Glycosylated Hemoglobin and Risk of Colorectal Cancer in Men and Women, the European Prospective Investigation into Cancer and Nutrition

Sabina Rinaldi, Sabine Rohrmann, Mazda Jenab, Carine Biessy, Sabina Sieri, Domenico Palli, Rosario Tumino, Amalla Mattiello, Paolo Vineis, Alexandra Nieters, Jakob Linseisen, Tobias Pischon, Heiner Boeing, Göran Hallmans, Richard Palmqvist, Jonas Manjer, Elisabet Wirfält, Francesca L. Crowe, Kay-Tee T. Khaw, Sheila Bingham, Anne Tjønneland, Anja Olsen, Kim Overvad, Eiliv Lund, Guri Skeie, Francoise Clavel-Chapelon, Marie-Christine Boutron-Ruault, Blandine de Lauzon-Guillain, Eva Ardanaz, Paula Jakszyn, Jose Ramon Quiros, Maria-Dolores Chirlaque, Maria-Jose Sanchez, Miren Dorronsoro, Antonia Trichopoulou, Pagona Lagiou, Dimitrious Trichopoulos, H. Bas Bueno-de-Mesquita, Fränzel J.B. van Duijnhoven, Petra H.M. Peeters, Nadia Slimani, Pietro Ferrari, Graham B. Byrnes, Elio Riboli, Rudolf Kaaks

Although large-scale prospective cohort studies have related hyperglycemia to increased risk of cancer overall, studies specifically on colorectal cancer have been generally small. We investigated the association between prediagnostic levels of glycosylated hemoglobin (HbA1c), a marker for average glucose level in blood, and colorectal cancer risk in a case-control study nested within the European Prospective Investigation into Cancer and Nutrition cohort. One thousand and twenty-six incident colorectal cancer cases (561 men and 465 women) and 1,026 matched controls were eligible for the study. Multivariate conditional logistic regression was used to estimate odds ratios (ORS) adjusted for possible confounders. Increasing HbA1c percentages were statistically significantly associated with a mild increase in colorectal cancer risk in the whole population [OR, 1.10; 95% confidence interval (CI), 1.01,1.19 for a 10% increase in HbA1c]. In women, increasing HbA1c percentages were associated with a statistically significant increase in colorectal cancer risk (OR, 1.16; 95% CI, 1.01, 1.32 for a 10% increase in HbA1c) and with a borderline statistically significant increase in rectum cancer (OR, 1.22; 95% CI, 0.99,1.50 for a 10% increase in HbA1c). No significant association with cancer risk was observed in men. The results of the current study suggest a mild implication of hyperglycemia in colorectal cancer, which seems more important in women than in men, and more for cancer of the rectum than of the colon.