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Glycosylated Hemoglobin and Risk of Colorectal Cancer in Men and Women, the European Prospective Investigation into Cancer and Nutrition

¹ IARC, Lyon, France; ² German Cancer Research Centre, Division of Cancer Epidemiology, Heidelberg, Germany; ³ Epidemiology Unit, National Cancer Institute, Milan, Italy; ⁴ Molecular and Nutritional Epidemiology Unit, CSPO-Scientific Institute of Tuscany, Florence, Italy; ⁵ Cancer Registry, Azienda Ospedaliera "Civile M.P.Arezzo," Ragusa, Italy; ⁶ Dipartimento di Medicina Clinica e Sperimentale, Universita' Federico II, Naples, Italy; ⁷ Environmental Epidemiology, Imperial College and ⁸ Division of Epidemiology, Public Health and Primary Care Faculty of Medicine, Imperial College, London, United Kingdom; ⁹ Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbruecke, Germany; ¹⁰ Public Health and Clinical Medicine, Nutrition Research and ¹¹ Department of Medical Biosciences, Pathology, Umeå University hospital, Umeå, Sweden; ¹² Department of Surgery, Malmö University Hospital, Malmö, Sweden; ¹³ Department of Clinical Sciences in Malmö/Nutrition Epidemiology, Lund University, Lund, Sweden; ¹⁴ Cancer Research UK Epidemiology Unit, University of Oxford, Oxford, United Kingdom; ¹⁵ Clinical Gerontology Unit, Addenbrooke's Hospital and ¹⁶ MRC Dunn Human Nutrition Unit, Cambridge, UK and MRC Centre for Nutritional Epidemiology in Cancer Prevention and Survival, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom; ¹⁷ Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark; ¹⁸ Department of Clinical Epidemiology, Aarhus University Hospital, Aahrus, Denmark; ¹⁹ Institute of Community Medicine, University of Tromsø, Tromsø, Norway; ²⁰ Inserm (Institut National de la Sante et de la Recherche Medicale), ERI 20/Universite Paris-Sud, EA 4045, IFR 69/Institut Gustave Roussy, Villejuif, France; ²¹ Public Health Institute of Navarra Pamplona, Spain and CIBER Epidemiología y Salud Pública (CIBERESP), Pamplona, Spain; ²² Epidemiology Department, Catalan Institute of Oncology, Barcelona, Spain; ²³ Consejeria de Salud y Servicios Sanitarios, Asturias, Spain; ²⁴ Epidemiology Department, Murcia Health Council, CIBER en Epidemiología y Salud Pública (CIBERESP), Murcia, Spain; ²⁵ Andalusian School of Public Health and CIBER Epidemiologia y Salud Pública (CIBERESP), Granada, Spain; ²⁶ Public Health Department of Gipuzkoa, Basque Government, Spain; ²⁷ University of Athens, School of Medicine, Department of Hygiene and Epidemiology, Athens, Greece; ²⁸ The National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands; and ²⁹ Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands

Requests for reprints: Sabina Rinaldi, IARC, 150, cours Albert Thomas, Lyon, 69372 Lyon Cedex 08, France. Phone: 33-4-72-73-83-28; Fax: 33-4-72-73-83-61. E-mail: Rinaldi{at}iarc.fr

Although large-scale prospective cohort studies have related hyperglycemia to increased risk of cancer overall, studies specifically on colorectal cancer have been generally small. We investigated the association between prediagnostic levels of glycosylated hemoglobin (HbA1c), a marker for average glucose level in blood, and colorectal cancer risk in a case-control study nested within the European Prospective Investigation into Cancer and Nutrition cohort. One thousand and twenty-six incident colorectal cancer cases (561 men and 465 women) and 1,026 matched controls were eligible for the study. Multivariate conditional logistic regression was used to estimate odds ratios (ORS) adjusted for possible confounders. Increasing HbA1c percentages were statistically significantly associated with a mild increase in colorectal cancer risk in the whole population [OR, 1.10; 95% confidence interval (CI), 1.01,1.19 for a 10% increase in HbA1c]. In women, increasing HbA1c percentages were associated with a statistically significant increase in colorectal cancer risk (OR, 1.16; 95% CI, 1.01, 1.32 for a 10% increase in HbA1c) and with a borderline statistically significant increase in rectum cancer (OR, 1.22; 95% CI, 0.99,1.50 for a 10% increase in HbA1c). No significant association with cancer risk was observed in men. The results of the current study suggest a mild implication of hyperglycemia in colorectal cancer, which seems more important in women than in men, and more for cancer of the rectum than of the colon. (Cancer Epidemiol Biomarkers Prev 2008;17(11):3108–15)