The Future Colorectal Cancer Burden Attributable to Modifiable Behaviors: A Pooled Cohort Study
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Date
2018
Authors
Vajdic, C.M.
MacInnis, R.J.
Canfell, K.
Hull, P.
Arriaga, M.E.
Hirani, V.
Cumming, R.G.
Mitchell, P.
Byles, J.E.
Giles, G.G.
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Journal article
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JNCI Cancer Spectrum, 2018; 2(3):1-9
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Claire M. Vajdic, Robert J. MacInnis, Karen Canfell, Peter Hull, Maria E. Arriaga, Vasant Hirani, Robert G. Cumming, Paul Mitchell, Julie E. Byles, Graham G. Giles, Emily Banks, Anne W. Taylor, Jonathan E. Shaw, Dianna J. Magliano, Julie Marker, Barbara-Ann Adelstein, Tiffany K. Gill, Maarit A. Laaksonen
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Abstract
Background: Previous estimates of the colorectal cancer (CRC) burden attributed to behaviors have not considered joint effects, competing risk, or population subgroup differences. Methods: We pooled data from seven prospective Australian cohort studies (n ¼ 367 058) and linked them to national registries to identify CRCs and deaths. We estimated the strength of the associations between behaviors and CRC risk using a parametric piecewise constant hazards model, adjusting for age, sex, study, and other behaviors. Exposure prevalence was estimated from contemporary National Health Surveys. We calculated population attributable fractions for CRC preventable by changes to current behaviors, accounting for competing risk of death and risk factor interdependence. Statistical tests were two-sided. Results: During the first 10 years of follow-up, there were 3471 incident CRCs. Overweight or obesity explained 11.1%, ever smoking explained 10.7% (current smoking 3.9%), and drinking more than two compared with two or fewer alcoholic drinks per day explained 5.8% of the CRC burden. Jointly, these factors were responsible for 24.9% (95% confidence interval [CI] ¼ 19.7% to 29.9%) of the burden, higher for men (36.7%) than women (13.2%, Pdifference < .001). The burden attributed to these factors was also higher for those born in Australia (28.7%) than elsewhere (16.8%, Pdifference ¼ .047). We observed modification of the smoking-attributable burden by alcohol consumption and educational attainment, and modification of the obesity-attributable burden by age group and birthplace. Conclusions: We produced up-to-date estimates of the future CRC burden attributed to modifiable behaviors. We revealed novel differences between men and women, and other high–CRC burden subgroups that could potentially benefit most from programs that support behavioral change and early detection.
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© The Author(s) 2018. Published by Oxford University Press. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/ licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com