Bowel cancer risk factors

Prevention

Preventable cases of bowel cancer, UK

Red and processed meat

Bowel cancer cases linked to eating red and processed meat, UK

Excess bodyweight

Bowel cancer cases linked to excess bodyweight, UK

Low fibre

Bowel cancer cases linked to eating too little fibre, UK

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

Bowel cancer is associated with a number of risk factors.[2,4]

Bowel Cancer Risk Factors

  Increases risk Decreases risk
'Sufficient' or 'convincing' evidence
  • Alcoholic drinks
  • Tobacco smoking
  • X-radiation, gamma-radiation[a]
  • Processed meat
  • Body fatness
  • Adult attained height
  • Physical activity[b]
'Limited' or 'probable' evidence
  • Asbestos
  • Schistosoma japonicum
  • Red meat
  • Wholegrains
  • Dietary fibre in foods
  • Dairy products
  • Calcium supplements
  • Oestrogen-progestogen contraceptives

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 WCRF/AICR classifies evidence on physical activity as convincing for colon, no conclusion was drawn for rectum.

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 119*. Accessed September 2017.
  3. Lauby-Secretan B, Scoccianti C, Loomis D, et al. Body Fatness and Cancer--Viewpoint of the IARC Working Group. N Engl J Med. 2016 Aug 25;375(8):794-8.
  4. World Cancer Research Fund / American Institute for Cancer Research. Continuous Update Project Findings & Reports. Accessed September 2017.
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International Agency for Research on Cancer (IARC) and World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) classify the role of this risk factor in cancer development.[1,2] An estimated 21% of bowel cancers each year in the UK are linked to eating red and processed meat.[3]

Bowel cancer risk is 17-30% higher per 100-120g/day of red meat intake, meta-analyses have shown.[4-7]

Bowel cancer risk is 9-50% higher per 25-50g/day of processed meat intake, meta-analyses have shown;[4-7] however bowel cancer risk was not associated with processed meat intake in a pooled analysis of UK case-control studies.[8] Colon cancer risk is 12% higher per 1mg/day of haem iron intake, a meta-analysis showed;[9] though bowel cancer risk was not associated with dietary iron intake in a pooled analysis of UK cohort studies.[10]

Serrated bowel polyp risk is 23% higher in people with the highest versus lowest levels of red meat intake, a meta-analysis showed.[11]

References

  1. International Agency for Research on Cancer. List of Classifications by cancer sites with sufficient or limited evidence in humans, Volumes 1 to 119*. Accessed September 2017. 
  2. World Cancer Research Fund / American Institute for Cancer Research. Continuous Update Project Findings & Reports. Accessed September 2017.
  3. Parkin DM. 5. Cancers attributable to dietary factors in the UK in 2010. Br J Cancer 2011;105(s2):s24-S26.
  4. 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.
  5. 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.
  6. 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.
  7. 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. 
  8. 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. 
  9. 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. 
  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.
  11. Bailie L, Loughrey MB, Coleman HG. Lifestyle Risk Factors for Serrated Colorectal Polyps: A Systematic Review and Meta-analysis.
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International Agency for Research on Cancer (IARC) and World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) classify the role of this risk factor in cancer development.[1,2] An estimated 13% of bowel cancers each year in the UK are linked to overweight or obesity.[3]

Body-mass index (BMI)

Colon cancer risk is 18% higher in men who are overweight (body mass index [BMI] 25-29.9) and 48% higher in men who are obese (BMI 30+), compared with men of a normal weight (BMI 18.5-24.9), a meta-analysis showed.[4] Colon cancer risk is 12% higher in women who are obese, compared with women of a normal weight, a meta-analysis showed.[4] There is no association with rectal cancer in overweight women;[4] the association in obese women may be stronger in premenopausal than postmenopausal women.[5]

Rectal cancer risk is 6% higher in men who are overweight and 25% higher in men who are obese, compared with men of a normal weight, a meta-analysis showed.[4] There is no association between BMI and rectal cancer in women.[4]

Bowel cancer risk among men is 10% higher per 5 BMI units gained during adulthood, a meta-analysis showed.[6] Bowel cancer risk among women is not associated with weight gain during adulthood.[6]

Bowel adenoma risk is 47% higher in people who are obese by BMI compared with those who are healthy-weight, a meta-analysis showed.[7]

Waist circumference

Bowel cancer risk is 46% higher in people with the largest waist circumference, versus those with the smallest, a meta-analysis showed.[8]

Bowel adenoma risk is 39% higher in people with the largest waist circumference, versus those with the smallest, a meta-analysis showed.[9]

References

  1. Lauby-Secretan B, Scoccianti C, Loomis D, et al. Body Fatness and Cancer--Viewpoint of the IARC Working Group. N Engl J Med. 2016 Aug 25;375(8):794-8.
  2. World Cancer Research Fund / American Institute for Cancer Research. Continuous Update Project Findings & Reports. Accessed September 2017.
  3. Parkin DM, Boyd L. Cancers attributable to overweight and obesity in the UK in 2010. Br J Cancer 2011;105 Suppl 2:S34-7.
  4. Xue K, Li FF, Chen YW, et al. Body mass index and the risk of cancer in women compared with men: a meta-analysis of prospective cohort studies. Eur J Cancer Prev. 2017 Jan;26(1):94-105.
  5. 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.
  6. 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.
  7. 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.
  8. 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.
  9. 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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International Agency for Research on Cancer (IARC) and World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) classify the role of this risk factor in cancer development.[1,2] An estimated 11% of bowel cancer cases each year in the UK are linked to alcohol consumption.[3]

Bowel cancer risk is 17% higher in people who consume around 12.5-50g (1.5-6 units) of alcohol per day, and 33% higher in those who consume 50g+ (6+ units) of alcohol per day, compared with non-/occasional drinkers, a meta-analysis showed.[4] Bowel cancer risk increases by 7% per unit of alcohol consumed per day.[5]

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.[6]

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International Agency for Research on Cancer (IARC) classifies the role of this risk factor in cancer development.[1] An estimated 8% of bowel cancer cases in the UK are linked to tobacco smoking.[2]

Bowel cancer risk is 17-21% higher in current cigarette smokers compared with never-smokers, meta-analyses of cohort studies have shown.[3-5] The association may be stronger in males than females, and stronger for rectal than colon cancer.[3-6

Bowel cancer risk is 17-25% higher in former cigarette smokers compared with never smokers, meta-analyses have shown.[3-5]

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.[4] Bowel cancer risk is higher in people who start smoking younger.[5

Adenomatous bowel polyp risk is around twice as high in current smokers compared with never-smokers, a meta-analysis showed.[7]

Serrated bowel polyp risk is more than twice as high in current smokers compared with never- and ex-smokers, a meta-analysis showed.[8]

References

  1.  International Agency for Research on Cancer. List of Classifications by cancer sites with sufficient or limited evidence in humans, Volumes 1 to 119*. Accessed September 2017.
  2. Parkin DM. 2. Tobacco-attributable cancer burden in the UK in 2010. Br J Cancer 2011;105(S2):S6-S13.
  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. 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. 
  5. 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.
  6. 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.
  7. Botteri E, Iodice S, Raimondi S, et al. Cigarette smoking and adenomatous polyps: a meta-analysis. Gastroenterology 2008;134(2):388-95.
  8. Bailie L, Loughrey MB, Coleman HG. Lifestyle Risk Factors for Serrated Colorectal Polyps: A Systematic Review and Meta-analysis. Gastroenterology. 2017 Jan;152(1):92-104.
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Diabetes

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 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]

Inflammatory bowel disease

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.[12] 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.[12,13] Bowel cancer risk may vary by location of IBD lesions.[14]

Adenomas

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.[15] 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.[16]

Aspirin

Bowel cancer risk is 32-49% lower in people who have used aspirin daily for at least five years, compared with non-users, a meta-analysis showed.[17]

Bowel adenoma risk is 17% lower in people who used aspirin, compared with those who took a placebo, a meta-analysis of randomised control trials showed.[18]

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. 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.
  7. 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
  8. Rokkas T, Portincasa P. Colon neoplasia in patients with type 2 diabetes on metformin: A meta-analysis. Eur J Intern Med. 2016 Jun 15.
  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.
  12. 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.
  13. 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.
  14. 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.
  15. Marti­nez ME, Baron JA, Lieberman DA, et al. A pooled analysis of advanced colorectal neoplasia diagnoses after colonoscopic polypectomy.Gastroenterology. 2009;136(3):832-41.
  16. Hassan C, Gimeno-Garcia 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.
  17. 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.
  18. 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.;17:212.
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Bowel cancer risk is 14-19% lower in ever-users versus never-users of oral contraceptives, meta-analyses have shown.[1,2]

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International Agency for Research on Cancer (IARC) classifies the role of this risk factor in cancer development.[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]

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Family history

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 more than doubled 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.[2,3]

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]

Familial adenomatous polyposis (FAP)

Familial adenomatous polyposis (FAP) accounts for less than 1% of bowel cancers.[6] Almost all FAP patients develop bowel cancer by age 40.[7]

Hereditary non-polyposis colorectal cancer (HNPCC)

Hereditary non-polyposis colorectal cancer (HNPCC) accounts for 1-4% of colon cancers.[6] Around 9 in 10 males and 7 in 10 females with HNPCC develop bowel cancer by age 70.[8]

BRCA1

BRCA1 Open a glossary item mutations may account for some bowel cancers, particularly in younger women.[9]

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
  6. Gala M, Chung DC. Hereditary colon cancer syndromes. Semin Oncol 2011;38(4):490-9. 
  7. Galiatsatos P, Foulkes WD. Familial adenomatous polyposis. Am J Gastroenterol 2006;101(2):385-98. 
  8. 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.
  9. 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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World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) classifies the role of this risk factor in cancer development.[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.[7]

References

  1. World Cancer Research Fund / American Institute for Cancer Research. Continuous Update Project Findings & Reports. Accessed September 2017.
  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.
  7. Wolin KY, Yan Y, Colditz GA. Physical activity and risk of colon adenoma: a meta-analysis. Br J Cancer. 2011 Mar 1;104(5):882-5.
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World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) classifies the role of this risk factor in cancer development.[1]

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.[2] 10% decreased risk per 10g/day total dietary fibre and cereal fibre (no association with fruit and vegetable fibre.[3]
  • Whole grains - 20% lower risk per 90g/day.[3]
  • Dietary fibre (bowel adenoma) - 9% lower risk per 10g/day of total dietary fibre (cereal and fruit fibre only, not vegetable fibre some evidence no association with serrated bowel polyps[4]).[5]

References

  1. World Cancer Research Fund / American Institute for Cancer Research. Continuous Update Project Findings & Reports. Accessed September 2017.
  2. Parkin DM, Boyd L. 6. Cancers attributable to dietary factors in the UK in 2010. Br J Cancer 2011;105(S2):S27-S30. 
  3. 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. 
  4. Bailie L, Loughrey MB, Coleman HG. Lifestyle Risk Factors for Serrated Colorectal Polyps: A Systematic Review and Meta-analysis. Gastroenterology. 2017 Jan;152(1):92-104.
  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.  
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