Bowel cancer risk factors

54% of bowel cancer cases each year in the UK are linked to major lifestyle and other risk factors.[1]

Bowel cancer risk is associated with a number of risk factors.[2,3]

Bowel Cancer Risk Factors

Increases risk ('sufficient' or 'convincing' evidence) May increase risk ('limited' or 'probable' evidence) Decreases risk ('sufficient' or 'convincing' evidence) May decrease risk ('limited' or 'probable' evidence)
  • X radiation, gamma radiationa
  • Alcoholic drinksb
  • Tobacco smoking
  • Red meat
  • Processed meat
  • Body fatness
  • Abdominal fatness
  • Adult attained height
  • Asbestos
  • Schistosoma japonicum
  • Physical activityc
  • Dietary fibre in foods
  • Garlic
  • Milk
  • Calcium

International Agency for Research on Cancer (IARC) and World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) classifications.

a IARC classifies evidence on X radiation and gamma radiation as sufficient for colon and limited for rectum; b IARC classification does not specify sex, WCRF/AICR classifies evidence on alcoholic drinks as convincing for males and probable for females; c WCRF/AICR classifies the evidence on physical activity as stronger for colon than rectum

Use our interactive tool to explore risk factors for bowel cancer.

More information about cancer risk factors evidence

References

  1. Parkin DM, Boyd L, Walker LC. The fraction of cancer attributable to lifestyle and environmental factors in the UK in 2010. Summary and conclusions. Br J Cancer 2011; 105 (S2):S77-S81. 
  2. International Agency for Research on Cancer. List of Classifications by cancer sites with sufficient or limited evidence in humans, Volumes 1 to 105*. Accessed December 2014. 
  3. World Cancer Research Fund/American Institute for Cancer Research. Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective. Washington DC: AICR; 2007. 
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Dietary factors classified by the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) in relation to bowel cancer risk include:[1]

  • Red meat, processed meat (increases risk)
  • Dietary fibre, garlic, milk, calcium (probably decreases risk)
  • Haem iron, dietary animal fat, cheese, dietary sugars (possibly increases risk)
  • Non-starchy vegetables, fruit, dietary folate, dietary and supplementary selenium, fish, dietary vitamin D (possibly decreases risk)

Other dietary factors have been studied but their relation to bowel cancer risk is not classified by WCRF/AICR because evidence is too limited to draw conclusions.[2]

References

  1. World Cancer Research Fund / American Institute for Cancer Research. Continuous Update Project: Colorectal Cancer Report 2010 Summary. Food, Nutrition, Physical Activity, and the Prevention of Colorectal Cancer. (PDF 1.11MB) 2011.
  2. Magalhaes B, Peleteiro B, Lunet N. Dietary patterns and colorectal cancer: systematic review and meta-analysis. Eur J Cancer Prev 2012;21(1):15-23.
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Red meat and processed meat are classified by the World Cancer Research Fund / American Institute for Cancer Research (WCRF/AICR) as causes of bowel cancer.[1] Haem iron (found in red meat) is classified by WCRF/AICR as a possible cause of bowel cancer, based on limited evidence.[1] An estimated 21% of bowel cancers in the UK are linked to eating red and processed meat.[2]

Bowel cancer risk is 17-30% higher per 100-120g/day of red meat intake, meta-analyses have shown.[3-6

Bowel cancer risk is 9-50% higher per 25-50g/day of processed meat intake, meta-analyses have shown;[3-6] however bowel cancer risk was not associated with processed meat intake in a pooled analysis of UK case-control studies.[7] Colon cancer risk is 12% higher per 1mg/day of haem iron intake, a meta-analysis showed;[8] though bowel cancer risk was not associated with dietary iron intake in a pooled analysis of UK cohort studies.[9]

References

  1. World Cancer Research Fund / American Institute for Cancer Research. Continuous Update Project: Colorectal Cancer Report 2010 Summary. Food, Nutrition, Physical Activity, and the Prevention of Colorectal Cancer. (PDF 1.11MB) 2011 
  2. Parkin DM. 5. Cancers attributable to dietary factors in the UK in 2010. Br J Cancer 2011;105(s2):s24-S26.
  3. Chan DS, Lau R, Aune D, et al. Red and processed meat and colorectal cancer incidence: meta-analysis of prospective studies. PLoS One 2011;6(6):e20456.
  4. Sandhu MS, White IR, McPherson K. Systematic review of the prospective cohort studies on meat consumption and colorectal cancer risk: a meta-analytical approach. Cancer Epidemiol Biomarkers Prev 2001;10(5):439-46.
  5. Norat T, Lukanova A, Ferrari P, et al. Meat consumption and colorectal cancer risk: dose-response meta-analysis of epidemiological studies. Int J Cancer 2002;98(2):241-56.
  6. Larsson SC, Wolk A. Meat consumption and risk of colorectal cancer: a meta-analysis of prospective studies. Int J Cancer 2006;119(11):2657-64. 
  7. Spencer EA, Key TJ, Appleby PN, et al. Meat, poultry and fish and risk of colorectal cancer: pooled analysis of data from the UK dietary cohort consortium. Cancer Causes Control 2010;21(9):1417-25. 
  8. Fonseca-Nunes A, Jakszyn P, Agudo A. Iron and Cancer Risk - A systematic review and meta-analysis of the epidemiological evidence. Cancer Epidemiol Biomarkers Prev. 2013 Nov 15. 
  9. Key TJ, Appleby PN, Masset G, et al. Vitamins, minerals, essential fatty acids and colorectal cancer risk in the United Kingdom dietary cohort consortium. Int J Cancer 2011. 
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Foods containing animal fats are classified by the World Cancer Research Fund / American Institute for Cancer Research (WCRF/AICR) as possible causes of bowel cancer, based on limited evidence.[1]

Bowel cancer risk is not associated with dietary fat intake, a meta-analysis showed.[2]

References

  1. World Cancer Research Fund / American Institute for Cancer Research. Continuous Update Project: Colorectal Cancer Report 2010 Summary. Food, Nutrition, Physical Activity, and the Prevention of Colorectal Cancer. (PDF 1.11MB) 2011.
  2. Liu L, Zhuang W, Wang RQ, et al. Is dietary fat associated with the risk of colorectal cancer? A meta-analysis of 13 prospective cohort studies. Eur J Nutr 2011;50(3):173-84. 
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Cheese is classified by the World Cancer Research Fund / American Institute for Cancer Research (WCRF/AICR) as a possible cause of bowel cancer, based on limited evidence.[1] This may be linked with saturated fatty acids.[1]

Bowel cancer risk is not associated with cheese and other non-milk dairy product intake, meta-analyses and a large cohort study have shown.[2-4]

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Foods containing sugar are classified by the World Cancer Research Fund / American Institute for Cancer Research (WCRF/AICR) as a possible cause of bowel cancer, based on limited evidence.[1]

Bowel or colon cancer risk is not associated with glycaemic index or glycaemic load, a meta-analysis of cohort studies showed;[2] Colon cancer risk is not associated with intake of sugar-sweetened soft drinks, a pooled analysis showed.[3]

References

  1. World Cancer Research Fund / American Institute for Cancer Research. Continuous Update Project: Colorectal Cancer Report 2010 Summary. Food, Nutrition, Physical Activity, and the Prevention of Colorectal Cancer. (PDF 1.11MB) 2011.
  2. Aune D, Chan DS, Lau R, et al. Carbohydrates, glycemic index, glycemic load, and colorectal cancer risk: a systematic review and meta-analysis of cohort studies. Cancer Causes Control. 2012 Apr;23(4):521-35. /li>
  3. Zhang X, Albanes D, Beeson WL, et al. Risk of colon cancer and coffee, tea, and sugar-sweetened soft drink intake: pooled analysis of prospective cohort studies . J Natl Cancer Inst 2010;102(11):771-83.
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Colon cancer risk may be 29% higher in people with the highest egg consumption, compared with those with the lowest, a meta-analysis showed.[1]

References

  1. Tse G, Eslick GD. Egg consumption and risk of GI neoplasms: dose-response meta-analysis and systematic review. Eur J Nutr. 2014 Feb 6.
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Body fatness and abdominal fatness are classified by the World Cancer Research Fund / American Institute for Cancer Research (WCRF/AICR) as causes of colon and rectum cancer.[1] An estimated 13% of bowel cancers in the UK are linked to overweight or obesity.[2]

References

  1. World Cancer Research Fund / American Institute for Cancer Research. Continuous Update Project: Colorectal Cancer Report 2010 Summary. Food, Nutrition, Physical Activity, and the Prevention of Colorectal Cancer. (PDF 1.11MB) 2011.
  2. Parkin DM, Boyd L. Cancers attributable to overweight and obesity in the UK in 2010. Br J Cancer 2011;105 Suppl 2:S34-7. 
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Bowel cancer risk is 33% higher in people who are obese by (body mass index, BMI 30+), compared with those who are a healthy weight, a meta-analysis showed.[1] The association is stronger for colon cancer than rectum cancer.[1]

The association with BMI is stronger for men than women, a meta-analysis showed.[1] The association is stronger in premenopausal than postmenopausal women.[2]

Bowel cancer risk among men is 10% higher per 5 BMI units gained during adulthood, a meta-analysis showed.[3] Bowel cancer risk among women is not associated with weight gain during adulthood.[3]

Bowel adenoma risk is 47% higher in people who are obese by BMI compared with those who are healthy-weight, a meta-analysis showed.[4]

References

  1. Ma Y, Yang Y, Wang F, et al. Obesity and risk of colorectal cancer: a systematic review of prospective studies. PLoS One. 2013;8(1):e53916.
  2. Ning Y, Wang L, Giovannucci EL. A quantitative analysis of body mass index and colorectal cancer: findings from 56 observational studies. Obes Rev. 2010 Jan: 11(1):19-30.
  3. Chen Q, Wang J, Yang J et al. Association between adult weight gain and colorectal cancer: A dose-response meta-analysis of observational studies.Int J Cancer. 2014 Nov 14.
  4. Omata F, Deshpande GA, Ohde S, et al. The association between obesity and colorectal adenoma: systematic review and meta-analysis. Scand J Gastroenterol. 2013 Feb;48(2):136-46.
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Bowel cancer risk is 46% higher in people with the largest waist circumference, versus those with the smallest, a meta-analysis showed.[1]

Bowel adenoma risk is 39% higher in people with the largest waist circumference, versus those with the smallest, a meta-analysis showed.[2]

References

  1. Ma Y, Yang Y, Wang F, et al. Obesity and risk of colorectal cancer: a systematic review of prospective studies. PLoS One. 2013;8(1):e53916.
  2. Hong S, Cai Q, Chen D, et al. Abdominal obesity and the risk of colorectal adenoma: a meta-analysis of observational studies. Eur J Cancer Prev. 2012 Nov;21(6):523-31.
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Alcoholic beverages are classified by the International Agency for Research on Cancer (IARC) and World Cancer Research Fund / American Institute for Cancer Research (WCRF/AICR) as a cause of colon and rectum cancers (WCRF/AICR classify the association as convincing for males and probable for females).[1,2] An estimated 11% of bowel cancer cases in the UK are linked to alcohol consumption.[3]

Bowel cancer risk is 21% higher in people who drink around 1.5-6 UK alcohol units per day, compared with non-/occasional drinkers, a meta-analysis showed.[4] Bowel cancer risk is 52% higher in those who consume around 6 units or more per day, compared with non-/occasional drinkers.[4] Bowel cancer risk increases by 7% per unit of alcohol consumed per day.[4]

Bowel adenoma risk is 27% higher in people who drink around 3 units per day, a meta-analysis showed; the association is limited to colon adenoma, not rectal.[5]

References

  1. World Cancer Research Fund / American Institute for Cancer Research. Continuous Update Project: Colorectal Cancer Report 2010 Summary. Food, Nutrition, Physical Activity, and the Prevention of Colorectal Cancer. (PDF 1.11MB) 2011.
  2. International Agency for Research on Cancer. List of Classifications by cancer sites with sufficient or limited evidence in humans, Volumes 1 to 105*. Available from: http://monographs.iarc.fr/ENG/Classification/index.php. Accessed April 2014.
  3. Parkin DM. Cancers attributable to consumption of alcohol in the UK in 2010. Br J Cancer 2011;105(S2):S14-S18. 
  4. Fedirko V, Tramacere I, Bagnardi V, et al. Alcohol drinking and colorectal cancer risk: an overall and dose-response meta-analysis of published studies. Ann Oncol 2011;22(9):1958-72.
  5. Ben Q, Wang L, Liu J et al. Alcohol drinking and the risk of colorectal adenoma: a dose-response meta-analysis. Eur J Cancer Prev. 2014 Aug 26 [Epub ahead of print]
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Tobacco smoking is classified by the International Agency for Research on Cancer (IARC) as a cause of colon and rectum cancers.[1] An estimated 8% of bowel cancer cases in the UK are linked to tobacco smoking.

Bowel cancer risk is 17-21% higher in current cigarette smokers compared with never-smokers, meta-analyses of cohort studies have shown.[2-4] The association may be stronger in males than females, and stronger for rectal than colon cancer.[2-5

Bowel cancer risk is 17-25% higher in former cigarette smokers compared with never smokers, meta-analyses have shown.[2-4]

Bowel cancer risk increases with the number of cigarettes smoked per day, by 7-11% per 10 cigarettes per day, a meta-analysis has shown.[3] Bowel cancer risk is higher in people who start smoking younger.[4

Bowel adenoma risk is around twice as high in current smokers compared with never-smokers, a meta-analysis showed.[6]

References

  1. International Agency for Research on Cancer. List of Classifications by cancer sites with sufficient or limited evidence in humans, Volumes 1 to 105*. Available from: http://monographs.iarc.fr/ENG/Classification/index.php. Accessed April 2014.
  2. Huxley RR, Ansary-Moghaddam A, Clifton P, et al. The impact of dietary and lifestyle risk factors on risk of colorectal cancer: a quantitative overview of the epidemiological evidence. Int J Cancer 2009;125(1):171-80. 
  3. Tsoi KK, Pau CY, Wu WK, et al. Cigarette smoking and the risk of colorectal cancer: a meta-analysis of prospective cohort studies. Clin Gastroenterol Hepatol 2009;7(6):682-88 e1-5. 
  4. Liang PS, Chen TY, Giovannucci E. Cigarette smoking and colorectal cancer incidence and mortality: systematic review and meta-analysis. Int J Cancer 2009;124(10):2406-15.
  5. Cheng J, Chen Y, Wang X, et al. Meta-analysis of prospective cohort studies of cigarette smoking and the incidence of colon and rectal cancers. Eur J Cancer Prev. 2014.
  6. Botteri E, Iodice S, Raimondi S, et al. Cigarette smoking and adenomatous polyps: a meta-analysis. Gastroenterology 2008;134(2):388-95. 
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Around 1% of people with larger (20mm+) adenomas, or adenomas with high-grade dysplasia, develop bowel cancer within around 4 years of having their adenomas removed, a pooled analysis showed.[1] Risk of advanced bowel cancer is 80% higher in people with low-risk polyps detected at first colonoscopy, compared with people with no polyps detected at first colonoscopy, a meta-analysis showed.[2]

References

  1. Martínez ME, Baron JA, Lieberman DA, et al. A pooled analysis of advanced colorectal neoplasia diagnoses after colonoscopic polypectomy. . Gastroenterology. 2009;136(3):832-41. 
  2. Hassan C, Gimeno-García A, Kalager M, et al. Systematic review with meta-analysis: the incidence of advanced neoplasia after polypectomy in patients with and without low-risk adenomas. Aliment Pharmacol Ther. 2014;39(9):905-12. 
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Bowel cancer risk is 70% higher in people with inflammatory bowel disease (IBD) (ulcerative or Crohn's colitis) compared with the general population, a meta-analysis showed.[1] Bowel cancer risk increases with extent and duration of IBD; patients who have IBD for 20 years or more have a 5% risk of developing bowel cancer.[1,2] Bowel cancer risk may vary by location of IBD lesions.[3]

Bowel cancer risk is increased in patients with complicated diverticulitis, a meta-analysis and large cohort study have shown, though uncomplicated diverticulitis does not increase risk.[4,5]

References

  1. Lutgens MW, van Oijen MG, van der Heijden GJ, et al. Declining risk of colorectal cancer in inflammatory bowel disease: an updated meta-analysis of population-based cohort studies. Inflamm Bowel Dis. 2013 Mar-Apr;19(4):789-99. 
  2. Castaño-Milla C, Chaparro M, Gisbert JP. Systematic review with meta-analysis: the declining risk of colorectal cancer in ulcerative colitis. Aliment Pharmacol Ther. 2014 Feb 9. 
  3. Canavan C, Abrams KR, Mayberry J. Meta-analysis: colorectal and small bowel cancer risk in patients with Crohn's disease. Aliment Pharmacol Ther 2006;23(8):1097-104. 
  4. Huang WY, Lin CC, Jen YM, et al. Association Between Colonic Diverticular Disease and Colorectal Cancer: A Nationwide Population-Based Study. Clin Gastroenterol Hepatol. 2013 Dec 17. 
  5. Sharma PV, Eglinton T, Hider P. Systematic Review and Meta-analysis of the Role of Routine Colonic Evaluation After Radiologically Confirmed Acute Diverticulitis. Ann Surg. 2013 Oct 28.
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Rectal cancer risk is 33% higher in people with gallstones versus those without, a meta-analysis showed.[1] Colon adenoma risk is more than doubled in people with gallstones versus those without, a meta-analysis showed.[2]

Rectal cancer risk and bowel adenoma risk is not associated with undergoing cholecystectomy (gallbladder removal), meta-analyses have shown.[1-3]

References

  1. Chiong C, Cox MR, Eslick GD. Gallstone disease is associated with rectal cancer: a meta-analysis. Scand J Gastroenterol. 2012;47(5):553-64.
  2. Chiong C, Cox MR, Eslick GD. Gallstones Are Associated with Colonic Adenoma: A Meta-analysis. World J Surg. 2012.
  3. Zhao C, Ge Z, Wang Y et al. Meta-analysis of observational studies on cholecystectomy and the risk of colorectal adenoma. Eur J Gastroenterol Hepatol. 2012 Apr:24(4)375-81
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Bowel cancer risk is 22-30% higher in people with type II diabetes, compared with non-diabetics, meta-analyses show.[1-5

Bowel cancer risk among diabetics may vary by treatment type, though treatment type often relates to diabetes stage, which may further confound findings. Bowel cancer risk is lower in metformin users compared with non-users, meta-analyses of cohort studies have shown;[6-8] however this may be for women only.[9] Bowel cancer risk is not associated with insulin use compared with non-use, meta-analyses of cohort studies have shown.[10,11]

References

  1. Jiang Y, Ben Q, Shen H, et al. Diabetes mellitus and incidence and mortality of colorectal cancer: a systematic review and meta-analysis of cohort studies. Eur J Epidemiol 2011;26(11):863-76.
  2. Kramer HU, Schottker B, Raum E, et al. Type 2 diabetes mellitus and colorectal cancer: Meta-analysis on sex-specific differences. Eur J Cancer 2011.
  3. Larsson SC, Orsini N, Wolk A. Diabetes mellitus and risk of colorectal cancer: a meta-analysis. J Natl Cancer Inst 2005;97(22):1679-87.
  4. Luo W, Cao Y, Liao C, et al. Diabetes mellitus and the incidence and mortality of colorectal cancer: A meta-analysis of twenty four cohort studies. Colorectal Dis 2011.  
  5. Wu L, Yu C, Jiang H, et al. Diabetes mellitus and the occurrence of colorectal cancer: an updated meta-analysis of cohort studies. Diabetes Technol Ther. 2013 May;15(5):419-27. 
  6. Soranna D, Scotti L, Zambon A, et al. Cancer risk associated with use of metformin and sulfonylurea in type 2 diabetes: a meta-analysis. Oncologist. 2012;17(6):813-22.
  7. Singh S, Singh H, Singh PP, et al. Antidiabetic Medications and the Risk of Colorectal Cancer in Patients with Diabetes Mellitus: A Systematic Review and Meta-analysis. Cancer Epidemiol Biomarkers Prev. 2013 Nov 12.
  8. Gandini S, Puntoni M, Heckman-Stoddard BM et al. Metformin and cancer risk and mortality: a systematic review and meta-analysis taking into account biases and confounders. Cancer Prev Res (Phila). 2014 Sept; 7(9)867-85
  9. Cardel M, Jensen SM, Pottegard A et al. Long-term use of metformin and colorectal cancer risk in type II diabetics: a population-based case-control study. Cancer Med. 2014 Oct;3(5)1458-66.
  10. Wang L, Cai S, Teng Z. Insulin therapy contributes to the increased risk of colorectal cancer in diabetes patients: a meta-analysis. Diagn Pathol. 2013 Oct 31;8(1):180.
  11. Sun A, Liu R, Sun G. Insulin therapy and risk of colorectal cancer: an updated meta-analysis of epidemiological studies. Curr Med Res Opin. 2013 Nov 6.  
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Bowel cancer risk is 33-41% higher in people with metabolic syndrome (characterised by a combination of diabetes, high blood pressure, and abdominal obesity), versus people without the syndrome, meta-analyses have shown.[1,2

Bowel adenoma risk may be increased in people with  non-alcoholic fatty liver disease[glossary - Non alcoholic fatty liver disease] (the hepatic manifestation of metabolic syndrome), a number of individual studies indicate.[3]

References

  1. Esposito K, Chiodini P, Capuano A, et al. Colorectal cancer association with metabolic syndrome and its components: a systematic review with meta-analysis. Endocrine. 2013 Dec;44(3):634-47.
  2. Jinjuvadia R, Lohia P, Jinjuvadia C, et al. The association between metabolic syndrome and colorectal neoplasm: systemic review and meta-analysis. J Clin Gastroenterol. 2013 Jan;47(1):33-44. 
  3. Muhidin SO, Magan AA, Osman KA, et al. The relationship between nonalcoholic fatty liver disease and colorectal cancer: the future challenges and outcomes of the metabolic syndrome. J Obes. 2012;2012:637538. 
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Asbestos is classified by the International Agency for Research on Cancer (IARC) as a probable cause of bowel cancer, based on limited evidence.[1] 

Bowel cancer risk may be higher in people with heavy prolonged occupational asbestos exposure, a cohort study showed.[2]

References

  1. International Agency for Research on Cancer. List of Classifications by cancer sites with sufficient or limited evidence in humans, Volumes 1 to 105*. Available from: http://monographs.iarc.fr/ENG/Classification/index.php. Accessed April 2014. 
  2. Offermans NS, Vermeulen R, Burdorf A, et al. Occupational asbestos exposure and risk of esophageal, gastric and colorectal cancer in the prospective Netherlands Cohort Study. Int J Cancer 2014. doi: 10.1002/ijc.28817. 
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Schistosoma japonicum is classified by the International Agency for Research on Cancer (IARC) as a probable cause of bowel cancer, based on limited evidence.[1]

Bowel cancer risk is up to 10 times higher in people with Human papillomavirus (HPV)  infection, compared with healthy controls, meta-analyses have shown.[2,3]

Bowel cancer risk is 39% higher in people with H Pylori infection, compared with uninfected people, meta-analyses have shown.[4,5] Colon cancer risk is 30% higher in people with H Pylori.[4,5]

References

  1. International Agency for Research on Cancer. List of Classifications by cancer sites with sufficient or limited evidence in humans, Volumes 1 to 105*. Available from: http://monographs.iarc.fr/ENG/Classification/index.php. Accessed April 2014. 
  2. Damin DC, Ziegelmann PK, Damin AP. Human papillomavirus infection and colorectal cancer risk: a meta-analysis. Colorectal Dis. 2013 Aug;15(8):e420-8. 
  3. Baandrup L, Thomsen LT, Olesen TB, Andersen KK, Norrild B, Kjaer SK. The prevalence of human papillomavirus in colorectal adenomas and adenocarcinomas: a systematic review and meta-analysis. Eur J Cancer. 2014;50(8):1446-61. 
  4. Wu Q, Yang ZP, Xu P, et al. Association between Helicobacter pylori infection and the risk of colorectal neoplasia: a systematic review and meta-analysis. Colorectal Dis. 2013 Jul;15(7):e352-64.
  5. Rokkas T, Sechopoulos P, Pistiolas D, et al. The relationship of Helicobacter pylori infection and colon neoplasia, on the basis of meta-analysis. Eur J Gastroenterol Hepatol. 2013 Nov;25(11):1286-94. 
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Bowel cancer risk is higher in survivors of bowel,[1] head and neck,[1,2] oesophageal,[1] larynx,[1] lung,[1] prostate,[1,2] cervix,[1,3] uterus,[1]or breast[2] cancers; chronic lymphocytic leukaemia[1] and melanoma[2], cohort studies have shown.

Digestive cancer risk is 10-28 times higher in children, teenagers and young adults who had any type of cancer in childhood, compared with the general population, a cohort study showed.[4]

This may relate to a combination of shared risk factors for the primary and secondary cancer, and to the effect of treatment (e.g. radiotherapy) for the primary cancer.

References

  1. Jégu J, Colonna M, Daubisse-Marliac L, et al. The effect of patient characteristics on second primary cancer risk in France. BMC Cancer. 2014 Feb 15;14:94. 
  2. Youlden DR, Baade PD. The relative risk of second primary cancers in Queensland, Australia: a retrospective cohort study. BMC Cancer. 2011 Feb 23;11:83. 
  3. Rodriguez AM, Kuo YF, Goodwin JS. Risk of colorectal cancer among long-term cervical cancer survivors. Med Oncol 2014;31(5):943.
  4. Reulen RC, Frobisher C, Winter DL, et al. Long-term risks of subsequent primary neoplasms among survivors of childhood cancer. JAMA 2011;305:2311-9. 
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X radiation and gamma radiation are classified by the International Agency for Research on Cancer (IARC) as causes of colon cancer; they are classified as probable causes of rectum cancer, based on limited evidence.[1] An estimated 2% of bowel cancer cases in the UK are linked to ionising radiation.[2]

Colon cancer risk is 53% higher in atomic bomb survivors compared with the general population, a cohort study has shown.[3]

Bowel cancer risk decreases with increasing age at radiation exposure.[4] Less than 1% of people chronically exposed to 0.1Gy radiation in early childhood will develop bowel cancer in their lifetime.[4]

References

  1. International Agency for Research on Cancer. List of Classifications by cancer sites with sufficient or limited evidence in humans, Volumes 1 to 105*. Available from: http://monographs.iarc.fr/ENG/Classification/index.php. Accessed April 2014. 
  2. Parkin DM, Darby SC.Cancers in 2010 attributable to ionising radiation exposure in the UK. Br J Cancer 2011;105 Suppl 2:S57-65. 
  3. Semmens EO, Kopecky KJ, Grant E et al. Relationship between anthropometric factors, radiation exposure, and colon cancer incidence in the Life Span Study cohort of atomic bomb survivors.Cancer Causes Control. 2013 Jan;24(1):27-37.
  4. Berrington de Gonsalez A, Iulian Apostoaei A, Veiga LH et al. RadRAT: a radiation risk assessment tool for lifetime cancer risk projection. J Radiol Prot. 2012 Sept;32(3):205-22
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  • Familial adenomatous polyposis (FAP) accounts for less than 1% of bowel cancers.[1,2] Almost all FAP patients develop bowel cancer by age 40.[3]
  • Hereditary non-polyposis colorectal cancer (HNPCC) accounts for 1-4% of colon cancers.[1,2] Around 9 in 10 males and 7 in 10 females with HNPCC develop bowel cancer by age 70.[4]
  • BRCA1 Open a glossary item mutations may account for some bowel cancers, particularly in younger women.[5]

References

  1. Lutgens MW, van Oijen MG, van der Heijden GJ, et al. Declining risk of colorectal cancer in inflammatory bowel disease: an updated meta-analysis of population-based cohort studies. Inflamm Bowel Dis. 2013 Mar-Apr;19(4):789-99. 
  2. Gala M, Chung DC. Hereditary colon cancer syndromes. Semin Oncol 2011;38(4):490-9. 
  3. Galiatsatos P, Foulkes WD. Familial adenomatous polyposis. Am J Gastroenterol 2006;101(2):385-98. 
  4. Dunlop MG, Farrington SM, Carothers AD, et al. Cancer risk associated with germline DNA mismatch repair gene mutations. Hum Mol Genet 1997;6(1):105-10. 
  5. Phelan CM, Iqbal J, Lynch HT, et al. Incidence of colorectal cancer in BRCA1 and BRCA2 mutation carriers: results from a follow-up study. Br J Cancer. 2014 Jan 21;110(2):530-4.
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Around 20% of bowel cancers are associated with hereditary factors other than Familial adenomatous polyposis (FAP) and Hereditary non-polyposis colorectal cancer (HNPCC).[1]

Bowel cancer risk is 80% higher in people with a first-degree relative (parent, sibling, child) with the disease, a meta-analysis showed.[2] Bowel cancer risk among people with a first-degree family history is higher in those with more than one affected relative, or a relative diagnosed at a younger age.[3]

Bowel adenoma risk is 70% higher in people with a first-degree relative with bowel cancer, a meta-analysis showed.[4]

Bowel cancer risk is not associated with having an adoptive parent with the disease, a cohort study showed; this may indicate genetic/biological factors rather than environmental factors underpin the familial risk.[5]

References

  1. Fearnhead NS, Wilding JL, Bodmer WF. Genetics of colorectal cancer: hereditary aspects and overview of colorectal tumorigenesis. Brit Med Bull 2002;64(1):27-43. 
  2. Butterworth AS, Higgins JP, Pharoah P. Relative and absolute risk of colorectal cancer for individuals with a family history: a meta-analysis. Eur J Cancer 2006;42(2):216-27.  
  3. Johns LE, Houlston RS. A systematic review and meta-analysis of familial colorectal cancer risk. Am J Gastroenterol 2001;96(10):2992-3003. 
  4. Wilschut JA, Habbema JD, Ramsey SD, et al. Increased risk of adenomas in individuals with a family history of colorectal cancer: results of a meta-analysis. Cancer Causes Control 2010;21(12):2287-93. 
  5. Zoller B, Li X, Sundguist J et al. Familial transmission of prostate, breast and colorectal cancer in adoptees is related to cancer in biological but not in adoptive parents: a nationwide family study.Eur J Cancer. 2014 Sept:50(13):2319-27
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Greater adult attained height is classified by the World Cancer Research Fund / American Institute for Cancer Research (WCRF/AICR) as a cause of bowel cancer.[1]

Colon cancer risk is 11% (females) and 9% (males) higher per 5cm height increment, a pooled analysis showed.[2] Rectum/anus cancer risk is 9% (females) and 6% (males) higher per 5cm height increment.[3]

References

  1. World Cancer Research Fund / American Institute for Cancer Research. Continuous Update Project: Colorectal Cancer Report 2010 Summary. Food, Nutrition, Physical Activity, and the Prevention of Colorectal Cancer. (PDF 1.11MB) 2011.
  2. Wiren S, Haggstrom C, Ulmer H, et al. Pooled cohort study on height and risk of cancer and cancer death. Cancer Causes Control. 2013 Oct 31. 
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Physical activity is classified by the World Cancer Research Fund / American Institute for Cancer Research (WCRF/AICR) as protective against bowel cancer (with evidence stronger for colon than rectum cancer).[1] An estimated 3% of bowel cancers (5% of colon cancers) in the UK are linked to inadequate physical activity.[2]

Colon cancer risk is 17-24% lower in the most physically active people, compared with the least physically active, meta-analyses of cohort studies have shown.[3-5] Colon cancer risk is 27% higher in the most sedentary people compared with the least, a meta-analysis of cohort studies showed.[6]

Rectal cancer risk is not associated with physical activity, a meta-analysis showed.[4] Rectal cancer risk is 6% higher in the most sedentary people compared with the least, a meta-analysis of cohort studies showed.[6]

Colon adenoma risk is 16% lower in the most physically active people, compared with the least physically active, a meta-analysis showed.[3]

References

  1. World Cancer Research Fund / American Institute for Cancer Research. Continuous Update Project: Colorectal Cancer Report 2010 Summary. Food, Nutrition, Physical Activity, and the Prevention of Colorectal Cancer. (PDF 1.11MB) 2011.
  2. Parkin DM. Cancers attributable to inadequate physical exercise in the UK in 2010. Br J Cancer 2011;105(S2):S38-S41. 
  3. Wolin KY, Yan Y, Colditz GA, et al. Physical activity and colon cancer prevention: a meta-analysis. Br J Cancer 2009;100(4):611-6 
  4. Robsahm TE, Aagnes B, Hjartaker A, et al. Body mass index, physical activity, and colorectal cancer by anatomical subsites: a systematic review and meta-analysis of cohort studies. Eur J Cancer Prev. 2013 Nov;22(6):492-505. 
  5. Boyle T, Keegel T, Bull F, et al. Physical activity and risks of proximal and distal colon cancers: a systematic review and meta-analysis. J Natl Cancer Inst. 2012 Oct 17;104(20):1548-61. 
  6. Cong YJ, Gan Y, Sun HL, et al. Association of sedentary behaviour with colon and rectal cancer: a meta-analysis of observational studies. Br J Cancer. 2013 Nov 21. 
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Dietary fibre, garlic, milk, and calcium are classified by the World Cancer Research Fund / American Institute for Cancer Research (WCRF/AICR) as probably protective against bowel cancer.[1]

Non-starchy vegetables, fruit, dietary folate, dietary or supplementary selenium, fish, and dietary vitamin D are classified by WCRF/AICR as possibly protective against bowel cancer, based on limited evidence.[2]

Bowel cancer risk is lower in people with higher intake of the following foods, meta- and pooled analyses, systematic reviews or cohort studies have shown:

  • Dietary fibre - 12% of bowel cancers in the UK are linked to eating less than 23g/day of fibre.[3] 10% decreased risk per 10g/day total dietary fibre and cereal fibre (no association with fruit and vegetable fibre(.[4]
  • Whole grains - 20% lower risk per 90g/day.[4]
  • Dietary fibre (bowel adenoma) - 9% lower risk per 10g/day of total dietary fibre (cereal and fruit fibre only, not vegetable fibre).[5]
  • Vegetables overall (colon cancer) - 2% lower risk per 100g/day.[6-8]
  • Milk - 20-30% lower risk per 200-250g/day[9,10] (may be limited to non-fermented milk and males).[11]
  • Milk (colon cancer) - 9-15% lower risk per 200-250g/day.[9,10]
  • Total calcium - 8% lower risk per 300mg/day;[12] 22% lower risk with highest intake versus lowest[10] (some evidence less effect of dietary than supplementary calcium,[10,13] some evidence no association with non-dairy dietary calcium[14]).
  • Calcium supplements - 9% lower risk per 300mg/day[12](though some evidence of no association.[15-17]

Bowel cancer risk is lower in people with the highest versus the lowest intake of the following foods, meta- and pooled analyses, systematic reviews or cohort studies have shown:

  • Cruciferous vegetables (colon cancer) - 9-22% lower risk.[6-8]
  • Fruits (colon cancer) - 11% lower risk.[6]
  • Fish – 7% lower risk (though no association with colon adenoma risk[18]).[19]
  • Dietary (not supplements) beta-carotene (colon cancer) - 31% lower risk.[20]
  • Dietary vitamin E (distal colon cancer) - 35% lower risk.[20]
  • Dietary vitamin C (distal colon cancer) - 40% lower risk.[20]
  • Dietary zinc - 20% lower risk.[21]

References

  1. World Cancer Research Fund / American Institute for Cancer Research. Continuous Update Project: Colorectal Cancer Report 2010 Summary. Food, Nutrition, Physical Activity, and the Prevention of Colorectal Cancer. (PDF 1.11MB) 2011.
  2. Liu L, Zhuang W, Wang RQ, et al. Is dietary fat associated with the risk of colorectal cancer? A meta-analysis of 13 prospective cohort studies. Eur J Nutr 2011;50(3):173-84.
  3. Parkin DM, Boyd L. 6. Cancers attributable to dietary factors in the UK in 2010. Br J Cancer 2011;105(S2):S27-S30. 
  4. Aune D, Chan DS, Lau R, et al. Dietary fibre, whole grains, and risk of colorectal cancer: systematic review and dose-response meta-analysis of prospective studies. BMJ 2011;343:d6617. 
  5. Ben Q, Sun Y, Chai R, et al. Dietary Fiber Intake Reduces Risk for Colorectal Adenoma: a Meta-Analysis. Gastroenterology. 2013 Nov 8. pii: S0016-5085(13)01586-2.  
  6. Aune D, Lau R, Chan DS, et al. Nonlinear reduction in risk for colorectal cancer by fruit and vegetable intake based on meta-analysis of prospective studies. Gastroenterology 2011;141(1):106-18. 
  7. Tse G, Eslick GD. Cruciferous vegetables and risk of colorectal neoplasms: a systematic review and meta-analysis. Nutr Cancer. 2014;66(1):128-39. 
  8. Wu QJ, Yang Y, Vogtmann E, et al. Cruciferous vegetables intake and the risk of colorectal cancer: a meta-analysis of observational studies. Ann Oncol. 2013 Apr;24(4):1079-87.  
  9. Aune D, Lau R, Chan DS, et al. Dairy products and colorectal cancer risk: a systematic review and meta-analysis of cohort studies. Ann Oncol 2012;23(1):37-45.
  10. Cho E, Smith-Warner SA, Spiegelman D, et al. Dairy foods, calcium, and colorectal cancer: a pooled analysis of 10 cohort studies. J Natl Cancer Inst 2004;96(13):1015-22. 
  11. Ralston RA, Truby H, Palermo CE, et al. Colorectal cancer and nonfermented milk, solid cheese, and fermented milk consumption: a systematic review and meta-analysis of prospective studies. Crit Rev Food Sci Nutr. 2014;54(9):1167-79. 
  12. Keum N, Aune D, Greenwood DC, et al. Calcium intake and colorectal cancer risk: Dose-response meta-analysis of prospective observational studies. Int J Cancer. 2014 Mar 13. 
  13. Key TJ, Appleby PN, Masset G, et al. Vitamins, minerals, essential fatty acids and colorectal cancer risk in the United Kingdom dietary cohort consortium. Int J Cancer 2011. 
  14. Murphy N, Norat T, Ferrari P, et al. Consumption of dairy products and colorectal cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC). PLoS One. 2013 Sep 2;8(9):e72715. 
  15. Cooper K, Squires H, Carroll C, et al. Chemoprevention of colorectal cancer: systematic review and economic evaluation. Health Technol Assess 2010;14(32):1-206. 
  16. Carroll C, Cooper K, Papaioannou D, Hind D, Pilgrim H, Tappenden P. Supplemental calcium in the chemoprevention of colorectal cancer: a systematic review and meta-analysis. Clin Ther 2010;32(5):789-803.
  17. Weingarten MA, Zalmanovici A, Yaphe J. Dietary calcium supplementation for preventing colorectal cancer and adenomatous polyps. Cochrane Database Syst Rev 2008(1):CD003548. 
  18. Xu B, Sun J, Sun Y, et al. No evidence of decreased risk of colorectal adenomas with white meat, poultry, and fish intake: a meta-analysis of observational studies. . Ann Epidemiol 2013;23(4):215-22.  
  19. Yu XF, Zou J, Dong J. Fish consumption and risk of gastrointestinal cancers: a meta-analysis of cohort studies. World J Gastroenterol. 2014 Nov 7;20(41):15398-412
  20. Leenders M, Leufkens AM, Siersema PD, et al. Plasma and dietary carotenoids and vitamins A, C and E and risk of colon and rectal cancer in the European Prospective Investigation into Cancer and Nutrition. Int J Cancer 2014. 
  21. Li P, Xu J, Shi Y, et al. Association between zinc intake and risk of digestive tract cancers: A systematic review and meta-analysis. Clin Nutr. 2013 Oct 10.  
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Bowel cancer risk is lower in people with higher levels of the following micronutrients, meta- and pooled analyses, systematic reviews or cohort studies have shown:

  • Retinol blood levels (colon cancer) - 37% lower risk for highest versus lowest levels.[1]
  • Vitamin D blood levels (25(OH)D) - 15-26% lower risk per 10-20ng/mL[2-5] (some evidence of modification by tumour states, other lifestyle factors and other medical conditions[6-8] some evidence vitamin D modifies effect of calcium[9], some evidence no effect of dietary vitamin D[10]).

 

References

  1. Leenders M, Leufkens AM, Siersema PD, et al. Plasma and dietary carotenoids and vitamins A, C and E and risk of colon and rectal cancer in the European Prospective Investigation into Cancer and Nutrition. Int J Cancer 2014. 
  2. Ma Y, Zhang P, Wang F, et al. Association between vitamin D and risk of colorectal cancer: a systematic review of prospective studies. J Clin Oncol 2011;29(28):3775-82.
  3. Yin L, Grandi N, Raum E, et al. Meta-analysis: Serum vitamin D and colorectal adenoma risk. Prev Med 2011;53(1-2):10-6.
  4. Gandini S, Boniol M, Haukka J, et al. Meta-analysis of observational studies of serum 25-hydroxyvitamin D levels and colorectal, breast and prostate cancer and colorectal adenoma. Int J Cancer 2011;128(6):1414-24. 
  5. Autier P, Boniol M, Pizot C, Mullie P. Vitamin D status and ill health: a systematic review. Lancet Diabetes Endocrinol 2014;2(1):76-89. 
  6. Jacobs ET, Hibler EA, Lance P, et al. Association between circulating concentrations of 25(OH)D and colorectal adenoma: a pooled analysis. Int J Cancer. 2013 Dec 15;133(12):2980-8.
  7. Ananthakrishnan AN, Cheng SC, Cai T, et al. Association Between Reduced Plasma 25-hydroxy Vitamin D and Increased Risk of Cancer in Patients with Inflammatory Bowel Diseases. Clin Gastroenterol Hepatol. 2013 Oct 23. pii: S1542-3565(13)01644-3. 
  8. Skaaby T, Husemoen LL, Thuesen BH, et al. Prospective population-based study of the association between serum 25-hydroxyvitamin-D levels and the incidence of specific types of cancer. Cancer Epidemiol Biomarkers Prev 2014;23(7):1220-9. 
  9. Wactawski-Wende J, Kotchen JM, Anderson GL, et al. Calcium plus vitamin D supplementation and the risk of colorectal cancer. N Engl J Med 2006;354(7):684-96.
  10. Key TJ, Appleby PN, Masset G, et al. Vitamins, minerals, essential fatty acids and colorectal cancer risk in the United Kingdom dietary cohort consortium. Int J Cancer 2011. 
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Bowel cancer risk is lower in people who use the following medications or have the following medical conditions, meta- and pooled analyses, systematic reviews or cohort studies have shown:

  • Hormone replacement therapy – 16% lower risk for ever-use versus never-use, and some suggestion of stronger association in current versus past users[1-4] (though some evidence this risk decrease has ‘little clinically meaningful impact’[5]).
  • Oral contraceptives – 14-19% reduced risk for ever-use versus never-use.[6-7]
  • Aspirin – 32-49% reduced risk for daily use for 5 years or more, versus non-use.[8]
  • Aspirin (bowel adenoma) – 17% reduced risk for aspirin versus placebo.[9]

References

  1. Grodstein F, Newcomb PA, Stampfer MJ. Postmenopausal hormone therapy and the risk of colorectal cancer: a review and meta-analysis. The American Journal of Medicine 1999;106(5):574-82.
  2. Hebert-Croteau N. A meta-analysis of hormone replacement therapy and colon cancer in women. Cancer Epidemiol Biomarkers Prev 1998;7(8):653-9.
  3. Nanda K, Bastian LA, Hasselblad V, et al. Hormone replacement therapy and the risk of colorectal cancer: a meta-analysis. Obstet Gynecol 1999;93(5 Pt 2):880-8. 
  4. Green J, Czanner G, Reeves G, et al. Menopausal hormone therapy and risk of gastrointestinal cancer: nested case-control study within a prospective cohort, and meta-analysis. Int J Cancer 2012;130(10):2387-96. 
  5. Marjoribanks J, Farquhar C, Roberts H, Lethaby A. Long term hormone therapy for perimenopausal and postmenopausal women.. Cochrane Database Syst Rev 2012;7:CD004143. 
  6. Bosetti C, Bravi F, Negri E, et al. Oral contraceptives and colorectal cancer risk: a systematic review and meta-analysis. Hum Reprod Update 2009;15(5):489-98. 
  7. Gierisch JM, Coeytaux RR, Urrutia RP, et al. Oral contraceptive use and risk of breast, cervical, colorectal, and endometrial cancers: a systematic review. Cancer Epidemiol Biomarkers Prev 2013;22(11):1931-43.
  8. Algra AM, Rothwell PM. Effects of regular aspirin on long-term cancer incidence and metastasis: a systematic comparison of evidence from observational studies versus randomised trials. Lancet Oncol. 2012;13(5):518-27. 
  9. Cole BF, Logan RF, Halabi S, et al. Aspirin for the chemoprevention of colorectal adenomas: meta-analysis of the randomized trials.. J Natl Cancer Inst 2009;101(4):256-66. 
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The World Cancer Research Fund / American Institute for Cancer Research (WCRF/AICR) make no judgement on the association between bowel cancer risk and intake of fish, folate, selenium, cereals, potatoes, poultry, shellfish and other seafood, other dairy products, total fat, fatty acid, cholesterol, sucrose, coffee, tea, caffeine, total carbohydrates, starch, vitamin A, retinol, vitamin C, vitamin E, multivitamins, non-dairy sources of calcium, methionine, beta-carotene, alpha-carotene, and lycopene, due to limited evidence.[1]

Bowel cancer risk is not associated with intake of the following foods, meta- and pooled analyses, systematic reviews or cohort studies have shown:

  • Fish[2-6] (though some evidence of rectal cancer risk decrease[6]), also no association with colon adenoma risk.[7]
  • Dietary omega-3 or -6 fatty acids.[8]
  • Allium vegetables (though some evidence of colon cancer risk increase in women).[9]
  • Dietary folate[10,8] (though some evidence of risk decrease[11,12]).
  • Folic acid supplements[13,14] (though some evidence of risk increase with long term use[14]).
  • Selenium[13,15-17] (though some evidence of risk decrease[18] perhaps limited to males REF:19]).
  • Dietary/supplementary vitamin B6[20,8] (though some evidence of risk decrease with higher blood levels,[20] and some evidence of rectal cancer risk increase.[21]
  • Vitamin B12[22,8,23] (though some evidence of rectal cancer risk decrease[24,25]).
  • Coffee.[26-30] (though some evidence of risk decrease[27])
  • Tea (all types) (though some evidence of a risk increase[30])
  • Vitamin D supplements.[31]
  • Retinol (blood levels or dietary).[8,32]
  • Dietary vitamin A.[8]
  • Dietary thiamin.[8]
  • Dietary riboflavin.[8]
  • Dietary magnesium.[8]
  • Dietary potassium.[8]
  • Beta carotene supplements.[17]
  • Poultry (bowel adenoma).[33]
  • White meat (bowel adenoma).[33]
  • Green or black tea.[30]

References

  1. World Cancer Research Fund / American Institute for Cancer Research. Continuous Update Project: Colorectal Cancer Report 2010 Summary. Food, Nutrition, Physical Activity, and the Prevention of Colorectal Cancer. (PDF 1.11MB) 2011.
  2. Geelen A, Schouten JM, Kamphuis C, et al. Fish consumption, n-3 fatty acids, and colorectal cancer: a meta-analysis of prospective cohort studies. Am J Epidemiol 2007;166(10):1116-25.
  3. Huxley RR, Ansary-Moghaddam A, Clifton P, et al. The impact of dietary and lifestyle risk factors on risk of colorectal cancer: a quantitative overview of the epidemiological evidence. Int J Cancer 2009;125(1):171-80.
  4. Sugawara Y, Kuriyama S, Kakizaki M, et al. Fish consumption and the risk of colorectal cancer: the Ohsaki Cohort Study. Br J Cancer 2009;101(5):849-54.
  5. Daniel CR, Cross AJ, Graubard BI, et al. Prospective investigation of poultry and fish intake in relation to cancer risk. Cancer Prev Res (Phila) 2011;4(11):1903-11. 
  6. Wu S, Feng B, Li K, et al. Fish consumption and colorectal cancer risk in humans: a systematic review and meta-analysis. Am J Med. 2012;125(6):551-9. 
  7. Xu B, Sun J, Sun Y, et al. No evidence of decreased risk of colorectal adenomas with white meat, poultry, and fish intake: a meta-analysis of observational studies. . Ann Epidemiol 2013;23(4):215-22.  
  8. Key TJ, Appleby PN, Masset G, et al. Vitamins, minerals, essential fatty acids and colorectal cancer risk in the United Kingdom dietary cohort consortium. Int J Cancer 2011. 
  9. Zhu B, Zou L, Qi L, et al. Allium Vegetables and Garlic Supplements do Not Reduce Risk of Colorectal Cancer, Based on Meta-analysis of Prospective Studies. Clin Gastroenterol Hepatol. 2014 Mar 26. 
  10. Kennedy DA, Stern SJ, Moretti M, et al. Folate intake and the risk of colorectal cancer: a systematic review and meta-analysis. Cancer Epidemiol 2011;35(1):2-10. 
  11. Sanjoaquin MA, Allen N, Couto E, et al. Folate intake and colorectal cancer risk: a meta-analytical approach. Int J Cancer 2005;113(5):825-8. 
  12. Gibson TM, Weinstein SJ, Pfeiffer RM, et al. Pre- and postfortification intake of folate and risk of colorectal cancer in a large prospective cohort study in the United States, Am J Clin Nutr 2011;94(4):1053-62. 
  13. Cooper K, Squires H, Carroll C, et al. Chemoprevention of colorectal cancer: systematic review and economic evaluation. Health Technol Assess 2010;14(32):1-206. 
  14. Fife J, Raniga S, Hider PN, et al. Folic acid supplementation and colorectal cancer risk: a meta-analysis. Colorectal Dis 2009;13(2):132-7. 
  15. Dennert G, Zwahlen M, Brinkman M, et al. Selenium for preventing cancer. Cochrane Database Syst Rev 2011(5):CD005195. 
  16. Papaioannou D, Cooper KL, Carroll C, et al. Antioxidants in the chemoprevention of colorectal cancer and colorectal adenomas in the general population: a systematic review and meta-analysis. Colorectal Dis 2011;13(10):1085-99. 
  17. Pais R, Dumitraşcu DL. Do antioxidants prevent colorectal cancer? A meta-analysis. . Rom J Intern Med 2013;51(3-4):152-63. 
  18. Jacobs ET, Jiang R, Alberts DS, et al. Selenium and colorectal adenoma: results of a pooled analysis. J Natl Cancer Inst 2004;96(22):1669-75. 
  19. Takata Y, Kristal AR, King IB, et al. Serum selenium, genetic variation in selenoenzymes, and risk of colorectal cancer: primary analysis from the Women's Health Initiative Observational Study and meta-analysis. Cancer Epidemiol Biomarkers Prev 2011;20(9):1822-30. 
  20. Larsson SC, Orsini N, Wolk A. Vitamin B6 and risk of colorectal cancer: a meta-analysis of prospective studies. JAMA 2010;303(11):1077-83. 
  21. Chan AT, Giovannucci EL. Primary prevention of colorectal cancer. Gastroenterology 2010;138(6):2029-43 e10. 
  22. Eussen SJ, Vollset SE, Hustad S, et al. Plasma vitamins B2, B6, and B12, and related genetic variants as predictors of colorectal cancer risk. Cancer Epidemiol Biomarkers Prev 2010;19(10):2549-61. 
  23. Le Marchand L, Wang H, Selhub J, et al. Association of plasma vitamin B6 with risk of colorectal adenoma in a multiethnic case-control study. Cancer Causes Control 2011;22(6):929-36. 
  24. Kune G, Watson L. Lowering the Risk of Rectal Cancer among Habitual Beer Drinkers by Dietary Means. Adv Prev Med 2011;2011:874048. 
  25. Dahlin AM, Van Guelpen B, Hultdin J, et al. Plasma vitamin B12 concentrations and the risk of colorectal cancer: a nested case-referent study. Int J Cancer 2008;122(9):2057-61. 
  26. Zhang X, Albanes D, Beeson WL, et al. Risk of colon cancer and coffee, tea, and sugar-sweetened soft drink intake: pooled analysis of prospective cohort studies . J Natl Cancer Inst 2010;102(11):771-83. 
  27. Li G, Ma D, Zhang Y, et al. Coffee consumption and risk of colorectal cancer: a meta-analysis of observational studies. Public Health Nutr. 2013 Feb;16(2):346-57.
  28. Je Y1, Liu W, Giovannucci E. Coffee consumption and risk of colorectal cancer: a systematic review and meta-analysis of prospective cohort studies. Int J Cancer. 2009 Apr 1;124(7):1662-8.
  29. Giovannucci E. Meta-analysis of coffee consumption and risk of colorectal cancer. Am J Epidemiol. 1998 Jun 1;147(11):1043-52. 
  30. Yu F, Jin Z, Jiang H, Xiang C, Tang J, Li T, He J. Tea consumption and the risk of five major cancers: a dose-response meta-analysis of prospective studies. BMC Cancer 2014;14:197.
  31. Autier P, Boniol M, Pizot C, Mullie P. Vitamin D status and ill health: a systematic review. Lancet Diabetes Endocrinol 2014;2(1):76-89. 
  32. Leenders M, Leufkens AM, Siersema PD, et al. Plasma and dietary carotenoids and vitamins A, C and E and risk of colon and rectal cancer in the European Prospective Investigation into Cancer and Nutrition. Int J Cancer 2014. 
  33. Xu B, Sun J, Sun Y, et al. No evidence of decreased risk of colorectal adenomas with white meat, poultry, and fish intake: a meta-analysis of observational studies. . Ann Epidemiol 2013;23(4):215-22.  
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Bowel cancer risk is not associated with use of the following medications, meta- and pooled analyses, systematic reviews or cohort studies have shown:

  • Statins (though some evidence of lower risk, mainly in case-control studies);[1-5] accordingly bowel cancer risk is not associated with total blood cholesterol level.[6]
  • Angiotensin receptor blockers (though some evidence of lower risk).[7-9]
  • ACE-inhibitors (though some evidence of lower risk).[7,8]
  • Thiopurines use among Inflammatory bowel disease (IBD) patients (bowel neoplasia and bowel cancer).[10,11]

References

  1. Bonovas S, Filioussi K, Flordellis CS, et al. Statins and the risk of colorectal cancer: a meta-analysis of 18 studies involving more than 1.5 million patients. J Clin Oncol 2007;25(23):3462-8.
  2. Boudreau DM, Yu O, Johnson J. Statin use and cancer risk: a comprehensive review. Expert Opin Drug Saf 2010;9(4):603-21.
  3. Browning DR, Martin RM. Statins and risk of cancer: a systematic review and metaanalysis. Int J Cancer 2007;120(4):833-43. 
  4. Liu Y, Tang W, Wang J, et al. Association between statin use and colorectal cancer risk: a meta-analysis of 42 studies. Cancer Causes Control 2014;25(2):237-49.
  5. Lytras T, Nikolopoulos G, Bonovas S. Statins and the risk of colorectal cancer: an updated systematic review and meta-analysis of 40 studies. World J Gastroenterol 2014;20(7):1858-70. 
  6. Melvin JC, Holmberg L, Rohrmann S, Loda M, Van Hemelrijck M. Serum lipid profiles and cancer risk in the context of obesity: four meta-analyses. J Cancer Epidemiol 2013;2013:823849.
  7. Makar GA, Holmes JH, Yang YX. Angiotensin-converting enzyme inhibitor therapy and colorectal cancer risk. J Natl Cancer Inst. 2014 Feb;106(2):djt374.
  8. Azoulay L, Assimes TL, Yin H, et al. Long-term use of angiotensin receptor blockers and the risk of cancer. PLoS One. 2012;7(12):e50893.
  9. Sipahi I, Debanne SM, Rowland DY, et al. Angiotensin-receptor blockade and risk of cancer: meta-analysis of randomised controlled trials . The Lancet Oncology, Volume 11, Issue 7, Pages 627 - 636, July 2010 
  10. Gong J, Zhu L, Guo Z, et al. Use of thiopurines and risk of colorectal neoplasia in patients with inflammatory bowel diseases: a meta-analysis. PLoS One. 2013 Nov 28;8(11):e81487. 
  11. Jess T, Lopez A, Andersson M et al. Thiopurines and risk of colorectal neoplasia in patients with inflammatory bowel disease: a meta-analysis. Clin Gastroenterol Hepatol. 2014 Nov:12(11):1793-1800
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Bowel cancer risk is not associated with these other factors, meta- and pooled analyses, systematic reviews or cohort studies have shown:

  • Irritable bowel syndrome (IBS) (no long-term risk increase; apparent higher risk soon after IBS diagnosis probably reflects increased medical monitoring or initial misdiagnosis of bowel cancer as IBS).[1-3]
  • Constipation[4] (some evidence of higher risk[4,5] though may be limited to poorly-managed constipation[6]).
  • Human immunodeficiency virus (HIV) infection.[7-9]
  • Parity (number of children given birth to).[10]
  • Drinking water disinfection by-products (some evidence of higher risk limited to case-control studies).[11]

References

  1. Nørgaard M, Farkas DK, Pedersen L, et al. Irritable bowel syndrome and risk of colorectal cancer: a Danish nationwide cohort study. Br J Cancer. 2011 Mar 29;104(7):1202-6.
  2. Hsiao CW, Huang WY, Ke TW, et al. Association between irritable bowel syndrome and colorectal cancer: A nationwide population-based study. Eur J Intern Med. 2014 Jan;25(1):82-6. 
  3. Canavan C, Card T, West J. The incidence of other gastroenterological disease following diagnosis of irritable bowel syndrome in the UK: a cohort study. PLoS One. 2014 Sept 19:9(9)
  4. Power AM, Talley NJ, Ford AC. Association between constipation and colorectal cancer: systematic review and meta-analysis of observational studies. Am J Gastroenterol 2013 ;108(6):894-903. 
  5. Guérin A, Mody R, Fok B, et al. Risk of developing colorectal cancer and benign colorectal neoplasm in patients with chronic constipation. Aliment Pharmacol Ther 2014;40(1):83-92. 
  6. Scarpignato C, Blandizzi C. Editorial: adequate management may reduce the colorectal cancer risk associated with constipation. Aliment Pharmacol Ther 2014;40(5):562-4. 
  7. Grulich AE, van Leeuwen MT, Falster MO, et al. Incidence of cancers in people with HIV/AIDS compared with immunosuppressed transplant recipients: a meta-analysis. Lancet. 2007 Jul 7;370(9581):59-67.
  8. Shiels MS, Cole SR, Kirk GD, et al. A meta-analysis of the incidence of non-AIDS cancers in HIV-infected individuals. J Acquir Immune Defic Syndr. 2009 Dec;52(5):611-22.
  9. Keller SC, Momplaisir F, Lo Re V, et al. Colorectal cancer incidence and screening in US Medicaid patients with and without HIV infection. AIDS Care. 2013 Nov 5. 
  10. Guan HB, Wu QJ, Gong TT, Lin B, Wang YL, Liu CX. Parity and risk of colorectal cancer: a dose-response meta-analysis of prospective studies. PLoS One 2013;8(9):e75279. 
  11. Rahman MB, Driscoll T, Cowie C et al. Disinfection by-products in drinking water and colorectal cancer: a meta-analysis. Int J Epidemiol. 2010 Jun; 39(3):733-45
Last reviewed:

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