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dc.contributor.authorMurphy, Neil
dc.contributor.authorWard, Heather A
dc.contributor.authorJenab, Mazda
dc.contributor.authorRothwell, Joseph A
dc.contributor.authorBoutron-Ruault, Marie-Christine
dc.contributor.authorCarbonnel, Franck
dc.contributor.authorKvaskoff, Marina
dc.contributor.authorKaaks, Rudolf
dc.contributor.authorKühn, Tilman
dc.contributor.authorBoeing, Heiner
dc.contributor.authorAleksandrova, Krasimira
dc.contributor.authorWeiderpass, Elisabete
dc.contributor.authorSkeie, Guri
dc.contributor.authorBorch, Kristin Benjaminsen
dc.contributor.authorTjønneland, Anne
dc.contributor.authorKyrø, Cecilie
dc.contributor.authorOvervad, Kim
dc.contributor.authorDahm, Christina C
dc.contributor.authorJakszyn, Paula
dc.contributor.authorSánchez, Maria-Jose
dc.contributor.authorGil, Leire
dc.contributor.authorHuerta, José M
dc.contributor.authorBarricarte, Aurelio
dc.contributor.authorQuirós, J Ramón
dc.contributor.authorKhaw, Kay-Tee
dc.contributor.authorWareham, Nicholas
dc.contributor.authorBradbury, Kathryn E
dc.contributor.authorTrichopoulou, Antonia
dc.contributor.authorLa Vecchia, Carlo
dc.contributor.authorKarakatsani, Anna
dc.contributor.authorPalli, Domenico
dc.contributor.authorGrioni, Sara
dc.contributor.authorTumino, Rosario
dc.contributor.authorFasanelli, Francesca
dc.contributor.authorPanico, Salvatore
dc.contributor.authorBueno-de-Mesquita, Bas
dc.contributor.authorPeeters, Petra H
dc.contributor.authorGylling, Björn
dc.contributor.authorMyte, Robin
dc.contributor.authorJirström, Karin
dc.contributor.authorBerntsson, Jonna
dc.contributor.authorXue, Xiaonan
dc.contributor.authorRiboli, Elio
dc.contributor.authorCross, Amanda J
dc.contributor.authorGunter, Marc J
dc.date.accessioned2018-11-07T00:30:58Z
dc.date.available2018-11-07T00:30:58Z
dc.date.issued2019-06
dc.identifier.issn1542-3565
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/284700
dc.description.abstractBACKGROUND & AIMS: Colorectal cancer located at different anatomical subsites may have distinct etiologies and risk factors. Previous studies that have examined this hypothesis have yielded inconsistent results, possibly because most studies have been of insufficient size to identify heterogeneous associations with precision. METHODS: In the European Prospective Investigation into Cancer and Nutrition study, we used multivariable joint Cox proportional hazards models, which accounted for tumors at different anatomical sites (proximal colon, distal colon, and rectum) as competing risks, to examine the relationships between 14 established/suspected lifestyle, anthropometric, and reproductive/menstrual risk factors with colorectal cancer risk. Heterogeneity across sites was tested using Wald tests. RESULTS: After a median of 14.9 years of follow-up of 521,330 men and women, 6291 colorectal cancer cases occurred. Physical activity was related inversely to proximal colon and distal colon cancer, but not to rectal cancer (P heterogeneity = .03). Height was associated positively with proximal and distal colon cancer only, but not rectal cancer (P heterogeneity = .0001). For men, but not women, heterogeneous relationships were observed for body mass index (P heterogeneity = .008) and waist circumference (P heterogeneity = .03), with weaker positive associations found for rectal cancer, compared with proximal and distal colon cancer. Current smoking was associated with a greater risk of rectal and proximal colon cancer, but not distal colon cancer (P heterogeneity = .05). No heterogeneity by anatomical site was found for alcohol consumption, diabetes, nonsteroidal anti-inflammatory drug use, and reproductive/menstrual factors. CONCLUSIONS: The relationships between physical activity, anthropometry, and smoking with colorectal cancer risk differed by subsite, supporting the hypothesis that tumors in different anatomical regions may have distinct etiologies.
dc.format.mediumPrint-Electronic
dc.languageeng
dc.publisherElsevier BV
dc.rightsAttribution 4.0 International
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/
dc.subjectColon
dc.subjectRectum
dc.subjectHumans
dc.subjectColorectal Neoplasms
dc.subjectColonoscopy
dc.subjectExercise
dc.subjectIncidence
dc.subjectRisk Factors
dc.subjectFollow-Up Studies
dc.subjectProspective Studies
dc.subjectAlcohol Drinking
dc.subjectSmoking
dc.subjectLife Style
dc.subjectAdult
dc.subjectMiddle Aged
dc.subjectEurope
dc.subjectFemale
dc.subjectMale
dc.titleHeterogeneity of Colorectal Cancer Risk Factors by Anatomical Subsite in 10 European Countries: A Multinational Cohort Study.
dc.typeArticle
prism.endingPage1331.e6
prism.issueIdentifier7
prism.publicationDate2019
prism.publicationNameClin Gastroenterol Hepatol
prism.startingPage1323
prism.volume17
dc.identifier.doi10.17863/CAM.32073
dcterms.dateAccepted2018-07-20
rioxxterms.versionofrecord10.1016/j.cgh.2018.07.030
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserved
rioxxterms.licenseref.startdate2019-06
dc.contributor.orcidWareham, Nicholas [0000-0003-1422-2993]
dc.identifier.eissn1542-7714
rioxxterms.typeJournal Article/Review
pubs.funder-project-idMedical Research Council (MC_UU_12015/1)
pubs.funder-project-idDepartment of Health (via National Institute for Health Research (NIHR)) (NF-SI-0617-10149)
pubs.funder-project-idDepartment of Health (via National Institute for Health Research (NIHR)) (NF-SI-0512-10135)
pubs.funder-project-idMedical Research Council (G0401527)
pubs.funder-project-idMedical Research Council (G1000143)
pubs.funder-project-idMedical Research Council (MR/N003284/1)


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Attribution 4.0 International
Except where otherwise noted, this item's licence is described as Attribution 4.0 International