Determinants of early-onset colorectal cancer: a multicenter case-control study in Iran

Giulia Collatuzzo; Monireh Sadat Seyyedsalehi; Hamideh Rashidian; Maryam Hadji; Roya Safari-Faramani; Abbas Rezaianzadeh; Reza Malekzadeh; Kazem Zendehdel; Paolo Boffetta

doi:10.1097/CEJ.0000000000000888

Determinants of early-onset colorectal cancer: a multicenter case-control study in Iran

Eur J Cancer Prev. 2024 Apr 29. doi: 10.1097/CEJ.0000000000000888. Online ahead of print.

Authors

Giulia Collatuzzo¹, Monireh Sadat Seyyedsalehi^{1

2}, Hamideh Rashidian², Maryam Hadji^{2

3}, Roya Safari-Faramani⁴, Abbas Rezaianzadeh⁵, Reza Malekzadeh^{6

7}, Kazem Zendehdel^{1

2

8}, Paolo Boffetta^{1

9

10}

Affiliations

¹ Department of Medical and Surgical Sciences, University of Bologna, Italy.
² Cancer Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran.
³ Health Sciences Unit, Faculty of Social Sciences, Tampere University, Tampere, Finland.
⁴ Research Center for Environmental Determinants of Health, School of Public Health, Kermanshah Medical Sciences University, Kermanshah, Iran.
⁵ Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
⁶ Digestive Diseases Research Center, Digestive Diseases Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
⁷ Digestive Oncology Research Center, Digestive Diseases Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
⁸ Cancer Biology Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran.
⁹ Stony Brook Cancer Center, Stony Brook University, Stony Brook, New York, USA.
¹⁰ Department of Family, Population and Preventive Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York, USA.

PMID: 38687254
DOI: 10.1097/CEJ.0000000000000888

Abstract

Background: We aimed to study the risk factors of early-onset colorectal cancer (CRC) incidence in the Iranian population. Early onset CRC in Iran is a relevant health issue that deserves further epidemiological efforts to be defined and controlled as far as possible. Early age screening of low-tract of the intestine would be particularly useful in families of colorectal cancer patients.

Methods: We analyzed data from a multicenter hospital-based case-control study in Iran (The Iranian Study of Opium and Cancer). Sociodemographic and lifestyle information was collected using validated questionnaires. Multivariate logistic regressions estimated the odds ratios (OR) and 95% confidence intervals (CIs) for the association of early-onset CRC in individuals under the age of 50 and potential risk factors, including physical activity, socioeconomic status, body shape at age 15, dietary factors, vitamin D, cigarettes and waterpipe smoking, opium use and family history of CRC. Additionally, a subgroup analysis was conducted for individuals with a very young age of CRC onset (i.e. <35 years).

Results: We analyzed data of 189 developed CRC below age 50 (99 colon and 90 rectum), and 66 patients under the age 35 (13 colon and 21 rectum). Early CRC was inversely associated with vegetables (OR, 0.59; 95% CI, 0.38-0.92 for 422-576 g/day) and vitamin D (OR, 0.49; 95% CI, 0.26-0.94), and positively associated with red meat intake (OR, 1.80; 1.15-2.83 per 25.65 g/day). Vegetables (OR, 0.51; 95% CI, 0.27-0.98 for 576 g/day), red meat (OR, 2.05; 95% CI, 1.11-3.79 for 25.65 g/day), vitamin D (OR, 0.29; 95% CI, 0.10-0.86) and opium use (OR, 2.61; 95% CI, 1.01-6.74) were associated with early rectum cancer. Results were heterogeneous by cancer site for high fruit and vegetables intakes and cigarette smoking. Family history was associated with CRC (OR, 3.16; 95% CI, 1.29-10.9) and rectum cancer (OR, 3.22; 95% CI, 1.24-14.4) in subjects younger than 35, and, to a lesser extent, with CRC and rectum cancer before age 50.

Conclusion: Early-onset CRC was related to the intake of vegetables, vitamin D and red meat in Iran. Early-onset rectum cancer was associated with regular opium use. Family history was associated with early CRC and early rectum cancer, particularly below the age of 35.