This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (103)  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Topic Collections  • Oncology  • Colon Cancer  • Gastrointestinal Diseases  • Alert me on articles by topic

Thomas P. Erlinger, MD, MPH; Elizabeth A. Platz, ScD, MPH; Nader Rifai, PhD; Kathy J. Helzlsouer, MD, MHS

JAMA. 2004;291:585-590.

Context  Inflammation may play a role in the pathogenesis of colorectal cancer; however, epidemiological evidence supporting this hypothesis in average-risk persons is sparse.

Objective  To determine the risk of incident colon and rectal cancer associated with elevated baseline plasma concentrations of C-reactive protein (CRP).

Design, Setting, and Participants  Prospective, nested case-control study of a cohort of 22 887 adults (>18 years and Washington County, Maryland, residents) enrolled between May and October 1989 and followed up through December 2000. A total of 172 colorectal cancer cases were identified through linkage with the Washington County and Maryland State Cancer registries. Up to 2 controls (n = 342) were selected from the cohort for each case and matched by age, sex, race, and date of blood draw.

Main Outcome Measure  Odds ratio (OR) of incident colon and rectal cancer.

Results  Plasma CRP concentrations were higher among all colorectal cases combined than controls (median CRP, 2.44 vs 1.94 mg/L; P = .01). The highest concentration was found in persons who subsequently developed colon cancer vs matched controls (median CRP, 2.69 vs 1.97 mg/L; P<.001). Among rectal cancer cases, CRP concentrations were not significantly different from controls (median CRP, 1.79 vs 1.81 mg/L; P = .32). The risk of colon cancer was higher in persons in the highest vs lowest quartile of CRP (OR, 2.55; 95% confidence interval [CI], 1.34-4.88; P for trend = .002). In nonsmokers, the corresponding association was stronger (OR, 3.51; 95% CI, 1.64-7.51; P for trend<.001). A 1-SD increase in log CRP (1.02 mg/L) was associated with an increased risk of colon cancer after adjusting for potential confounders and excluding cases occurring within 2 years of baseline (OR, 1.35; 95% CI, 1.05-1.74) or excluding those with late-stage colon cancer at the time of diagnosis (OR, 1.38; 95% CI, 0.99-1.91).

Conclusions  Plasma CRP concentrations are elevated among persons who subsequently develop colon cancer. These data support the hypothesis that inflammation is a risk factor for the development of colon cancer in average-risk individuals.

Author Affiliations: Department of Medicine (Drs Erlinger and Helzlsouer) and Sidney Kimmel Comprehensive Cancer Center (Dr Platz), Johns Hopkins Medical Institutions, and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (Drs Erlinger, Platz, and Helzlsouer), Baltimore, Md; and Department of Pathology, Harvard Medical School, and Department of Laboratory Medicine, Children's Hospital, Boston, Mass (Dr Rifai).

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

No Reduction in C-Reactive Protein following a 12-Month Randomized Controlled Trial of Exercise in Men and Women
Campbell et al.
Cancer Epidemiol. Biomarkers Prev. 2008;17:1714-1718.
ABSTRACT | FULL TEXT  

Serum C-Reactive Protein as Independent Prognostic Variable in Patients with Ovarian Cancer
Hefler et al.
Clin. Cancer Res. 2008;14:710-714.
ABSTRACT | FULL TEXT  

C-Reactive Protein and All-Cause Mortality in a Large Hospital-Based Cohort
Marsik et al.
Clin. Chem. 2008;54:343-349.
ABSTRACT | FULL TEXT  

Prospective Study of High-Sensitivity C-Reactive Protein as a Determinant of Mortality: Results from the MONICA/KORA Augsburg Cohort Study, 1984-1998
Koenig et al.
Clin. Chem. 2008;54:335-342.
ABSTRACT | FULL TEXT  

Circulating Levels of Inflammatory Cytokines and Risk of Colorectal Adenomas
Kim et al.
Cancer Res. 2008;68:323-328.
ABSTRACT | FULL TEXT  

Associations between healthy eating patterns and immune function or inflammation in overweight or obese postmenopausal women
Boynton et al.
Am. J. Clin. Nutr. 2007;86:1445-1455.
ABSTRACT | FULL TEXT  

Biomarkers for the Early Detection of Cancer: An Inflammatory Concept
Roy and Khandekar
Arch Intern Med 2007;167:1822-1824.
FULL TEXT  

Prospective Study of Leukocyte Count as a Predictor of Incident Breast, Colorectal, Endometrial, and Lung Cancer and Mortality in Postmenopausal Women
Margolis et al.
Arch Intern Med 2007;167:1837-1844.
ABSTRACT | FULL TEXT  

A systematic review of the association between circulating concentrations of C reactive protein and cancer
Heikkila et al.
J. Epidemiol. Community Health 2007;61:824-833.
ABSTRACT | FULL TEXT  

IL6, Aspirin, Nonsteroidal Anti-inflammatory Drugs, and Breast Cancer Risk in Women Living in the Southwestern United States
Slattery et al.
Cancer Epidemiol. Biomarkers Prev. 2007;16:747-755.
ABSTRACT | FULL TEXT  

C-Reactive Protein Concentrations and Subsequent Ovarian Cancer Risk
McSorley et al.
Obstet Gynecol 2007;109:933-941.
ABSTRACT | FULL TEXT  

Long-term Aspirin Use and Mortality in Women
Chan et al.
Arch Intern Med 2007;167:562-572.
ABSTRACT | FULL TEXT  

C-Reactive Protein Levels, Variation in the C-Reactive Protein Gene, and Cancer Risk: The Rotterdam Study
Siemes et al.
JCO 2006;24:5216-5222.
ABSTRACT | FULL TEXT  

Serum heat shock protein 70 levels and lung cancer risk: a case-control study nested in a large cohort study.
Suzuki et al.
Cancer Epidemiol. Biomarkers Prev. 2006;15:1733-1737.
ABSTRACT | FULL TEXT  

Plasma C-reactive protein and risk of colorectal cancer in a nested case-control study: Japan public health center-based prospective study.
Otani et al.
Cancer Epidemiol. Biomarkers Prev. 2006;15:690-695.
ABSTRACT | FULL TEXT  

A Prospective Study of Serum C-Reactive Protein and Colorectal Cancer Risk in Men
Gunter et al.
Cancer Res. 2006;66:2483-2487.
ABSTRACT | FULL TEXT  

Plasma C-reactive protein and risk of cancer: a prospective study from Greece.
Trichopoulos et al.
Cancer Epidemiol. Biomarkers Prev. 2006;15:381-384.
ABSTRACT | FULL TEXT  

Association Between Circulating White Blood Cell Count and Cancer Mortality: A Population-Based Cohort Study
Shankar et al.
Arch Intern Med 2006;166:188-194.
ABSTRACT | FULL TEXT  

C-Reactive Protein Is a Marker for Human Immunodeficiency Virus Disease Progression
Lau et al.
Arch Intern Med 2006;166:64-70.
ABSTRACT | FULL TEXT  

A 4-wk intervention with high intake of carotenoid-rich vegetables and fruit reduces plasma C-reactive protein in healthy, nonsmoking men
Watzl et al.
Am. J. Clin. Nutr. 2005;82:1052-1058.
ABSTRACT | FULL TEXT  

Depressive Symptoms and Prospective Incidence of Colorectal Cancer in Women
Kroenke et al.
Am J Epidemiol 2005;162:839-848.
ABSTRACT | FULL TEXT  

Circulating Levels of Inflammatory Markers and Cancer Risk in the Health Aging and Body Composition Cohort
Il'yasova et al.
Cancer Epidemiol. Biomarkers Prev. 2005;14:2413-2418.
ABSTRACT | FULL TEXT  

The Association of Physical Activity and Body Mass Index with the Risk of Large Bowel Polyps
Wallace et al.
Cancer Epidemiol. Biomarkers Prev. 2005;14:2082-2086.
ABSTRACT | FULL TEXT  

Associations between apoE genotype and colon and rectal cancer
Slattery et al.
Carcinogenesis 2005;26:1422-1429.
ABSTRACT | FULL TEXT  

C-Reactive Protein Levels Are Not Associated with Increased Risk for Colorectal Cancer in Women
Zhang et al.
ANN INTERN MED 2005;142:425-432.
ABSTRACT | FULL TEXT  

PTGS2 (COX-2) -765G > C Promoter Variant Reduces Risk of Colorectal Adenoma among Nonusers of Nonsteroidal Anti-inflammatory Drugs
Ulrich et al.
Cancer Epidemiol. Biomarkers Prev. 2005;14:616-619.
ABSTRACT | FULL TEXT  

Alteration of Gene Expression in Macroscopically Normal Colonic Mucosa from Individuals with a Family History of Sporadic Colon Cancer
Hao et al.
Clin. Cancer Res. 2005;11:1400-1407.
ABSTRACT | FULL TEXT  

Inflammation and Cancer IV. Colorectal cancer in inflammatory bowel disease: the role of inflammation
Itzkowitz and Yio
Am. J. Physiol. Gastrointest. Liver Physiol. 2004;287:G7-G17.
ABSTRACT | FULL TEXT  

C-Reactive Protein and Risk of Colon Cancer
Al-Shaer
JAMA 2004;291:2819-2819.
FULL TEXT  

C-Reactive Protein and Risk of Colon Cancer
Pasceri and Cammarota
JAMA 2004;291:2818-2819.
FULL TEXT  

Elevated C-Reactive Protein Associated with Colon Cancer
JWatch Gastroenterology 2004;2004:1-1.
FULL TEXT  

Is C-Reactive Protein an Inflammation Opsonin That Signals Colon Cancer Risk?
Pasche and Serhan
JAMA 2004;291:623-624.
FULL TEXT