Diet, physical activity, and colorectal cancer among Chinese in North America and China.

In a population-based case-control study of colorectal cancer among Chinese men and women in western North America and the People's Republic of China, a common protocol was used to assess past life-style characteristics of 905 cases diagnosed during 1981-1986 and 2,488 controls. Risks for cancers of both the colon and rectum increased with increased food energy from fat, protein, carbohydrate, and all energy sources combined, for both sexes and on both continents. Yet, in multivariate analysis, colorectal cancer risk was significantly associated only with saturated fat; no relationships were seen with other dietary sources of energy. Colon cancer risk was elevated among men employed in sedentary occupations. On both continents and in both sexes, risks for cancers of both the colon and rectum increased with increasing time spent sitting. Further, the association between colorectal cancer risk and saturated fat was stronger among the sedentary than among the active. Risk among sedentary Chinese Americans of either sex increased more than fourfold from the lowest to the highest category of saturated fat intake. Among migrants to North America, risk increased with increasing years lived in North America. These observations suggest (a) that colorectal cancer risk increases with duration of exposure to a sedentary life-style and a diet rich in saturated fat; (b) that higher incidence among Chinese-American men relative to women is due to longer duration of these habits among men, who have lived longer in North America; and (c) that higher risk among Chinese Americans of both sexes relative to risk among the general population in China is due to differences in such habits. Attributable risk calculations suggest that, if these associations are causal, saturated fat intakes exceeding 10 g/day, particularly in combination with physical inactivity, could account for 60% of colorectal cancer incidence among Chinese-American men and 40% among Chinese-American women.

Reproductive factors and colorectal cancer risk among Chinese females.

We report results from a population-based case-control study of colorectal cancer among Chinese women in western North America (NA) and the People's Republic of China (China). A common protocol was used to assess reproductive characteristics and hormone use of 395 Chinese women (189 from NA and 206 from China) with cancer of the colon or rectum and of 1112 age-matched Chinese controls (494 from NA and 618 from China). In NA, risks for cancers of both the colon and rectum were lower among parous compared to nulliparous women (odds ratio for colorectal cancer, 0.6, P = 0.08), but the trend in risk was not smooth with increasing number of livebirths. This association with parity was absent for both cancer sites in China. There were no consistent patterns in the relationships between other reproductive factors (including age at menarche, age at first livebirth, menopausal status) and risk of colon and rectal cancer on either continent.

Diagnostic value of occult fecal blood testing for colorectal cancer screening.

AIM: To evaluate the diagnostic value of occult fecal blood testing in mass colorectal cancer screening. METHODS: A reverse passive hemagglutination reaction fecal occult blood test (RPHA-FOBT) and colorectal cancer risk factor quantitative method were used as preliminary screening for colorectal cancer. A 60-cm fiber optic colonoscopy was used to validate the preliminary screen and was used to detect colorectal cancer in a community of 75813 subjects. RESULTS: Compared to the 60-cm fiber optic colonoscopy as a standard reference, FOBT has a sensitivity of 41.9%, specificity of 95.8%, Youden's index of 0.38, and positive predictive value of 0.68%. These results increased with subject age from the first detection. A 3-year follow up in the target mass showed that all new cases had initially been FOBT-negative. CONCLUSION: The value of FOBT as an indicator of colorectal cancer in mass screening is limited.

Colorectal cancer in Chinese and Chinese-Americans.

Rationale and plans are described for a collaborative case-control study of large bowel cancer among Chinese-Americans in Los Angeles and the San Francisco Bay Area and among Chinese in Zhejiang Province, People's Republic of China. A common protocol and questionnaire will be used during personal interviews of approximately 400 Chinese and 300 Chinese-American patients with histologically confirmed adenocarcinoma of the colon or rectum and 2,100 Chinese and Chinese-American controls. Controls will be matched to patients on age, sex, and community of residence. The information requested from subjects will permit testing of hypotheses relating colorectal cancer risk to: dietary factors, including intake of fat (saturated and unsaturated), animal protein, fiber, and vitamins A and E and ascorbic acid; physical activity levels and body mass index; reproductive factors among women; history of bowel disease; and family history of cancer. The information requested of Chinese-American subjects will also permit testing of hypotheses relating cancer risk to such migrant factors as United States versus Chinese nativity, duration of residence in the United States, and Chinese province of ancestry. These factors will be tested for associations with cancers of the colon and rectum separately and with cancers of the large intestine as a whole. We will examine sex and geographic differences in relative risks for etiologic factors, location of tumors within the large bowel, histologic subtype of adenocarcinoma, and frequency of accompanying polyps.