American Journal of Epidemiology Vol. 151, No. 10: 958-964
Copyright © 2000 by The Johns Hopkins University School of Hygiene and Public Health
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Prospective Study of Bowel Movement, Laxative Use, and Risk of Colorectal Cancer among Women
1Department of Nutrition, Harvard School of Public Health Boston, MA.
2Geriatric University Clinic, Kantonsspital Basel Basel, Switzerland.
3Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School Boston, MA.
4Department of Epidemiology, Harvard School of Public Health Boston, MA.
5Division of Medical Oncology, Dana-Farber Cancer Institute Boston, MA.
6Department of Biostatistics, Harvard School of Public Health Boston, M.A.
Reprint requests to Dr. Edward Giovannucci, 665 Huntington Ave., Boston, MA 02115 (e-mail: edward.giovannucci@channing. harvard.edu).
The authors prospectively examined the association between bowel movement frequency, laxative use, and the risk of colorectal cancer in 84, 577 women of the Nurses' Health Study living in the United States, 36–61 years of age and free of cancer in 1982. Between 1984 and 1996, 611 incident cases of colorectal cancer were documented. After controlling for age, body mass index, fiber intake, postmenopausal status and hormone use, physical activity, and use of laxatives, the relative risks associated with having bowel movements every third day or less, compared with those with bowel movements once daily, were 0.94 (95% confidence interval (Cl): 0.69, 1.28) for colorectal cancer, 0.88 (95% Cl: 0.62, 1.26) for colon cancer, and 1.18 (95% Cl: 0.63, 2.20) for rectal cancer. Compared with women who never used laxatives, the multivariate relative risks associated with weekly to daily laxative use were 1.00 (95% Cl: 0.72, 1.40) for colorectal cancer, 1.09 (95% Cl: 0.76, 1.57) for colon cancer, and 0.68 (95% Cl: 0.29, 1.57) for rectal cancer. These findings do not support an association between infrequent bowel movement, laxative use, and risk of colorectal cancer and indicate that simple questions directed at bowel movement frequency are unlikely to enhance our ability to predict colorectal cancer risk. Am J Epidemiol2000; 151: 958-64.
cathartics; colorectal neoplasms; constipation; prospective studies
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