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Physical Activity and Risk of Colon and Rectal Cancers: The European Prospective Investigation into Cancer and Nutrition

¹ Nutrition and Hormones Group, IARC, Lyon, France; ² Division of Population Health and Information, Alberta Cancer Board, Calgary, Alberta, Canada; ³ Unit of Environmental Epidemiology, German Cancer Research Centre; ⁴ Division of Clinical Epidemiology, German Cancer Research Centre, Heidelberg, Germany; ⁵ Institut National de la Santé et de la Recherche Medicale U521, Institut Gustave Rouissy, Villejuif, France; ⁶ Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbruecke, Germany; ⁷ Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark; ⁸ Department of Clinical Epidemiology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark; ⁹ Department of Epidemiology, Catalan Institute of Oncology, Institut d'Investigació Biomèdica de Bellvitge, Barcelona, Spain; ¹⁰ Public Health and Health Planning Directorate, Oviedo, Spain; ¹¹ Escuela Andaluza de Salud Publica, Granada, Spain; ¹² Department of Public Health of Guipuzcoa, San Sebastian, Spain; ¹³ Department of Epidemiology, Health Council of Murcia, Murcia, Spain; ¹⁴ Public Health Institute of Navarra, Pamplona, Spain; ¹⁵ Dunn Human Nutrition Unit, Medical Research Council MRC Centre for Nutritional Epidemiology in Cancer Prevention and Survival, University of Cambridge, United Kingdom; ¹⁶ Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom; ¹⁷ Cancer Research UK Epidemiology Unit, University of Oxford, United Kingdom; ¹⁸ Department of Hygiene and Epidemiology, School of Medicine, University of Athens, Athens, Greece; ¹⁹ Epidemiology Unit, National Cancer Institute, Milan, Italy; ²⁰ Molecular and Nutritional Epidemiology Unit, Centro per lo Studio e la Prevenzione Oncologica-Scientific Institute of Tuscany, Florence, Italy; ²¹ Cancer Registry, Azienda Ospedaliera "Civile M.P. Arezzo," Ragusa, Italy; ²² Dipartimento di Medicina Clinica e Sperimentale, Università di Napoli, Naples, Italy; ²³ University of Torino, Turin, Italy; ²⁴ Department of Epidemiology and Public Health, Imperial College, London, United Kingdom; ²⁵ National Institute of Public Health and the Environment, Bilthoven, the Netherlands; ²⁶ Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht, the Netherlands; ²⁷ Department of Clinical Sciences, Malmö University Hospital; and ²⁸ Department of Surgery, Malmö University Hospital, Malmö, Sweden

Requests for reprints: Christine Friedenreich, Division of Population Health and Information, Alberta Cancer Board, Calgary, Alberta, Canada T2N 4N2. Phone: 403-521-3841; Fax: 403-270-8003; E-mail: chrisf{at}cancerboard.ab.ca

We investigated several aspects of the role of physical activity in colon and rectal cancer etiology that remain unclear in the European Prospective Investigation into Nutrition and Cancer. This cohort of 413,044 men and women had 1,094 cases of colon and 599 cases of rectal cancer diagnosed during an average of 6.4 years of follow-up. We analyzed baseline data on occupational, household, and recreational activity to examine associations by type of activity, tumor subsite, body mass index (BMI), and energy intake. The multivariate hazard ratio for colon cancer was 0.78 [95% confidence interval (95% CI), 0.59-1.03] among the most active participants when compared with the inactive, with evidence of a dose-response effect (P_trend = 0.04). For right-sided colon tumors, the risk was 0.65 (95% CI, 0.43-1.00) in the highest quartile of activity with evidence of a linear trend (P_trend = 0.004). Active participants with a BMI under 25 had a risk of 0.63 (95% CI, 0.39-1.01) for colon cancer compared with the inactive. Finally, an interaction between BMI and activity (P_interaction = 0.03) was observed for right-sided colon cancers; among moderately active and active participants with a BMI under 25, a risk of 0.38 (95% CI, 0.21-0.68) was found as compared with inactive participants with BMI >30. No comparable decreased risks were observed for rectal cancer for any type of physical activity for any subgroup analyses or interactions considered. We found that physical activity reduced colon cancer risk, specifically for right-sided tumors and for lean participants, but not rectal cancer. (Cancer Epidemiol Biomarkers Prev 2006;15(12):2398–407)

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