Annals of Oncology Advance Access originally published online on January 22, 2009
Annals of Oncology 2009 20(6):1113-1120; doi:10.1093/annonc/mdn736
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epidemiology |
Time-dependent association of total serum cholesterol and cancer incidence in a cohort of 172 210 men and women: a prospective 19-year follow-up study
1 Department of Medical Statistics, Informatics and Health Economics, Innsbruck Medical University, Innsbruck, Austria
2 Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda
3 Gerontology Research Center, National Institute on Aging, Baltimore
4 Institute of Epidemiology, Ulm University, Ulm, Germany
5 Department of Haematology and Oncology, Innsbruck Medical University, Innsbruck
6 Cancer Registry of Tyrol, Department of Clinical Epidemiology of the Tyrolean State Hospitals Ltd, Innsbruck
7 Institute of Statistics, University of Innsbruck, Innsbruck
8 Agency for Preventive and Social Medicine, Bregenz
9 Departments of Cardiac Surgery
10 Departments of Radiology, Innsbruck Medical University, Innsbruck, Austria
* Correspondence to: Dr A. M. Strasak, Department of Medical Statistics, Informatics and Health Economics, Innsbruck Medical University, Schoepfstrasse 41, 6020 Innsbruck, Austria. Tel: +43-512-9003-70921; Fax: +43-512-9003-73922; E-mail: alexander.strasak{at}i-med.ac.at
Background: The relationship between serum cholesterol and cancer incidence remains controversial.
Patients and methods: We investigated the association of total serum cholesterol (TSC) with subsequent cancer incidence in a population-based cohort of 172 210 Austrian adults prospectively followed up for a median of 13.0 years. Cox regression, allowing for time-dependent effects, was used to estimate adjusted hazard ratios (HRs) with 95% confidence intervals (95% CIs) for the association of TSC with cancer.
Results: We observed pronounced short-term associations of TSC and overall cancer incidence in both men and women. For malignancies diagnosed shortly (<5 months) after baseline TSC measurement, the highest TSC tertile (>235.0 mg/dl in men and >229.0 in women) compared with the lowest tertile (<194.0 mg/dl in men and <190.0 in women) was associated with a significantly lower overall cancer risk [HR = 0.58 (95% CI 0.43–0.78, Ptrend = 0.0001) in men, HR = 0.69 (95% CI 0.49–0.99, Ptrend = 0.03) in women]. However, after roughly 5 months from baseline measurement, overall cancer risk was not significantly associated with TSC. The short-term inverse association of TSC with cancer was mainly driven by malignancies of the digestive organs and lymphoid and hematopoietic tissue.
Conclusion: The short-term decrease of cancer risk seen for high levels of TSC may largely capture preclinical effects of cancer on TSC.
Key words: cancer incidence, prospective study, reverse causality, time dependency, total serum cholesterol
Received for publication September 19, 2008. Revision received November 6, 2008. Accepted for publication November 6, 2008.