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000148832 1001_ $$00000-0001-5184-2935$$aWang, Xiaoliang$$b0
000148832 245__ $$aCombined effect of modifiable and non-modifiable risk factors for colorectal cancer risk in a pooled analysis of 11 population-based studies.
000148832 260__ $$aLondon$$bBMJ Publishing Group$$c2019
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000148832 520__ $$a'Environmental' factors associated with colorectal cancer (CRC) risk include modifiable and non-modifiable variables. Whether those with different non-modifiable baseline risks will benefit similarly from reducing their modifiable CRC risks remains unclear.Using 7945 cases and 8893 controls from 11 population-based studies, we combined 17 risk factors to characterise the overall environmental predisposition to CRC (environmental risk score (E-score)). We estimated the absolute risks (ARs) of CRC of 10 and 30 years across E-score using incidence-rate data from the Surveillance, Epidemiology, and End Results programme. We then combined the modifiable risk factors and estimated ARs across the modifiable risk score, stratified by non-modifiable risk profile based on genetic predisposition, family history and height.Higher E-score was associated with increased CRC risk (ORquartile, 1.33; 95% CI 1.30 to 1.37). Across E-scores, 30-year ARs of CRC increased from 2.5% in the lowest quartile (Q1) to 5.9% in the highest (Q4) quartile for men, and from 2.1% to 4.5% for women. The modifiable risk score had a stronger association in those with high non-modifiable risk (relative excess risk due to interaction=1.2, 95% CI 0.5 to 1.9). For those in Q4 of non-modifiable risk, a decrease in modifiable risk reduced 30-year ARs from 8.9% to 3.4% for men and from 6.0% to 3.2% for women, a level lower or comparable to the average population risk.Changes in modifiable risk factors may result in a substantial decline in CRC risk in both sexes. Those with high inherited risk may reap greater benefit from lifestyle modifications. Our results suggested comprehensive evaluation of environmental factors may facilitate CRC risk stratification.
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000148832 7001_ $$aO'Connell, Kelli$$b1
000148832 7001_ $$aJeon, Jihyoun$$b2
000148832 7001_ $$aSong, Mingyang$$b3
000148832 7001_ $$aHunter, David$$b4
000148832 7001_ $$0P:(DE-He78)6c5d058b7552d071a7fa4c5e943fff0f$$aHoffmeister, Michael$$b5$$udkfz
000148832 7001_ $$aLin, Yi$$b6
000148832 7001_ $$aBerndt, Sonja$$b7
000148832 7001_ $$0P:(DE-He78)90d5535ff896e70eed81f4a4f6f22ae2$$aBrenner, Hermann$$b8$$udkfz
000148832 7001_ $$aChan, Andrew T$$b9
000148832 7001_ $$0P:(DE-He78)c259d6cc99edf5c7bc7ce22c7f87c253$$aChang-Claude, Jenny$$b10$$udkfz
000148832 7001_ $$aGong, Jian$$b11
000148832 7001_ $$aGunter, Marc J$$b12
000148832 7001_ $$aHarrison, Tabitha A$$b13
000148832 7001_ $$aHayes, Richard B$$b14
000148832 7001_ $$aJoshi, Amit$$b15
000148832 7001_ $$aNewcomb, Polly$$b16
000148832 7001_ $$aSchoen, Robert$$b17
000148832 7001_ $$aSlattery, Martha L$$b18
000148832 7001_ $$aVargas, Ashley$$b19
000148832 7001_ $$aPotter, John D$$b20
000148832 7001_ $$aLe Marchand, Loic$$b21
000148832 7001_ $$aGiovannucci, Edward$$b22
000148832 7001_ $$aWhite, Emily$$b23
000148832 7001_ $$aHsu, Li$$b24
000148832 7001_ $$aPeters, Ulrike$$b25
000148832 7001_ $$aDu, Mengmeng$$b26
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