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American Journal of Epidemiology Vol. 153, No. 1 : 31-37
Copyright © 2001 by The Johns Hopkins University School of Hygiene and Public Health

ORIGINAL CONTRIBUTIONS

Bone Mass and the Risk of Colon Cancer among Postmenopausal Women

The Framingham Study

Yuqing Zhang1,2, David T. Felson1, R. Curtis Ellison2, Bernard E. Kreger2,3,4,5, Arthur Schatzkin6, Joanne F. Dorgan7, L. Adrienne Cupples8, Daniel Levy3,4 and Douglas P. Kiel9,10

1 Boston University Arthritis Center, Boston University School of Medicine, Boston, MA.
2 Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, MA.
3 Section of General Internal Medicine, Evans Department of Medicine, Boston University School of Medicine, Boston, MA.
4 Framingham Heart Study, Framingham, MA.
5 National Heart, Lung, and Blood Institute, Bethesda, MD.
6 Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD.
7 Division of Population Science, Fox Chase Cancer Center, Philadelphia, PA.
8 Department of Epidemiology and Biostatistics, Boston University School of Public Health, Boston, MA.
9 Hebrew Rehabilitation Center for Aged, Boston, MA.
10 Harvard Medical School Division on Aging, Boston, MA.

Although postmenopausal estrogen use has been associated with a lower risk of colon cancer in women, some studies do not confirm such findings. No known study has examined the effect of cumulative estrogen exposure on colon cancer risk. Bone mass has been proposed as a marker of cumulative exposure to endogenous and exogenous estrogens. By using data on 1,394 Massachusetts women in the Framingham Study who underwent hand radiography in 1967–1970, the authors examined the association between bone mass (from relative areas of the second metacarpal) and colon cancer incidence. Over 27 years of follow-up, 44 incident colon cancer cases occurred. Colon cancer incidence decreased from 2.19 per 1,000 person-years among the women in the lowest age-specific tertile of bone mass to 1.59 and 1.08 among women in the middle and the highest tertiles, respectively. After adjustment for age and other potential confounding factors, the rate ratios of colon cancer were 1.0, 0.7 (95% confidence interval: 0.3, 1.3), and 0.4 (95% confidence interval: 0.2, 0.9) from the lowest to the highest tertile (p for trend = 0.033). No association was found between bone mass and rectal cancer. The findings suggest that women with higher bone mass, perhaps reflecting greater cumulative estrogen exposure, have a decreased risk of colon cancer.

bone density; cohort studies; colorectal neoplasms; estrogens

Abbreviations: CI, confidence interval


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