Pairwise association of key lifestyle factors and risk of colorectal cancer: a prospective pooled multicohort study

Eira Roos; Karri Seppä; Olli Pietiläinen; Heidi Ryynänen; Sanna Heikkinen; Johan G Eriksson; Tommi Härkänen; Pekka Jousilahti; Paul Knekt; Seppo Koskinen; Maarit Laaksonen; Satu Männistö; Teemu Roos; Ossi Rahkonen; Nea Malila; Janne Pitkäniemi; METCA Study Group

doi:10.1002/cnr2.1612

Pairwise association of key lifestyle factors and risk of colorectal cancer: a prospective pooled multicohort study

Cancer Rep (Hoboken). 2022 Nov;5(11):e1612. doi: 10.1002/cnr2.1612. Epub 2022 Mar 3.

Authors

Eira Roos¹, Karri Seppä², Olli Pietiläinen¹, Heidi Ryynänen², Sanna Heikkinen², Johan G Eriksson³, Tommi Härkänen³, Pekka Jousilahti³, Paul Knekt³, Seppo Koskinen³, Maarit Laaksonen^{3

4}, Satu Männistö³, Teemu Roos⁵, Ossi Rahkonen¹, Nea Malila², Janne Pitkäniemi^{2

6}; METCA Study Group

Affiliations

¹ Department of Public Health, University of Helsinki, Helsinki, Finland.
² Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland.
³ The Finnish Institute for Health and Welfare (THL), Helsinki, Finland.
⁴ School of Mathematics and Statistics, University of New South Wales, Sydney, Australia.
⁵ Department of Computer Science, University of Helsinki, Helsinki, Finland.
⁶ School of Health Sciences, University of Tampere, Tampere, Finland.

Abstract

Background: Several lifestyle factors are associated with an increased risk of colorectal cancer (CRC). Although lifestyle factors co-occur, in most previous studies these factors have been studied focusing upon a single risk factor or assuming independent effects between risk factors.

Aim: To examine the pairwise effects and interactions of smoking, alcohol consumption, physical inactivity, and body mass index (BMI) with risk of subsequent colorectal cancer (CRC).

Methods and results: We used METCA cohort data (pooled data from seven population-based Finnish health behavior survey studies during years 1972-2015) consisting of 171 063 women and men. Participants' smoking, alcohol consumption, physical inactivity and BMI measures were gathered, and participants were categorized into those exposed and those not exposed. The incidence of CRC was modeled by Poisson regression with main and interaction effects of key lifestyle factors. The cohort members were followed-up through register linkage to the Finnish Cancer Registry for first primary CRC case until the end of 2015. Follow-up time was 1715, 690 person years. The highest pairwise CRC risk was among male smokers who had overweight (BMI ≥ 25 kg/m² ) (HR 1.75, 95% CI 1.36-2.26) and women who had overweight and consumed alcohol (HR 1.45, 95% CI 1.14-1.85). Overall, among men the association of lifestyle factors and CRC risk was stronger than among women. In men, both having overweight and being a smoker combined with any other adverse lifestyle factor increased CRC risk. Among women, elevated CRC risks were observed for those who were physically inactive and who consumed alcohol or had overweight. No statistically significant interactions were detected between pairs of lifestyle factors.

Conclusions: This study strengthens the evidence of overweight, smoking, and alcohol consumption as CRC risk factors. Substantial protective benefits in CRC risk can be achieved by preventing smoking, maintaining BMI to <25 kg/m² and not consuming alcohol.

Keywords: alcohol; cohort study; colorectal cancer; obesity; physical inactivity; smoking.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Body Mass Index
Colorectal Neoplasms* / epidemiology
Colorectal Neoplasms* / etiology
Colorectal Neoplasms* / prevention & control
Female
Humans
Life Style
Male
Overweight* / complications
Overweight* / epidemiology
Prospective Studies