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Abusal F, Aladwan M, Alomari Y, Obeidat S, Abuwardeh S, AlDahdouh H, Al-shami Q, Odat Q. Oral contraceptives and colorectal cancer risk - A meta-analysis and systematic review. Ann Med Surg (Lond) 2022; 83:104254. [PMID: 36389202 PMCID: PMC9661645 DOI: 10.1016/j.amsu.2022.104254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 11/06/2022] Open
Abstract
There is limited understanding of the potential relationship between the risk of colorectal cancer and oral contraceptive use among women of different ages. Further investigation on the issue helps develop an informed choice of contraception. Data for this meta-analysis were derived from case-control and cohort studies of colorectal cancer and oral contraceptive use conducted between June 2000 and May 2022. The studies had a very high heterogeneity, as shown by an I2 of 99%, and a confidence interval of 95% was considered significant. Other results from the meta-analysis were as follows; Heterogeneity: Chi2 = 585.13, df = 6 (P < 0.00001). A test of the overall effect of ever use versus never use of oral contraceptives was Z = 21.85 (P < 0.00001). All the studies had a pooled risk ratio (RR) of 0.53. The use of oral contraceptives is associated with reduced risk of developing colorectal cancer. There is a need for further research into the biological mechanisms underlying these relationships, which may lead to insights into potential preventive interventions for colorectal carcinogenesis in women. The keywords used to locate studies included in this meta-analysis include Keywords targeting oral contraceptives included oral contraceptive pills, and birth control pills. Search keywords targeting colorectal carcinogenesis included neoplasms, tumors, or colon and rectal cancer. Oral contraceptive use in woman does affect the risk of developing colorectal cancer. Colorectal cancer has many identifiable and nonidentifiable risk factors. OCP usage in women of various age groups shown a lower risk of colorectal cancer development than those who never used OCPs. Regarding the population at risk for colorectal cancer due to a variety of reasons, many studies have deemed OCP usage safe.
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Li CY, Song B, Wang YY, Meng H, Guo SB, Liu LN, Lv HC, Wu QJ. Age at menarche and risk of colorectal cancer: a meta-analysis. PLoS One 2013; 8:e65645. [PMID: 23762403 PMCID: PMC3675201 DOI: 10.1371/journal.pone.0065645] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 04/25/2013] [Indexed: 12/30/2022] Open
Abstract
Background Various observational studies have focused on the relationship between menarcheal age and the risk of colorectal cancer (CRC). However, the association is still controversial because of inconsistent results. Therefore, we performed a meta-analysis to assess this issue from epidemiological studies. Methods After a literature search in MEDLINE, EMBASE, and Web of Science for studies of menarcheal age and CRC risk published through the end of January 2013, we pooled the relative risks (RRs) from included studies using a fixed- or random-effects model and performed heterogeneity and publication bias analyses. All statistical tests were two-sided. Results Eleven case-control and 11 cohort studies were eligible for inclusion in our analysis. The random-effects pooled RR for oldest versus youngest menarcheal age was 0.95 [95% confidence intervals (CIs) = 0.85–1.06], with significant heterogeneity (Q = 61.03, P<0.001, I2 = 65.6%). When separately analyzed, case-control (RR = 0.95, 95% CI = 0.75–1.21) and cohort studies (RR = 0.97, 95% CI = 0.90–1.04) yielded similar results. Moreover, similar results were also observed among the subgroup analyses by study quality, population, exposure assessment, anatomic cancer site, subsite of colon cancer, and several potential important confounders and risk factors. There was no evidence of publication bias and significant heterogeneity between subgroups detected by meta-regression analyses. Conclusions Findings from this meta-analysis demonstrated that menarcheal age was not associated with the risk of CRC in humans. Further studies are warranted to stratify results by the subsite of colon cancer and menopause status in the future.
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Affiliation(s)
- Chun-Yan Li
- Department of Gastroenterology, the First Affiliated Hospital of Dalian Medical University, Dalian, China.
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Bosetti C, Bravi F, Negri E, La Vecchia C. Oral contraceptives and colorectal cancer risk: a systematic review and meta-analysis. Hum Reprod Update 2009; 15:489-98. [DOI: 10.1093/humupd/dmp017] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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Nichols HB, Trentham-Dietz A, Hampton JM, Newcomb PA. Oral Contraceptive Use, Reproductive Factors, and Colorectal Cancer Risk: Findings from Wisconsin. Cancer Epidemiol Biomarkers Prev 2005; 14:1212-8. [PMID: 15894674 DOI: 10.1158/1055-9965.epi-04-0845] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We investigated the association of oral contraceptive (OC) use and reproductive factors with colorectal cancer risk in a large population-based case-control study. Cases were women ages 20 to 74 years, living in Wisconsin, with a new diagnosis of colon (n = 1,122) or rectal (n = 366) cancer. Control participants were randomly selected from population lists of similarly aged female Wisconsin residents (n = 4,297). Risk factor information was collected through structured telephone interviews. Compared with never users, OC users had an odds ratio (OR) of 0.89 [95% confidence interval (95% CI), 0.75-1.06] for colorectal cancer. OC use associations did not differ significantly between colon and rectal cancer sites; however, when compared with never users, recent OC users (<14 years) seemed at reduced risk of rectal cancer (OR, 0.53; 95% CI, 0.28-1.00). Women with age at first birth older than the median (23 years) had 0.83 times the risk of colon cancer compared with women with age at first birth below the median (95% CI, 0.70-0.98). We observed an inverse trend between increasing parity and rectal cancer risk (P = 0.05). Compared with nulliparous women, women with five or more births had 0.66 times the risk of rectal cancer (95% CI, 0.43-1.02). Compared with postmenopausal women, premenopausal women were at reduced risk (OR, 0.67; 95% CI, 0.47-0.97) of colorectal cancer. No significant associations were observed between colorectal cancer risk and age at menarche or age at menopause. These findings suggest differential roles of reproductive factors in colon and rectal cancer etiology.
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Affiliation(s)
- Hazel B Nichols
- UW Comprehensive Cancer Center, University of Wisconsin Comprehensive Cancer Center, WARF Building Room 305, 610 Walnut Street, Madison, WI 53726, USA.
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Tamakoshi K, Wakai K, Kojima M, Watanabe Y, Hayakawa N, Toyoshima H, Yatsuya H, Kondo T, Tokudome S, Hashimoto S, Suzuki K, Suzuki S, Kawado M, Ozasa K, Ito Y, Tamakoshi A. A prospective study of reproductive and menstrual factors and colon cancer risk in Japanese women: findings from the JACC study. Cancer Sci 2004; 95:602-7. [PMID: 15245598 PMCID: PMC11158833 DOI: 10.1111/j.1349-7006.2004.tb02494.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The effects of reproductive factors on the etiology of colon cancer in Asian populations remain unexplored. So we examined 38,420 Japanese women aged 40-79 years who responded to a questionnaire on reproductive and other lifestyle factors from 1988 to 1990 in the Japan Collaborative Cohort Study for Evaluation of Cancer Risk. During an average 7.6 years of follow-up, we documented 207 incident colon cancers. Multivariate analysis indicated that colon cancer risk was likely to be lower among parous women than among nulliparous. Women who had two abortions or more had a 72% higher risk of developing colon cancer [relative risk (RR) 1.72; 95% confidence interval (CI) 1.16-2.55; trend P < 0.01] compared with women who never had an abortion. The RR of colon cancer among postmenopausal women significantly decreased with increasing age at menarche (trend P = 0.01). No apparent association between colon cancer and gravida, age at first birth, age at menopause, or duration of menstruation was seen. These prospective data support the hypothesis that female reproductive events modify colon cancer risk, and suggest that reproductive factors, particularly age at menarche and having an abortion, may be of importance in the etiology of colon cancer among Japanese women.
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Affiliation(s)
- Koji Tamakoshi
- Department of Public Health/Health Information Dynamics, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya 466-8550, Japan.
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Tamakoshi K, Wakai K, Kojima M, Watanabe Y, Hayakawa N, Toyoshima H, Yatsuya H, Kondo T, Tokudome S, Hashimoto S, Suzuki K, Ito Y, Tamakoshi A. A prospective study on the possible association between having children and colon cancer risk: findings from the JACC Study. Cancer Sci 2004; 95:243-7. [PMID: 15016324 PMCID: PMC11159313 DOI: 10.1111/j.1349-7006.2004.tb02210.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
If having children is regarded as an exposure in life, its effect on a host could be considered as being due to female sex hormones associated with pregnancy in women and some lifestyle factors associated with large families in both men and women. To explore the roles of having children in the etiology of colon cancer, we examined 36,629 women and 24,877 men aged 40-79 years who completed a questionnaire on the number of children and other lifestyle factors from 1988 to 1990 in the Japan Collaborative Cohort Study for Evaluation of Cancer Risk. During 291,080 and 200,648 person-years of follow-up, we documented 198 female and 202 male incident colon cancers, respectively. After adjusting for some factors known or suspected to modify the risk of colon cancer, compared with the women with no children, the multivariate-adjusted relative risks of colon cancer were 0.74 (95% confidence interval [CI]: 0.30-1.84) for one child, 1.00 (95% CI: 0.46-2.20) for two, 0.70 (95% CI: 0.31-1.55) for three, and 0.59 (95% CI: 0.26-1.33) for four or more. The risk of colon cancer showed a significantly monotonic decrease with increasing number of children (P value for trend = 0.047). There was no association between the number of children and colon cancer risk among men. From these prospective data, having children may reduce risk of colon cancer among women, but not among men, suggesting that modifications of hormone profiles secondary to pregnancies may influence female colon cancer risk.
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Affiliation(s)
- Koji Tamakoshi
- Department of Public Health/Health Information Dynamics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan.
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Fernandez E, La Vecchia C, Balducci A, Chatenoud L, Franceschi S, Negri E. Oral contraceptives and colorectal cancer risk: a meta-analysis. Br J Cancer 2001; 84:722-7. [PMID: 11237397 PMCID: PMC2363788 DOI: 10.1054/bjoc.2000.1622] [Citation(s) in RCA: 138] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Several studies have suggested an inverse association between use of combined oral contraceptives (OC) and the risk of colorectal cancer and here we present a meta-analysis of published studies. Articles considered were epidemiological studies published as full papers in English up to June 2000 that included quantitative information on OC use. The pooled relative risks (RR) of colorectal cancer for ever OC use from the 8 case-control studies was 0.81 (95% confidence interval (CI): 0.69-0.94), and the pooled estimate from the 4 cohort studies was 0.84 (95% CI: 0.72-0.97). The pooled estimate from all studies combined was 0.82 (95% CI: 0.74-0.92), without apparent heterogeneity. Duration of use was not associated with a decrease in risk, but there was some indication that the apparent protection was stronger for women who had used OCs more recently (RR = 0.46; 95% CI: 0.30-0.71). A better understanding of this potential relation may help informed choice of contraception.
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Affiliation(s)
- E Fernandez
- Institut Català d'Oncologia, L'Hospitalet (Barcelona), Av. Gran Via s/n km 27, 08907, Spain
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Abstract
Post-menopausal women who have never used hormone replacement therapy have a higher risk of colon, but not rectal, cancer than do premenopausal women of the same age, socio-cultural class and dietary habits. Such risk increase seems to last about 10 years and to be restricted to lean women, a group who have lower levels of oestradiol after ovarian function ceases after menopause.
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Affiliation(s)
- S Franceschi
- Servizio di Epidemiologia, Centro di Riferimento Oncologico, Aviano (PN), Italy
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van Wayenburg CA, van der Schouw YT, van Noord PA, Peeters PH. Age at menopause, body mass index, and the risk of colorectal cancer mortality in the Dutch Diagnostisch Onderzoek Mammacarcinoom (DOM) cohort. Epidemiology 2000; 11:304-8. [PMID: 10784248 DOI: 10.1097/00001648-200005000-00013] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We investigated whether age at menopause is associated with subsequent mortality from colorectal cancer along with the possible modification of this association by body mass index. Our data are from the Diagnostisch Onderzoek Mammacarcinoom cohort of 10,671 postmenopausal women in the Netherlands, enrolled between 1974 and 1977, with a median follow-up of 18 years. During this follow-up, 95 women died of colorectal cancer. Women 49 years of age or older at menopause showed a lower risk of colorectal cancer mortality compared with women younger than 49 at menopause. This protective effect, however, was found only among nonoverweight women (< or =24 kg/m2), for whom the hazard ratio was 0.46 (95% confidence interval = 0.21-1.03). In larger women, the hazard ratio was 1.17 (95% confidence interval = 0.68-2.00).
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Affiliation(s)
- C A van Wayenburg
- Julius Center for Patient Oriented Research, University Medical Center Utrecht, The Netherlands
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Abstract
PURPOSE Colorectal cancer is the fourth most common incident cancer in the United States and causes more cancer deaths than any site except lung. Twenty-two epidemiologic studies have examined the relationship of estrogen replacement therapy and colon and rectal cancers with inconsistent results. However, recent studies suggest a reduced risk among current users. The purpose of the present study was to analyze the Leisure World Cohort for possible association of estrogen replacement therapy with colorectal cancer risk. METHODS A cohort of 7,701 female members who were initially free of cancer and self-reported their use of estrogen replacement therapy were followed up from June 1981 through December 1995 for development of colorectal cancer. RESULTS We observed 249 incident colorectal cancer cases and 89 colorectal cancer deaths. Women who had used estrogen replacement therapy had an age-adjusted colorectal cancer incidence rate of 2.67 per 1,000 person-years compared with 3.30 per 1,000 person-years among lifetime nonusers (relative risk = 0.81; 95 percent confidence interval, 0.63 to 1.04). Among recent users the incidence was one-third lower than among lifetime nonusers (relative risk = 0.66; 95 percent confidence interval, 0.44 to 0.98). Risk did not differ by duration of estrogen replacement therapy, usual dose of conjugated estrogen, or route of estrogen administration. The effects of current estrogen replacement therapy on colon cancer incidence (relative risk = 0.70; 95 percent confidence interval, 0.45 to 1.09), right-sided colon cancer incidence (relative risk = 0.75, 95 percent confidence interval, 0.38 to 1.48), left-sided colon cancer incidence (relative risk = 0.76; 95 percent confidence interval, 0.41 to 1.41), rectal cancer incidence (relative risk = 0.52; 95 percent confidence interval, 0.21 to 1.31), and colorectal cancer mortality (relative risk = 0.82; 95 percent confidence interval, 0.44 to 1.54) were similar. CONCLUSION A reduced risk of colorectal cancer may be an additional benefit of recent estrogen replacement therapy use, which should be considered by postmenopausal women when deciding whether to use hormones.
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Affiliation(s)
- A Paganini-Hill
- Department of Preventive Medicine, University of Southern California School of Medicine, Los Angeles 90089-9680, USA
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11
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Franceschi S, La Vecchia C. Oral contraceptives and colorectal tumors. A review of epidemiologic studies. Contraception 1998; 58:335-43. [PMID: 10095969 DOI: 10.1016/s0010-7824(98)00128-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Over the last two decades, the mortality rates of colorectal cancer in many developed countries have declined in women but not in men. One of the explanations of this difference between the genders may be the favorable influence of the spread of exogenous female hormone use (i.e., oral contraceptives [OC] and hormone replacement therapy) Reduced risk in ever-users of OC was found in three of four cohort studies available on this topic, and was significant in the one based on colorectal cancer mortality. The fourth one showed no difference. Of 11 case-control studies (or groups of studies), none showed significantly elevated risk. Five reported lowered colorectal cancer risk among ever-users, with a significant inverse association in the largest investigation available. Recent OC use, more than long duration use, seemed to be related to some risk reduction. One cohort study and three case-control investigations suggested that OC use was not related to the risk of colorectal adenomatous polyps. Thus, at present, it seems that OC use does not increase and may even have a favorable effect on either incidence or mortality of colorectal cancer.
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Affiliation(s)
- S Franceschi
- Servizio di Epidemiologia-Centro di Riferimento Oncologico, Aviano, Italy.
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12
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Ghadirian P, Maisonneuve P, Perret C, Lacroix A, Boyle P. Epidemiology of sociodemographic characteristics, lifestyle, medical history, and colon cancer: a case-control study among French Canadians in Montreal. CANCER DETECTION AND PREVENTION 1998; 22:396-404. [PMID: 9727620 DOI: 10.1046/j.1525-1500.1998.00058.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Colon cancer is the second most common cancer in both men and women in North America and other developed countries. In a population-based case-control study of colon cancer among French Canadians in greater Montreal, a total of 402 cases and 668 controls were interviewed. The cancer cases were identified through the admission offices of five major Francophone teaching hospitals in Montreal from 1989 to 1993. The controls, matched by age, sex, place of residence, and language, were selected by a modified random digit dialing method. The results show that subjects who had ever been married had a lower risk for colon cancer (odds ratio [OR]: 0.58; 95% confidence interval [95% CI]: 0.48-0.84) than did individuals who had never been married. A significant association (OR: 1.90; p for trend = 0.003) was found between the height of subjects and the risk of colon cancer. The OR for individuals with a family history of colorectal cancer was 2.78 with a p value of 0.01. A direct and significant association (OR: 2.01) was found among constipation, use of laxatives (OR: 1.41), and the risk of colon cancer. Among women, a suggestive inverse association was detected between the number of full-term pregnancies and the risk of colon cancer in female subjects (the OR for five or more pregnancies was 0.58 with a p for trend of 0.08). There was also a suggestive linear trend (increased age-decreased risk) between age at menarche and the risk of colon cancer. No association was apparent between other sociodemographic characteristics and the risk of colon cancer. In conclusion, married individuals had lower risk for colon cancer, perhaps due to food habits or other characteristics of being single. Higher height and weight history 10 years before the diagnosis of cancer are risk factors for breast cancer, while both current weight and body mass index seem to be protective. Positive family history of colon cancer increased the risk of colon cancer significantly.
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Affiliation(s)
- P Ghadirian
- Research Center, CHUM, Department of Nutrition, University of Montreal, Quebec, Canada
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Talamini R, Franceschi S, Dal Maso L, Negri E, Conti E, Filiberti R, Montella M, Nanni O, La Vecchia C. The influence of reproductive and hormonal factors on the risk of colon and rectal cancer in women. Eur J Cancer 1998; 34:1070-6. [PMID: 9849456 DOI: 10.1016/s0959-8049(98)00019-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
A case-control study was conducted between 1992 and 1996 in six Italian areas. It included 537 women with colon cancer, 291 women with rectal cancer and 2081 control women in hospital for acute conditions, unrelated to hormonal or gynaecological diseases. A higher age at menopause was associated with increased colon cancer risk (odds ratio (OR) for > or = 53 years compared with < 50 years = 1.39, 95% confidence interval (CI) 1.04-1.87). Among parous women, a significant trend of decreasing colon cancer risk with increasing number of births was seen for colon (OR for > or = 4 births compared with 1 birth = 0.62, 95% CI 0.42-0.90), but not for rectal cancer. Nulliparous women, however, were at lower risk than women with a single birth, and age at first birth was directly associated with risk. While oral contraceptive use showed no significant influence, ever users of hormone replacement therapy had a reduced risk of rectal cancer (OR = 0.56, 95% CI 0.31-1.01). Thus, the association of colorectal cancer with reproductive and menstrual factors is neither strong nor consistent.
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Affiliation(s)
- R Talamini
- Servizio di Epidemiologia, Centro di Riferimento Oncologico, Aviano, Italy
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Fernandez E, La Vecchia C, D'Avanzo B, Franceschi S, Negri E, Parazzini F. Oral contraceptives, hormone replacement therapy and the risk of colorectal cancer. Br J Cancer 1996; 73:1431-5. [PMID: 8645593 PMCID: PMC2074477 DOI: 10.1038/bjc.1996.272] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The relationship between oral contraceptives (OCs), menopausal hormone replacement therapy (HRT) and the risk of colorectal cancer was investigated in a case-control study conducted in northern Italy between 1985 and 1992 on 709 women with incident colorectal cancer and 992 controls admitted to hospital for a wide spectrum of acute, non-neoplastic, non-digestive tract, non-hormone-related disorders. A reduced risk of colorectal cancer was observed in women who had ever used OCs [multivariate odds ratio (OR) = 0.58; 95% confidence interval (CI): 0.36-0.92]. The OR was 0.52 (95% CI 0.27-1.02) for use over 2 years. For women ever using HRT, the multivariate OR was 0.40 (95% CI 0.25-0.66). The risk was inversely related to duration of use, with ORs of 0.46 for 2 years or less and 0.25 for more than 2 years of use. No consistent pattern of trends was observed with time since first or last use. This study provides further evidence that OC and HRT do not increase, and possibly decrease, the risk of colorectal cancer. These results, if confirmed, would have important implications for the ultimate risk-benefit assessment of female hormone preparations.
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Affiliation(s)
- E Fernandez
- Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
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15
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Broeders MJ, Lambe M, Baron JA, Leon DA. History of childbearing and colorectal cancer risk in women aged less than 60: an analysis of Swedish routine registry data 1960-1984. Int J Cancer 1996; 66:170-5. [PMID: 8603806 DOI: 10.1002/(sici)1097-0215(19960410)66:2<170::aid-ijc5>3.0.co;2-#] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Data from a computerised linkage between the Swedish Cancer Registry and the Fertility Registry were used to study the influence of reproductive history on the risk of colorectal cancer in women aged less than 60, in the period 1960 to 1984. A "nested" case-control design was used with 1,415 colon cancer cases and 733 rectal cancer cases, and 7,073 and 3,665 age-matched controls, respectively. Conditional logistic regression was employed to study the independent effects of parity, age at first birth and years since last birth on the risk of colorectal cancer. High parity was associated with reduced risk in women older then 50 years at diagnosis, both for the colon as a whole and for colon subsites. Women having had 5 children or more had an odds of colon cancer of 0.44 (95% confidence interval 0.24-0.82) relative to that of nulliparous woman. Contrary to the hypothesis advanced by McMichael and Potter (J. Nat. Cancer Inst., 75, 185-191 [1985]), which predicted a strong protective effect of parity in the proximal compared to the distal colon, we found the reverse. Increasing years since last birth seemed to be associated with a reduced risk of rectal cancer. A significant positive trend with increasing age at first birth was suggested with respect to distal colon cancer and rectal cancer risk. The mutually adjusted effects of the reproductive variables under study were similar to the unadjusted effects. Our data suggest that increasing parity is associated with a decline in risk of colon cancer but not rectal cancer, although the association with colon cancer is restricted to women aged 50 or more. The effects of age at first birth and years since last birth are not consistent or pronounced.
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Affiliation(s)
- M J Broeders
- Department of Epidemiology, University of Nijmegen, The Netherlands
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Jacobson JS, Neugut AI, Garbowski GC, Ahsan H, Waye JD, Treat MR, Forde KA. Reproductive risk factors for colorectal adenomatous polyps (New York City, NY, United States). Cancer Causes Control 1995; 6:513-8. [PMID: 8580299 DOI: 10.1007/bf00054159] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Events of reproductive life, such as parity and age at menarche, have been found in some but not all studies to be associated with risk for colorectal cancer in females. Because adenomatous polyps (adenomas) are precursors of colorectal cancer, we investigated whether reproductive variables were associated with colorectal adenomas. We conducted a case-control study among patients examined in three colonoscopy practices in New York City (NY, United States) from 1986 to 1988. Adenoma cases (n = 128) were defined as women who had an adenoma detected at the index colonoscopy with no history of inflammatory bowel disease, adenomas, or cancer. Controls (n = 283) were women with a normal index colonoscopy and no history of inflammatory bowel disease, adenomas, or cancer. The adjusted odds ratio (OR) for the association of early menarche (age less than 13 years) with adenomas was 0.6 (95 percent confidence interval = 0.4-0.9). Parity, history of spontaneous or induced abortion, infertility, type of menopause, age at menopause, use of oral contraceptives, and use of menopausal hormone replacement therapy were not associated statistically significantly with adenoma risk, although some possible trends were observed. Our findings do not implicate reproductive events, nulliparity, or overexposure to estrogens or to menstrual cycles as mechanisms of increased risk for colorectal neoplasia.
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Affiliation(s)
- J S Jacobson
- Columbia College of Physicians and Surgeons, New York, NY, USA
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MacLennan SC, MacLennan AH, Ryan P. Colorectal cancer and oestrogen replacement therapy: A meta‐analysis of epidemiological studies. Med J Aust 1995. [DOI: 10.5694/j.1326-5377.1995.tb140014.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Suzanna C MacLennan
- Departments of Obstetrics and Gynaecology and Community MedicineUniversity of Adelaide Adelaide SA
| | - Alastair H MacLennan
- Departments of Obstetrics and Gynaecology and Community MedicineUniversity of Adelaide Adelaide SA
| | - Philip Ryan
- Departments of Obstetrics and Gynaecology and Community MedicineUniversity of Adelaide Adelaide SA
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Parry BR, Tan BK, Chan WB, Goh HS. Rectal carcinoma during pregnancy. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1994; 64:618-20. [PMID: 8085977 DOI: 10.1111/j.1445-2197.1994.tb02304.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Rectal carcinoma presenting during pregnancy is rare with a reported incidence of 0.002%. Management of such an emotionally charged condition can be difficult, especially when the twin goals of curing the disease and preserving the pregnancy are divergent. Four cases of rectal carcinoma presenting during pregnancy are reported. In the first or second trimester of pregnancy, it is possible to resect the tumour with preservation of pregnancy, and in the third trimester, it is best to bring the pregnancy to term before removing the tumour. Unfortunately, the prognosis for such rectal cancer is poor.
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Affiliation(s)
- B R Parry
- Department of Colorectal Surgery, Singapore General Hospital
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Jacobs EJ, White E, Weiss NS. Exogenous hormones, reproductive history, and colon cancer (Seattle, Washington, USA). Cancer Causes Control 1994; 5:359-66. [PMID: 8080948 DOI: 10.1007/bf01804987] [Citation(s) in RCA: 91] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The associations between exogenous hormones, reproductive history, and colon cancer were investigated in a case-control study among women aged 30-62 years. The study was conducted in the Seattle, Washington (USA) metropolitan area between 1985 and 1989 and included 193 incident cases of colon cancer and 194 controls. There was little overall association between colon cancer and oral contraceptive use, parity, age at first birth, hysterectomy or oophorectomy status, or age at menopause. Use of noncontraceptive hormones at or after age 40, most likely hormone replacement therapy (HRT), was associated with decreased risk of colon cancer (adjusted odds ratio [OR] = 0.60, 95 percent confidence interval [CI] = 0.35-1.01), particularly among women with more than five years of use (OR = 0.47, 95 percent CI = 0.24-0.91). While results from previous studies have not been consistent, any protective effect of HRT against colon cancer would be important given the continuing debate over its potential risks and benefits.
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Affiliation(s)
- E J Jacobs
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA 98104
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Abstract
Nation-wide incidence rates are presented of colorectal cancer in Denmark from 1943 to 1988. In Denmark notification of malignant and related diseases is mandatory. The percentage of histologically confirmed tumours is now 95. The annual incidence rate of colon cancer in Denmark has been increasing among men and women combined from 684 cases in 1943-47 to 2020 cases in 1988. In the same period the incidence of rectal cancer has been increasing from 762 cases in 1943-47 to 1108 cases in 1988. We analyzed the effects of age, calendar time, and birth cohort with multiplicative Poisson models. We did not find consistent period effects in the models. We suggest the trends in colorectal cancer incidence rates may be due to changes in environmental factors such as dietary habits and in physical activity. Furthermore, we suggest an etiologic distinction between carcinoma of the rectum, the left colon and the right colon.
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Affiliation(s)
- C Johansen
- Danish Cancer Registry, Institute of Cancer Epidemiology, Danish Cancer Society, København
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Kravdal O, Glattre E, Kvåle G, Tretli S. A sub-site-specific analysis of the relationship between colorectal cancer and parity in complete male and female Norwegian birth cohorts. Int J Cancer 1993; 53:56-61. [PMID: 8416205 DOI: 10.1002/ijc.2910530112] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Register and census data for complete cohorts of Norwegian men and women born between 1935 and 1969 have been used to examine the relationship between reproductive factors and the incidence of colorectal cancer. Among 1.1 million men and 1.1 million women under observation, 491 male and 859 female cases of colorectal cancer were diagnosed during the period of follow-up. Our hazard model estimates clearly show that in these young cohorts, women with 2 or more children run a lower risk of having a malignant tumor in the cecum or ascending colon than do other women of the same age and in the same birth cohort. No association with parity is found with respect to cancer in the transverse or descending colon, whereas a downward trend in the effect estimates, followed by an upturn, appears for the rectum, sigmoid colon and rectosigmoid junction. Such correlations, which also hold when we control for education and place of residence, are not found for men. The observed relationship between parity and cancer incidence is not likely to be exclusively explained by life-style differentials. Presumably, there is a biological effect of the number of pregnancies and deliveries, net of age at first birth and other reproductive factors, on the development of colorectal cancer.
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Affiliation(s)
- O Kravdal
- Central Bureau of Statistics, Oslo, Norway
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Barra S, Negri E, Franceschi S, Guarneri S, La Vecchia C. Alcohol and colorectal cancer: a case-control study from northern Italy. Cancer Causes Control 1992; 3:153-9. [PMID: 1562705 DOI: 10.1007/bf00051655] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The role of alcohol consumption in the etiology of colorectal cancer has been investigated in a case-control study conducted from 1985 to 1990 in the northern part of Italy, on 889 cases of colon cancer, 581 cases of rectal cancer, and 2,475 controls admitted to hospital for acute, non-neoplastic, nondigestive disorders. After allowance for age, education, study center, body mass index, and approximate total energy intake, no significant associations between alcohol intake and the risk of cancer of the colon or rectum were found (odds ratios [OR] for greater than or equal to 42 drinks/week cf none = 1.0 (95 percent confidence interval [CI] = 0.8-1.4) and 0.7 (CI = 0.5-1.0) for cancer of the colon and rectum, respectively). A significant increase in the risk of colon cancer with increasing alcohol consumption was, however, observed in females (OR for greater than or equal to 28 drinks/week cf none = 1.8 (CI = 1.1-3.0). While the results of the present case-control study do not suggest that alcohol plays a role in the etiology of colon or rectum cancer overall, they provide a hint for a weak association between alcohol consumption and colon cancer among females which, because of the similarities with breast cancer, should be evaluated in the context of the possible relationship between colon cancer, alcohol intake, and female hormones.
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Affiliation(s)
- S Barra
- Epidemiology Unit, Aviano Cancer Center, Italy
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