Wei Esther K, Colditz Graham A, Giovannucci Edward L, Fuchs Charles S, Rosner Bernard A
Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
Am J Epidemiol. 2009 Oct 1;170(7):863-72. doi: 10.1093/aje/kwp210. Epub 2009 Sep 1.
The authors developed a comprehensive model of colon cancer incidence that allows for nonproportional hazards and accounts for the temporal nature of risk factors. They estimated relative risk based on cumulative incidence of colon cancer by age 70 years. Using multivariate, nonlinear Poisson regression, they determined colon cancer risk among 83,767 participants in the Nurses' Health Study. The authors observed 701 cases of colon cancer between 1980 and June 1, 2004. There was increased risk for a positive family history of colon or rectal cancer (55%), 10 or more pack-years of cigarette smoking before age 30 years (16%), and tallness (67 inches (170 cm) vs. 61 inches (155 cm): 19%). Reduced risk was observed for current postmenopausal hormone use (-23%), being physically active (21 metabolic equivalent (MET)-hours/week vs. 2 MET-hours/week: -49%), taking aspirin (7 tablets/week vs. none: -29%), and being screened (-24%). Women who smoked, had a consistently high relative weight, had a low physical activity level, consumed red or processed meat daily, were never screened, and consumed low daily amounts of folate had almost a 4-fold higher cumulative risk of colon cancer by age 70 years. For women with a high risk factor profile, adopting a healthier lifestyle could dramatically reduce colon cancer risk.
作者开发了一个全面的结肠癌发病率模型，该模型考虑了非比例风险，并考虑了风险因素的时间特性。他们根据70岁时结肠癌的累积发病率估计相对风险。通过多变量非线性泊松回归，他们确定了护士健康研究中83767名参与者的结肠癌风险。作者在1980年至2004年6月1日期间观察到701例结肠癌病例。结肠癌或直肠癌家族史阳性（55%）、30岁前吸烟史达10包年或以上（16%）以及身材高大（67英寸（170厘米）对比61英寸（155厘米）：19%）会增加风险。当前绝经后激素使用（-23%）、身体活跃（每周21代谢当量（MET）小时对比每周2 MET小时：-49%）、服用阿司匹林（每周7片对比不服用：-29%）以及接受筛查（-24%）会降低风险。吸烟、相对体重持续较高、身体活动水平低、每天食用红肉或加工肉、从未接受筛查且每天叶酸摄入量低的女性，到70岁时患结肠癌的累积风险几乎高出4倍。对于具有高风险因素特征的女性，采用更健康的生活方式可显著降低结肠癌风险。
