Smoking and colorectal cancer in a non-western population: A prospective cohort study in Japan

BACKGROUND: The risk of colorectal cancer in relation to smoking habits has been examined mostly in Caucasians, and evidence for other ethnic groups is still scarce. METHODS: Our data came from the Japan Collaborative Cohort (JACC) Study. From 1988 through 1990, 25,260 men and 34,619 women aged 40-79 years completed a questionnaire on cigarette smoking and other lifestyle factors. Hazard ratios (HR) were estimated by fitting proportional hazards models. RESULTS: During the mean follow-up of 7.6 years through December 1997, we documented 408 incident colon cancers and 204 rectal cancers. We found a non-significant increase in colon cancer risk in male current smokers compared with never smokers. The multivariate-adjusted hazard ratios were 1.07 (95% confidence interval [Cl]: 0.72-1.59) for ex-smokers and 1.23 (95% Cl: 0.85-1.78) for current smokers. We however failed to observe a clear dose-response relationship between smoking intensity or duration and colon cancer risk. The adjusted hazard ratio was 1.07 (95% Cl: 0.71-1.61) even for 40+ years of smoking. Almost no increase in colon cancer risk was detected for female smokers, and male smokers were not at an enhanced risk of rectal cancer. CONCLUSIONS: Cigarette smoking was not a strong risk factor for colorectal cancer even after a long-term exposure, although a weak association remains open to discussion.