Population attributable fraction estimation for established colorectal cancer risk factors in Korea

Abstract

Background: Colorectal cancer incidence has increased in Korea in accordance with westernization. We estimated the population attributable fraction (PAF) of well-established risk factors for colorectal cancer, using both nationwide and worldwide risk estimates. Materials and methods: We estimated the PAFs attributable to tobacco smoking, alcohol consumption, obesity, physical inactivity, and meat intake. Relative risks (RRs) were estimated from the meta-analyses of the studies conducted in both Korean and worldwide populations. Worldwide RRs were obtained from previous studies that reported summary effect sizes of associations between colorectal cancer and each risk factor and included the largest number of studies or colorectal cancer cases. The prevalence of each exposure was calculated by using data from the 2001 Korean National Health Examination Survey. National cancer incidence data from the Korea Central Cancer Registry were used to estimate the number of colorectal cancer cases attributable to each risk factor. Results: When using RRs estimated in the Korean population, the PAFs of all selected risk factors considered in this study were 44.5% for men and 22.7% for women. The most important risk factor for colorectal cancer among men was alcohol consumption (24.3%) and among women was meat intake (14.2%). When using RRs estimated in worldwide populations, the PAFs were 54.7% for men and 37.3% for women. The most important risk factor among both men and women was red meat intake (men, 23.1%

women, 23.0%). When global estimated RRs were applied to the risk factors from the limited numbers of Korean studies (n > 3), the PAFs for all selected risk factors were 55.8% for men and 38.3% for women. Conclusions: Appropriate lifestyle modifications could decrease risk for colorectal cancer in the Korean population by 55.8% for men and 38.3% for women.