COMMENTARY

Are We Doing All We Can to Prevent Colon Cancer?

Tom G. Bartol, NP

Disclosures

November 10, 2014

Combined Impact of Healthy Lifestyle Factors on Colorectal Cancer: A Large European Cohort Study

Aleksandrova K, Pischon T, Jenab M, et al
BMC Med. 2014;12:168

Lifestyle and Colorectal Cancer Risk

Lifestyle plays an important role in colorectal cancer (CRC) risk. Many studies have explored the association between CRC and individual lifestyle factors, such as excess body weight, low physical activity, smoking, alcohol consumption, and diet; these factors are individually related to CRC risk.

This study investigated the combined impact of various healthy lifestyle behaviors on CRC risk, using data from the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. The investigators also estimated population attributable risks, which can be used to help determine what proportion of disease risk can be prevented over a specified time if a risk factor or combination of risk factors is absent in a given population.

The EPIC study population was recruited from January 1992 through December 2000 from 10 European countries. A total of 347,237 adult men and women provided diet and lifestyle information at study entry.

To assess the association between CRC and lifestyle, a healthy lifestyle index (HLI) was developed. EPIC cohort individuals were assigned an HLI by giving one point for each of five healthy lifestyle factors:

Body mass index 18-25 kg/m2 or waist circumference < 94 cm for men and < 80 cm for women;

High or very high physical activity: manual or heavy manual occupation and recreational metabolic equivalents > 57 for men and > 82 for women

Nonsmoking: never or former smokers;

Limited alcohol consumption (two or fewer standard drinks daily for men and one or fewer standard drink daily for women); and

Healthy diet: higher in fruits, vegetables, fiber, fish, nuts, garlic, and yogurt and lower in red or processed meats.

A total of zero points represented the least healthy HLI, and five points was the healthiest HLI.

Over a median follow-up of 12 years, 3759 cases of CRC (2369 colon cancers and 1390 rectal cancers) were identified. Participants with higher HLIs were more likely to be women and tended to have a higher educational level.

In individuals, compared with an HLI of zero or one, an increasing HLI (number of healthy lifestyle factors) was associated with a reduction in the incidence of CRC (Table).

Table. Effect of HLI on CRC Risk[a]

HLI 2 3 4 5
Reduction in CRC 13% 21% 34% 37%

CRC = colorectal cancer; HLI = healthy lifestyle index; [a] P for trend < .001

The estimated population attributable risks revealed cancer-site and sex-specific gradients in CRC risk. In men, 36% of rectal cancer cases, and in women, 20% of colon cancer cases were attributable to not adhering to all five healthy lifestyle factors. When risk was analyzed according to different combinations of lifestyle factors (two to four factors compared with zero or one factor), the risk was no lower for any combination of two factors, but the combination of healthy weight, nonsmoking, and healthy diet was associated with as low a risk as the combination of all five lifestyle factors.

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