Reproductive history and risk of colorectal cancer in postmenopausal women

Alice Zervoudakis, Howard Strickler, Yikyung Park, Xiaonan (Nan) Xue, Albert Hollenbeck, Arthur Schatzkin, Marc J. Gunter

Research output: Contribution to journalArticle

54 Citations (Scopus)

Abstract

Background There are conflicting data regarding the role of sex hormones in colorectal cancer development. Whereas clinical trials data indicate that hormone therapy use reduces the risk of colorectal cancer, data from prospective cohort studies suggest that circulating estrogen levels are positively associated with colorectal cancer risk. A surrogate measure of lifetime estrogen exposure is reproductive history. We investigated the relationship between reproductive factors and the risk of colorectal cancer. Methods Subjects were postmenopausal women enrolled in the National Institutes of Health-American Association of Retired Persons Diet and Health Study, a cohort of 214162 individuals (aged 50-71 years) that included 2014 incident cases of colorectal cancer that occurred over a mean follow-up of 8.2 years. Questionnaires were used to collect data on reproductive factors, including ages at menarche, birth of first child, and menopause; parity, and use of oral contraceptives. Multivariable Cox proportional hazards models were constructed to examine associations between these reproductive factors and the risk of colorectal cancer, with adjustment for established colorectal cancer risk factors. All statistical tests were two-sided. Results Age at menopause (≥55 vs <40 years: hazard ratio [HR] = 1.50, 95% confidence interval [CI] = 1.23 to 1.83; Ptrend =. 008) and age at birth of first child (≥30 vs ≤19 years: HR = 1.26, 95% CI = 1.01 to 1.58; Ptrend =. 05) were positively associated with the risk of colorectal cancer. Among women with no history of hormone therapy use, age at menarche (≥15 vs 11-12 years: HR = 0.73, 95% CI = 0.57 to 0.94; Ptrend =. 02) and parity (≥5 children vs no children: HR = 0.80, 95% CI = 0.63 to 1.02; Ptrend =. 10) were inversely associated with the risk of colorectal cancer. Conclusion These data support a role for sex hormones in colorectal tumorigenesis and suggest that greater endogenous estrogen exposure may increase the risk of colorectal cancer in postmenopausal women.

Original languageEnglish (US)
Pages (from-to)826-834
Number of pages9
JournalJournal of the National Cancer Institute
Volume103
Issue number10
DOIs
StatePublished - May 18 2011

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Reproductive History
Colorectal Neoplasms
Confidence Intervals
Estrogens
Menarche
Birth Order
Gonadal Steroid Hormones
Menopause
Parity
Cohort Studies
Hormones
Age Factors
National Institutes of Health (U.S.)
Oral Contraceptives
Proportional Hazards Models
Carcinogenesis
Clinical Trials
Prospective Studies
Diet

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Reproductive history and risk of colorectal cancer in postmenopausal women. / Zervoudakis, Alice; Strickler, Howard; Park, Yikyung; Xue, Xiaonan (Nan); Hollenbeck, Albert; Schatzkin, Arthur; Gunter, Marc J.

In: Journal of the National Cancer Institute, Vol. 103, No. 10, 18.05.2011, p. 826-834.

Research output: Contribution to journalArticle

Zervoudakis, Alice ; Strickler, Howard ; Park, Yikyung ; Xue, Xiaonan (Nan) ; Hollenbeck, Albert ; Schatzkin, Arthur ; Gunter, Marc J. / Reproductive history and risk of colorectal cancer in postmenopausal women. In: Journal of the National Cancer Institute. 2011 ; Vol. 103, No. 10. pp. 826-834.
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abstract = "Background There are conflicting data regarding the role of sex hormones in colorectal cancer development. Whereas clinical trials data indicate that hormone therapy use reduces the risk of colorectal cancer, data from prospective cohort studies suggest that circulating estrogen levels are positively associated with colorectal cancer risk. A surrogate measure of lifetime estrogen exposure is reproductive history. We investigated the relationship between reproductive factors and the risk of colorectal cancer. Methods Subjects were postmenopausal women enrolled in the National Institutes of Health-American Association of Retired Persons Diet and Health Study, a cohort of 214162 individuals (aged 50-71 years) that included 2014 incident cases of colorectal cancer that occurred over a mean follow-up of 8.2 years. Questionnaires were used to collect data on reproductive factors, including ages at menarche, birth of first child, and menopause; parity, and use of oral contraceptives. Multivariable Cox proportional hazards models were constructed to examine associations between these reproductive factors and the risk of colorectal cancer, with adjustment for established colorectal cancer risk factors. All statistical tests were two-sided. Results Age at menopause (≥55 vs <40 years: hazard ratio [HR] = 1.50, 95{\%} confidence interval [CI] = 1.23 to 1.83; Ptrend =. 008) and age at birth of first child (≥30 vs ≤19 years: HR = 1.26, 95{\%} CI = 1.01 to 1.58; Ptrend =. 05) were positively associated with the risk of colorectal cancer. Among women with no history of hormone therapy use, age at menarche (≥15 vs 11-12 years: HR = 0.73, 95{\%} CI = 0.57 to 0.94; Ptrend =. 02) and parity (≥5 children vs no children: HR = 0.80, 95{\%} CI = 0.63 to 1.02; Ptrend =. 10) were inversely associated with the risk of colorectal cancer. Conclusion These data support a role for sex hormones in colorectal tumorigenesis and suggest that greater endogenous estrogen exposure may increase the risk of colorectal cancer in postmenopausal women.",
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AB - Background There are conflicting data regarding the role of sex hormones in colorectal cancer development. Whereas clinical trials data indicate that hormone therapy use reduces the risk of colorectal cancer, data from prospective cohort studies suggest that circulating estrogen levels are positively associated with colorectal cancer risk. A surrogate measure of lifetime estrogen exposure is reproductive history. We investigated the relationship between reproductive factors and the risk of colorectal cancer. Methods Subjects were postmenopausal women enrolled in the National Institutes of Health-American Association of Retired Persons Diet and Health Study, a cohort of 214162 individuals (aged 50-71 years) that included 2014 incident cases of colorectal cancer that occurred over a mean follow-up of 8.2 years. Questionnaires were used to collect data on reproductive factors, including ages at menarche, birth of first child, and menopause; parity, and use of oral contraceptives. Multivariable Cox proportional hazards models were constructed to examine associations between these reproductive factors and the risk of colorectal cancer, with adjustment for established colorectal cancer risk factors. All statistical tests were two-sided. Results Age at menopause (≥55 vs <40 years: hazard ratio [HR] = 1.50, 95% confidence interval [CI] = 1.23 to 1.83; Ptrend =. 008) and age at birth of first child (≥30 vs ≤19 years: HR = 1.26, 95% CI = 1.01 to 1.58; Ptrend =. 05) were positively associated with the risk of colorectal cancer. Among women with no history of hormone therapy use, age at menarche (≥15 vs 11-12 years: HR = 0.73, 95% CI = 0.57 to 0.94; Ptrend =. 02) and parity (≥5 children vs no children: HR = 0.80, 95% CI = 0.63 to 1.02; Ptrend =. 10) were inversely associated with the risk of colorectal cancer. Conclusion These data support a role for sex hormones in colorectal tumorigenesis and suggest that greater endogenous estrogen exposure may increase the risk of colorectal cancer in postmenopausal women.

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