Risk factors for early-onset colorectal cancer: a population-based case-control study in Ontario, Canada.

PURPOSE: There has been an alarming increase in colorectal cancer (CRC) incidence among young adults aged < 50 years, and factors driving this upward trend are unknown. This study investigated associations between various medical, lifestyle, and dietary factors and risk of early-onset CRC (EO-CRC). METHODS: A population-based case-control study was conducted in Ontario, Canada during 2018-2019. EO-CRC cases aged 20-49 years (n = 175) were identified from the Ontario Cancer Registry; sex- and age group-matched controls (n = 253) were recruited through random digit dialing. Data on potential a priori risk factors were collected using a web-based self-reported questionnaire. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using multivariable logistic regression. RESULTS: Family history of CRC in a first- or second-degree relative (OR 2.37; 95% CI 1.47-3.84), longer sedentary time (≥ 10 vs. < 5 h/day, OR 1.93; 95% CI 1.02-3.65), greater consumption of sugary drinks (≥ 7 vs. < 1 drinks/week, OR 2.99; 95% CI 1.57-5.68), and a more Westernized dietary pattern (quartile 4 vs. 1, OR 1.92; 95% CI 1.01-3.66) were each associated with an increased risk of EO-CRC. Conversely, calcium supplement use (OR 0.53; 95% CI 0.31-0.92), history of allergy or asthma (OR 0.62; 95% CI 0.39-0.98), and greater parity in females (≥ 3 vs. nulliparity, OR 0.29; 95% CI 0.11-0.76) were each associated with a reduced risk. CONCLUSION: Modifiable factors, particularly sedentary behavior and unhealthy diet including sugary drink consumption, may be associated with EO-CRC risk. Our findings, if replicated, may help inform prevention strategies targeted at younger persons.

Maximizing research impacts on cancer prevention: An integrated knowledge translation approach used by the Canadian Population Attributable Risk of Cancer (ComPARe) study.

With a strong focus on end user, or knowledge user, engagement throughout the study, an integrated knowledge translation approach (iKT) is expected to enhance the quality, relevance and reach of research findings. From its initiation, the Canadian Population Attributable Risk of Cancer (ComPARe) study combined the expertise of the knowledge producers (cancer prevention researchers) and select knowledge users in an iKT approach. We describe in detail our iKT approach, including governance, outputs and early reflections. In our model, knowledge users were integrated as members of the research team or members of a KT Advisory Committee. The integrated knowledge users took a lead role on the KT activities for ComPARe, including developing the KT Blueprint, a four phase systematic approach to guide the planning and implementation of KT activities. This approach included planning, knowledge product development, dissemination and evaluation, with advisory committee engagement built in throughout. Our early reflections identified enablers and challenges of an iKT approach for this study. Enablers included co-investigators' commitment and attitude towards iKT, support for iKT from the funding agency, an established partnership early on, understanding of and experience in each other's area of expertise, dedicated funding, clearly delineated roles, advisory committee buy-in and existing tools. Challenges included anticipating all costs, continuity of involvement, competing priorities, relationship management and geographic distance. A future evaluation will determine the effectiveness and impact of the iKT approach and KT Blueprint. In the interim, the approach we describe here can be modeled by others interested in collaborative, action-oriented research.