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@ARTICLE{Wang:148832,
      author       = {X. Wang and K. O'Connell and J. Jeon and M. Song and D.
                      Hunter and M. Hoffmeister$^*$ and Y. Lin and S. Berndt and
                      H. Brenner$^*$ and A. T. Chan and J. Chang-Claude$^*$ and J.
                      Gong and M. J. Gunter and T. A. Harrison and R. B. Hayes and
                      A. Joshi and P. Newcomb and R. Schoen and M. L. Slattery and
                      A. Vargas and J. D. Potter and L. Le Marchand and E.
                      Giovannucci and E. White and L. Hsu and U. Peters and M. Du},
      title        = {{C}ombined effect of modifiable and non-modifiable risk
                      factors for colorectal cancer risk in a pooled analysis of
                      11 population-based studies.},
      journal      = {BMJ open gastroenterology},
      volume       = {6},
      number       = {1},
      issn         = {2054-4774},
      address      = {London},
      publisher    = {BMJ Publishing Group},
      reportid     = {DKFZ-2020-00024},
      pages        = {e000339},
      year         = {2019},
      abstract     = {'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.},
      cin          = {C070 / C020},
      ddc          = {610},
      cid          = {I:(DE-He78)C070-20160331 / I:(DE-He78)C020-20160331},
      pnm          = {313 - Cancer risk factors and prevention (POF3-313)},
      pid          = {G:(DE-HGF)POF3-313},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:31875139},
      pmc          = {pmc:PMC6904202},
      doi          = {10.1136/bmjgast-2019-000339},
      url          = {https://inrepo02.dkfz.de/record/148832},
}