The Future Colorectal Cancer Burden Attributable to Modifiable Behaviors: A Pooled Cohort Study
Autor: | Paul Mitchell, Barbara-Ann Adelstein, Maarit A. Laaksonen, Julie Byles, Karen Canfell, Dianna J. Magliano, Anne W. Taylor, Maria E Arriaga, Robert G. Cumming, Julie Marker, Tiffany K. Gill, Graham G. Giles, Robert J. MacInnis, Emily Banks, Peter Hull, Vasant Hirani, Jonathan E. Shaw, Claire M. Vajdic |
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Jazyk: | angličtina |
Rok vydání: | 2018 |
Předmět: |
Cancer Research
medicine.medical_specialty Colorectal cancer Population Overweight Article 03 medical and health sciences 0302 clinical medicine medicine 030212 general & internal medicine Risk factor education education.field_of_study business.industry Public health public health medicine.disease Obesity Confidence interval 3. Good health Oncology 030220 oncology & carcinogenesis medicine.symptom business Demography Cohort study |
Zdroj: | JNCI Cancer Spectrum |
Popis: | 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 = 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] = 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 = .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. |
Databáze: | OpenAIRE |
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