ArticleClinical epidemiology2019
Exploring geographical differences in the incidence of colorectal cancer in the Norwegian Women and Cancer Study: a population-based prospective study.
Article in Clinical epidemiology, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 1 of them a synthesis that pooled it.
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Who cites it
6 citing papers in PubMed, 1 synthesis or guideline pooled it, 11 citations in OpenAlex.
- Adult-Attained Height and Colorectal Cancer Risk: A Cohort Study, Systematic Review, and Meta-Analysis.Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology · 2022Pooled it
- Spatial analysis of colorectal cancer outcomes: investigating the impact of place-specific factors using causal inference methods for spatial data.Journal of public health (Oxford, England) · 2025Article
- Article
- Overall lifestyle changes in adulthood are associated with cancer incidence in the Norwegian Women and Cancer Study (NOWAC) - a prospective cohort study.BMC public health · 2023Article
- Combined Lifestyle Behaviors and the Incidence of Common Cancer Types in the Norwegian Women and Cancer Study (NOWAC).Clinical epidemiology · 2021Article
- Competing mortality risks analysis of prediagnostic lifestyle and dietary factors in colorectal cancer survival: the Norwegian Women and Cancer Study.BMJ open gastroenterology · 2019Article
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Authors and funding
5 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeNorway has experienced an unexplained, steep increase in colorectal cancer (CRC) incidence in the last half-century, with large differences across its counties. We aimed to determine whether geographical distribution of lifestyle-related CRC risk factors can explain these geographical differences in CRC incidence in Norwegian women.
methodsWe followed a nationally representative cohort of 96,898 women with self-reported information on lifestyle-related CRC risk factors at baseline and at follow-up 6-8 years later in the Norwegian Women and Cancer Study. We categorized Norwegian counties into four county groups according to CRC incidence and used Cox proportional hazard models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for risk factors. We used the Karlson, Holm, and Breen (KHB) method of mediation analysis to investigate the extent to which the risk factors accounted for the observed differences in CRC incidence between counties.
resultsDuring an average of 15.5 years of follow-up, 1875 CRC cases were diagnosed. Height (HR=1.12; 95% CI 1.08, 1.17 per 5 cm increase); being a former smoker who smoked ≥10 years (HR=1.34; 95% CI 1.15, 1.57); or being a current smoker who has smoked for ≥10 years (HR=1.28; 95% CI 1.12, 1.46) relative to never smokers was associated with increased CRC risk. Duration of education >12 years (HR=0.78; 95% CI 0.69, 0.87) vs ≤12 years, and intake of vegetables and fruits >300 g (HR=0.90; 95% CI 0.80, 0.99) vs ≤300 g per day were associated with reduced CRC risk. However, these risk factors did not account for the differences in CRC risk between geographical areas of low and high CRC incidence. This was further confirmed by the KHB method using baseline and follow-up measurements (
conclusionLifestyle-related CRC risk factors did not explain the geographical variations in CRC incidence among Norwegian women. Possible residual explanations may lie in heritable factors.
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