The Future Colorectal Cancer Burden Attributable to Modifiable Behaviors: A Pooled Cohort Study
Abstract 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 nationa...
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Published in | JNCI cancer spectrum Vol. 2; no. 3; p. pky033 |
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Main Authors | , , , , , , , , , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
England
Oxford University Press
01.07.2018
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Abstract | Abstract
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. |
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AbstractList | Abstract
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. Previous estimates of the colorectal cancer (CRC) burden attributed to behaviors have not considered joint effects, competing risk, or population subgroup differences. 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. 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%, < .001). The burden attributed to these factors was also higher for those born in Australia (28.7%) than elsewhere (16.8%, = .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. 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. |
Author | Shaw, Jonathan E Taylor, Anne W Gill, Tiffany K Adelstein, Barbara-Ann Byles, Julie E Hull, Peter Giles, Graham G MacInnis, Robert J Marker, Julie Vajdic, Claire M Banks, Emily Mitchell, Paul Hirani, Vasant Laaksonen, Maarit A Arriaga, Maria E Canfell, Karen Magliano, Dianna J Cumming, Robert G |
AuthorAffiliation | 11 ANU College of Medicine, Biology and Environment, Australian National University, Canberra, Australia 3 Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Australia 5 Cancer Research Division, Cancer Council New South Wales, Sydney, Australia 7 School of Life and Environmental Sciences, Charles Perkins Centre, University of Sydney, Sydney, Australia 15 Cancer Voices South Australia, Adelaide, Australia 4 Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia 6 School of Public Health, University of Sydney, Sydney, Australia 8 Centre for Vision Research, Westmead Institute for Medical Research, University of Sydney, Sydney, Australia 14 Diabetes and Population Health Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia 1 Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia 13 Clinical Diabetes Laboratory, Baker Heart and Dia |
AuthorAffiliation_xml | – name: 5 Cancer Research Division, Cancer Council New South Wales, Sydney, Australia – name: 3 Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Australia – name: 6 School of Public Health, University of Sydney, Sydney, Australia – name: 8 Centre for Vision Research, Westmead Institute for Medical Research, University of Sydney, Sydney, Australia – name: 1 Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia – name: 7 School of Life and Environmental Sciences, Charles Perkins Centre, University of Sydney, Sydney, Australia – name: 2 Prince of Wales Clinical School, University of New South Wales, Sydney, Australia – name: 13 Clinical Diabetes Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia – name: 10 Research Centre for Gender, Health and Ageing, University of Newcastle, Newcastle, Australia – name: 4 Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia – name: 11 ANU College of Medicine, Biology and Environment, Australian National University, Canberra, Australia – name: 14 Diabetes and Population Health Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia – name: 9 ANZAC Research Institute, University of Sydney and Concord Hospital, Sydney, Australia – name: 15 Cancer Voices South Australia, Adelaide, Australia – name: 12 Adelaide Medical School, University of Adelaide, Adelaide, Australia |
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Previous estimates of the colorectal cancer (CRC) burden attributed to behaviors have not considered joint effects, competing risk, or... Previous estimates of the colorectal cancer (CRC) burden attributed to behaviors have not considered joint effects, competing risk, or population subgroup... |
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Title | The Future Colorectal Cancer Burden Attributable to Modifiable Behaviors: A Pooled Cohort Study |
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