Cancer Research Centre, Seattle, WA, USA
| | - J D Potter
- Cancer Prevention Program, Fred Hutchinson Cancer Research Centre, Seattle, WA, USA
| | - L Le Marchand
- Cancer Research Center of Hawaii, University of Hawaii, Honolulu, HI, USA
| | - S Gallinger
- Cancer Care Ontario, Toronto, Ontario, Canada
| | - J L Hopper
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, The University of Melbourne, Melbourne School of Population Health, Level 3, 207 Bouverie Street, Parkville, Victoria 3010, Australia
| | - M A Jenkins
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, The University of Melbourne, Melbourne School of Population Health, Level 3, 207 Bouverie Street, Parkville, Victoria 3010, Australia
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