Adult Stature and Risk of Cancer at Different Anatomic Sites in a Cohort of Postmenopausal Women

Geoffrey C. Kabat; Matthew L. Anderson; Moonseong Heo; H. Dean Hosgood; Victor Kamensky; Jennifer W. Bea; Lifang Hou; Dorothy S. Lane; Jean Wactawski-Wende; JoAnn E. Manson; Thomas E. Rohan

doi:10.1158/1055-9965.EPI-13-0305

DOI: 10.1158/1055-9965.EPI-13-0305 Published August 2013

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Figure 1.
Association of height with all cancer and cancer at 19 anatomic sites. HR4s are adjusted for covariates in footnote h in Table 3.
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Figure 2.
Association of height with risk of all cancers by level of potential effect modifiers. HR4s are adjusted for covariates in footnote h in Table 3.

Table 1.

Baseline characteristics by quintiles of height in the WHI

	Quintiles of height in cm
	<156.5	156.5–<160.2	160.2–<163.5	163.5–<167.1	≥167.1
N	28,536	29,291	29,180	28,912	28,782
Mean person-years	295,762	312,015	315,329	314,447	315,208
Mean age (y)	65.1	63.8	63.0	62.3	61.1
Mean weight (kg)	66.8	70.9	73.5	75.7	79.8
Mean BMI (kg/m²)	28.5	28.2	28.1	27.7	27.4
Mean MET-h/wk^a	11.4	11.8	11.9	12.0	12.2
Mean pack-years of smoking	8.2	9.2	9.8	9.9	10.5
Mean servings of alcohol/wk	1.7	2.1	2.4	2.6	2.9
Education, % >16 y	23.1	26.4	27.7	30.4	34.9
Ethnicity
White, %	72.5	81.7	84.6	86.1	87.3
Black, %	7.4	9.0	9.3	9.7	10.3
Hispanic, %	9.4	4.9	3.2	2.1	1.0
Other, %	10.7	4.4	2.9	2.1	1.4
Income ≥$75,000	13.2	16.7	17.9	20.1	23.0
Parity, % nulliparous	10.9	10.6	11.0	11.2	14.4
Age of menarche,% <12 y	27.1	23.4	21.9	20.1	16.9
Age at first birth,% ≥30 y^b	10.0	8.5	8.2	8.7	9.8
Oral contraceptive use, % ever	33.8	39.1	42.3	45.3	49.3
Hormone therapy, % ever	52.4	54.7	57.5	58.1	60.3
Current smokers, %	6.0	6.7	7.1	7.1	7.8
Mammography screening^c	81.9	82.7	83.3	84.0	84.5
Pap screening^d	86.3	88.4	88.6	89.5	90.0
Colorectal cancer screening^e	43.2	43.7	44.5	44.4	44.2

↵^aDefined as caloric need per kilogram of body weight per hour of activity divided by the caloric need per kilogram of body weight per hour of rest, per hour per week.
↵^bN parous women = 117,603.
↵^cHad mammogram within past 2 years.
↵^dHad Pap screening within past 3 years.
↵^eHad any screening in the year before year 1 visit: rectal exam, Hemoccult, or colonoscopy or sigmoidoscopy.

Table 2.

Effect of adjustment for different potential confounding variables on the association of height with all cancer (per 10 cm increment) in the WHI

	HR	95% CI
Adjusted for age only	1.15	1.12–1.17
Additionally adjusted individually for
Education years	1.14	1.12–1.17
Ethnicity	1.13	1.11–1.16
Smoking (pack-yrs)	1.13	1.11–1.16
Weight (kg)	1.12	1.09–1.14
BMI (kg/m²)	1.17	1.14–1.19
Alcohol intake (servings)	1.14	1.12–1.17
Physical activity (MET-hrs/wk)	1.15	1.12–1.17
Age at menarche	1.16	1.13–1.18
Oral contraceptive use (ever)	1.15	1.12–1.17
Hormone therapy (ever)	1.15	1.12–1.17
Hormone therapy (type)^a	1.15	1.12–1.17
Parity	1.15	1.12–1.17
Age at menopause	1.15	1.12–1.17
Mammography in past 2 years	1.15	1.13–1.18
Pap screening in past 3 years	1.15	1.12–1.19
Adjusted for main covariates^b	1.13	1.11–1.16

↵^aNever, estrogen alone, estrogen + progestin, both E and E + P.
↵^bAge (continuous), hormone therapy (yes, no), pack-years of smoking (continuous), alcohol intake (continuous), W/H^1.7 (continuous), age at menarche (<12, 12, 13, >13), education (less than high school grad, high school grad/some college, college grad, post-college), ethnicity (White, Black, other), randomization to treatment arm of clinical trials (yes, control, placebo, not randomized).

Table 3.

HRs and 95% CIs for the association of height (per 10 cm increase) with specific cancers in the WHI

Cancer site	N cases	HR1	95% CI	HR2	95% CI	HR3	95% CI	HR4	95% CI
Colorectum^a	1,904	1.13	1.05–1.21	1.15	1.07–1.24	1.19	1.10–1.28	1.17	1.09–1.26
Colon^b	1,516	1.13	1.04–1.22	1.14	1.04–1.24	1.18	1.08–1.29	1.16	1.07–1.26
Rectum^b	257	1.22	1.00–1.48	1.26	1.03–1.55	1.37	1.10–1.70	1.25	1.02–1.53
Breast^c	6,798	1.14	1.10–1.18	1.11	1.07–1.16	1.14	1.09–1.18	1.13	1.08–1.17
Endometrium^d	1,109	1.18	1.07–1.29	1.10	1.00–1.22	1.19	1.08–1.31	1.16	1.07–1.26
Ovary^e	683	1.11	0.99–1.25	1.14	1.01–1.29	1.11	0.98–1.26	1.13	1.00–1.29^f
Cervix^g	83	1.30	0.93–1.83	1.41	0.99–2.01	1.42	0.99–2.02	1.38	0.96–1.99
Kidney^h	369	1.18	1.00–1.38	1.23	1.03–1.45	1.26	1.06–1.50	1.23	1.05–1.43
Bladder^g	457	1.13	0.97–1.30	1.05	0.90–1.22	1.05	0.90–1.22	1.06	0.90–1.24
Thyroidⁱ	270	1.27	1.06–1.54	1.32	1.08–1.62	1.33	1.08–1.63	1.29	1.05–1.58
Lung (NS)^j	269	1.12	0.93–1.36	1.13	0.93–1.37	1.20	0.98–1.47	1.12	0.92–1.38
Lung (ES)^g	1,466	0.99	0.91–1.07	1.00	0.92–1.09	0.98	0.90–1.07	1.09	1.00–1.19
Stomach^g	152	0.98	0.77–1.26	1.01	0.78–1.31	1.02	0.79–1.33	1.05	0.82–1.35
Pancreas^g	459	1.03	0.90–1.19	1.03	0.89–1.20	1.03	0.89–1.21	1.03	0.89–1.20
Melanoma^g	1,169	1.29	1.17–1.41	1.15	1.04–1.26	1.16	1.05–1.27	1.15	1.04–1.26
Brain^g	176	1.26	1.00–1.59	1.28	1.00–1.63	1.28	1.00–1.65	1.26	0.99–1.62
Leukemia^g	447	1.09	0.94–1.26	1.04	0.89–1.21	1.04	0.89–1.22	1.05	0.90–1.22
NHL^g	888	1.11	1.00–1.23	1.11	1.00–1.24	1.11	1.00–1.24	1.11	0.99–1.23
Multiple myeloma^g	282	1.29	1.07–1.56	1.30	1.07–1.57	1.28	1.06–1.56	1.29	1.06–1.57
All cancers^h	20,928	1.15	1.12–1.17	1.12	1.10–1.15	1.14	1.11–1.16	1.13	1.11–1.16

NOTE: Shading indicates statistically significant associations. Women with a history of bilateral oophorectomy were excluded from the analysis of ovarian cancer, and women with a history of hysterectomy were excluded from the analysis of endometrial cancer.

Abbreviations: HR1, age-adjusted; HR2, multivariable-adjusted but without weight or BMI; HR3, multivariable-adjusted + BMI; HR4, multivariable + site-specific scaling of W/H^X; NS, never smoker; ES, ever smoker.

↵^aHR2 adjusted for age (continuous), servings of alcohol per week (continuous), pack-years of smoking (continuous), hormone therapy (ever, never), age at menarche (<12, 12, 13, >13), family history of colorectal cancer (yes, no, missing), physical activity (MET-hrs/wk—continuous), red meat intake (medium servings per day—continuous), folate intake (μg/day—continuous), aspirin use (yes, no), diabetes (yes, no), education (less than high school graduate, high school graduate/some college, college graduate, post-college), ethnicity (White, Black, other), randomization status in each of the clinical trials (dummy variables for treatment, control, placebo, not randomized).
↵^bHR2 adjusted for age, alcohol, pack-years, hormone therapy, family history of colorectal cancer, physical activity, red meat intake, folate intake, aspirin use, diabetes, education, ethnicity, randomization status.
↵^cHR2 adjusted for age, alcohol, pack-years, hormone therapy, parity (continuous), age at menarche, age at first birth (<20, 20–29, ≥30, missing), age at menopause (<45, 45–54, ≥55, missing), family history of breast cancer in a first degree relative (yes, no, missing), history of breast biopsy (ever, never, missing), education, ethnicity, randomization status in clinical trials.
↵^dHR2 adjusted for age, alcohol, pack-years, hormone therapy, parity, oral contraceptive use (ever, never), education, ethnicity, randomization status.
↵^eHR2 adjusted for age, alcohol, pack-years, hormone therapy, oral contraceptive use (ever, never), education, ethnicity, and randomization status.
↵^fLower confidence limit = 1.001.
↵^gHR2 adjusted for age, alcohol, pack-years, hormone therapy, education, ethnicity, and randomization status.
↵^hHR2 adjusted for age, alcohol, pack-years, hormone therapy, age at menarche, education, ethnicity, and randomization status.
↵ⁱHR2 adjusted for age, alcohol, pack-years, hormone therapy, history of thyroid nodules, history of goiter, education, ethnicity, and randomization status.
↵^jHR2 adjusted for age, alcohol, hormone therapy, education, ethnicity, and randomization status.

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Supplementary Figure Legend - PDF - 22KB, Legends for supplementary figures 1-5.
Supplementary Figure 1 - PDF - 68KB, Association of height with risk of breast cancer by level of potential effect modifiers. HR4s are adjusted for covariates in footnote 3 in Table 3.
Supplementary Figure 2 - PDF - 68KB, Association of height with risk of colorectal cancer by level of potential effect modifiers. HR4s are adjusted for covariates in footnote 1 in Table 3.
Supplementary Figure 3 - PDF - 69KB, Association of height with risk of melanoma cancer by level of potential effect modifiers. HR4s are adjusted for covariates in footnote 6 in Table 3.
Supplementary Figure 4 - PDF - 67KB, Association of height with risk of lung cancer in ever smokers by level of potential effect modifiers. HR4s are adjusted for covariates in footnote 6 in Table 3.
Supplementary Figure 5 - PDF - 68KB, Association of height with risk of endometrial cancer by level of potential effect modifiers. HR4s are adjusted for covariates in footnote 4 in Table 3.