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Risk factors for colorectal cancer significantly vary by anatomic site.

Demb J, Earles A, Martínez ME, Bustamante R, Bryant AK, Murphy JD, Liu L, Gupta S. Risk factors for colorectal cancer significantly vary by anatomic site. BMJ open gastroenterology. 2019 Aug 24; 6(1):e000313.

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Objective: To conduct an anatomic site-specific case-control study of candidate colorectal cancer (CRC) risk factors. Design: Case-control study of US veterans with > 1 colonoscopy during 1999-2011. Cases had cancer registry-identified CRC at colonoscopy, while controls were CRC free at colonoscopy and within 3 years of colonoscopy. Primary outcome was CRC, stratified by anatomic site: proximal, distal, or rectal. Candidate risk factors included age, sex, race/ethnicity, body mass index, height, diabetes, smoking status, and aspirin exposure summarised by adjusted ORs and 95% CIs. Results: 21 744 CRC cases (n = 7017 rectal; n = 7039 distal; n = 7688 proximal) and 612 646 controls were included. Males had significantly higher odds relative to females for rectal cancer (OR = 2.84, 95% CI 2.25 to 3.58) than distal cancer (OR = 1.84, 95% CI 1.50 to 2.24). Relative to whites, blacks had significantly lower rectal cancer odds (OR = 0.88, 95% CI 0.82 to 0.95), but increased distal (OR = 1.27, 95% CI 1.19 to 1.37) and proximal odds (OR = 1.62, 95% CI 1.52 to 1.72). Diabetes prevalence was more strongly associated with proximal (OR = 1.29, 95% CI 1.22 to 1.36) than distal (OR = 1.15, 95% CI 1.08 to 1.22) or rectal cancer (OR = 1.12, 95% CI 1.06 to 1.19). Current smoking was more strongly associated with rectal cancer (OR = 1.81, 95% CI 1.68 to 1.95) than proximal cancer (OR = 1.53, 95% CI 1.43 to 1.65) or distal cancer (OR = 1.46, 95% CI 1.35 to 1.57) compared with never smoking. Aspirin use was significantly more strongly associated with reduced rectal cancer odds (OR = 0.71, 95% CI 0.67 to 0.76) than distal (OR = 0.85, 95% CI 0.81 to 0.90) or proximal (OR = 0.91, 95% CI 0.86 to 0.95). Conclusion: Candidate CRC risk factor associations vary significantly by anatomic site. Accounting for site may enable better insights into CRC pathogenesis and cancer control strategies.

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