Abstract
Objectives To test the hypothesis that high bone mass density (BMD), a potential marker for cumulative exposure to endogenous estrogen, calcium and vitamin D intake, is associated with a lower risk of colon cancer, and that women with a lower BMD are likely to develop a more aggressive form of colon cancer, as defined by mortality. Study design and setting BMD was measured in three different sites (Ward’s triangle, trochanter, femoral neck) in 1,471 women 60 years of age. All incident cases of colon cancers were identified through record-linkage of cancer registry. The women were followed for a mean of 9.5 years. Results Overall 31 cases of colon cancer were observed among 28.6 expected (standardized incidence ratio (SIR) = 1.09, 95% confidence interval: 0.79–1.25). The SIR decreased with increasing BMD showing a significantly decreasing risk of 20% for women who were at the higher BMD comparatively to women who were at the lower BMD in all the skeletal sites. The 10-year survival rates showed that survival was increasing with increased BMD, but not significantly. Conclusion The findings suggest that postmenopausal women with lower BMD have an increased risk of colon cancer. The biological mechanisms linking bone mass to colon cancer risk are not clear.
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Jemal A, Siegel R, Ward E, et al. Cancer statistics 2007. CA Cancer J Clin. 2007;57(1):43–6.
Jemal A, Siegel R, Ward E, et al. Cancer statistics 2006. CA Cancer J Clin. 2006;56(2):106–30.
Bouvier AM, Remontet L, Jougla E, et al. Incidence of gastrointestinal cancers in France. Gastroenterol Clin Biol. 2004;28(10):877–81.
Wactawski-Wende J, Kotchen JM, Anderson GL, et al. Calcium plus vitamin D supplementation and the risk of colorectal cancer. N Engl J Med. 2006;354(7):684–96.
Lin J, Zhang S, Cook NR. Intakes of calcium and vitamin D and risk of colorectal cancer in women. Am J Epidemiol. 2005;161:755–64.
Cho E, Smith-Warner SA, Spiegelman D, Beeson WI, et al. Dairy foods, calcium and colorectal cancer: a pooled analysis of 10 cohort studies. J Natl Cancer Inst. 2004;96(13):1015–22.
Park SY, Murphy S, Wilkens L, et al. Calcium and vitamin D intake and risk of colorectal cancer: the multiethnic cohort study. Am J Epidemiol. 2007;165:784–93.
Wu K, Feskanich D, Fuchs C, et al. A nested case-control study of plasma 25-hydroxyvitamin D concentrations and risk of colorectal cancer. J Natl Cancer Inst. 2007;99(14):1120–28.
Mc Michael AJ, Potter JD. Reproduction, endogenous and exogenous sex hormones and colon cancer: a review and hypothesis. J Natl Cancer Inst. 1980;65:1201–07.
LaVecchia C, Gallus S, Fernandez E. Hormone replacement therapy and colorectal cancer: an update. J Br Menopause Soc. 2005;114(4):166–72.
Chlebowski RT, Wactawski-Wende J, Ritenbaugh C, et al. Estrogen plus progestin and colorectal cancer in postmenopausal women. N Engl J Med. 2004;350:991–1004.
Lappe JM, Travers-Gustafson D, Davies KM, Davies KM, Recker RR, Heaney RP. Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial. Am J Clin Nutr. 2007;6:1586–91.
Ganry O, Sebert JL. Bone mass and breast cancer in postmenopausal women. Rev Rhum. 1998;65:159–60.
Dawson-Hughes B. Vitamin D and calcium: recommended intake for bone health. Osteoporos Int. 1998;8(Suppl 2):S30–4.
Krall EA, Wehler C, Garcia RI, Harris SS, Dawson-Hughes B. Calcium and vitamin D supplements reduce tooth loss in the elderly. Am J Med. 2001;111(6):452–6.
Dawson-Hughes B, Harris SS. Calcium intake influences the association of protein intake with rates of bone loss in elderly men and women. Am J Clin Nutr. 2002;75(4):773–9.
New SA, Millward DJ. Calcium, protein, and fruit and vegetables as dietary determinants of bone health. Am J Clin Nutr. 2003;77(5):1340–1.
Lin J, Zhang SM, Cook NR, et al. Oral contraceptives factors and risk of colorectal cancer among women in a prospective cohort study. Am J Epidemiol. 2007;165(7):794–801.
Hou L, Ji BT, Blair A, et al. Body mass index and colon cancer risk in Chinese people: menopause as an effect modifier. Eur J Cancer. 2006;42(1):84–90.
Pischon T, Lahmann PH, Boeing H, et al. Body size and risk of colon and rectal cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC). J Natl Cancer Inst. 2006;98(13):920–31.
Calton BA, Lacey JV, Schatzkin A, et al. Physical activity and the risk of colon cancer among women: a prospective cohort study. Int J Cancer. 2006;119(2):385–91.
Larsson SC, Wolk A. Obesity and colon and rectal cancer risk : a meta-analysis of prospective studies. Am J Clin Nutr. 2007;86(3):556–65.
Nelson RL, Turyk M, Kim J, Persky V. Bone mineral density and the subsequent risk of cancer in the NHANES-I follow-up cohort. BMC Cancer. 2006;22:2–9.
Zhang Y, Felson DT, Ellison RC. Bone mass and the risk of colon cancer among postmenopausal women. Am J Epidemiol. 2001;153:31–7.
Ganry O, Baudoin C, Fardellone P. Bone mass density, subsequent risk of breast cancer risk and mortality in older women. Eur J Epidemiol. 2004;9:24–31.
Fardellone P, Sebert JL, Bouraya M, et al. Evaluation of the calcium content of diet by frequential self-questionnaire. Rev Rhum Mal Osteoartic. 1991;58(2):99–103.
Bagger YZ, Tanko LB, Alexandersen P, et al. Two to three years of hormone replacement treatment in healthy women have long-term preventive effects on bone mass and osteoporotic fractures: the PERF study. Bone. 2004;34:728–35.
Maddalozzo GF, Widrick JJ, Cardinal BJ, et al. The effects of hormone replacement therapy and resistance training on spine bone mineral density in early postmenopausal women. Bone. 2007;40(5):1241–51.
Lamprecht SA, Lipkin M. Chemoprevention of colon cancer by calcium, vitamin D and folate: molecular mechanisms. Nat Rev Cancer. 2003;3:601–14.
Ganry O, Peng J, Dubreuil A. Is there a reduced risk of breast cancer among women with hip fractures? Eur J Epidemiol. 1999;15(4):313–15.
Ganry O, Tramier B, Fardellone P, Raverdy N, Dubreuil A. High-bone mass density as a marker for breast cancer in post-menopausal women. Breast. 2000;10:313–18.
Cauley J, Lucas FL, Kuller L, et al. Bone mineral density and risk of breast cancer in older women. JAMA. 1996;276:1404–8.
Zhang YD, Kiel DP, Kreger BE, et al. Bone mass and the risk of breast cancer among postmenopausal women. N Engl J Med. 1997;336:611–17.
Kuller LH, Cauley JA, Lucas L, et al. Sex steroid hormones, bone mineral density and risk of breast cancer. Environ Health Perspec. 1997;105:593–9.
Lucas FL, Cauley JA, Stone Ra, et al. Bone mineral density and risk of breast cancer. Differences by family history of breast cancer. Am J Epidemiol. 1998;148:22–9.
Buist DS, LaCroix AZ, Barlow WE, et al. Bone mineral density and breast cancer risk in postmenopausal women. J Clin Epidemiol. 2001;54:417–22.
Parfitt AM. Quantum concept of bone remodelling and turnover: implications for the pathogenesis of osteoporosis. Calcif Tissue Int. 1979;28:1–5.
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This study was funded by a grant From the Clinical Research Regional Program of The Picardy area.
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Ganry, O., Lapôtre-Ledoux, B., Fardellone, P. et al. Bone mass density, subsequent risk of colon cancer and survival in postmenopausal women. Eur J Epidemiol 23, 467–473 (2008). https://doi.org/10.1007/s10654-008-9256-0
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DOI: https://doi.org/10.1007/s10654-008-9256-0