Elsevier

Cancer Epidemiology

Volume 33, Issues 3–4, October 2009, Pages 189-193
Cancer Epidemiology

A case–control study on diet and colorectal cancer from Mumbai, India

https://doi.org/10.1016/j.canep.2009.07.009Get rights and content

Abstract

Colorectal cancer is more common in the western countries. Studies have reported on risk factors for colorectal cancer across the globe but no study results are reported yet from India. This is the first hospital-based case–control study on colorectal cancer from India. This study conducted at Tata Memorial hospital, Mumbai, India, included 203 cases of colorectal cancer and 1628 hospital controls. Data was collected on chewing, smoking, alcohol habits and dietary habits. The results indicated no significant excess risk for chewers, smokers and alcohol drinkers compared to those without the habits. However some significant findings emerged regarding the dietary habits. Cabbage-eaters had a 50% reduction in risk among both the sexes, compared to those who did not eat cabbage. Sprout eaters also had an 30–50% reduction in risk. There was an enhanced 1.6-fold risk among men who ate ‘dry-fish’ compared to those who did not eat dry-fish (OR = 1.6; CI: 1.0, 2.6). Among women, meat-eaters had a 2.4-fold excess risk than non-meat-eaters. Likewise for fresh-fish eaters, there was a 40–70% reduction in risk compared to those who did not eat fresh-fish. Dark-green-leafy-vegetables and ‘other vegetables’ did not show any protective effect for colorectal cancer in this study.

Introduction

Colorectal cancer is the fourth most common form of cancer occurring worldwide. Colorectal cancer is more prevalent in North America, Argentina, Australia, New Zealand and parts of Europe, Japan, and Israel, and for this reason is commonly regarded as a western life-style disease. Although incidence and mortality are higher in western countries, yet majority of the world's cases of colorectal cancer occur outside of countries in which traditional western life-styles are dominant. The profile varies greatly in different populations, and the evidence suggests that this variation is mainly a consequence of different life-style and environmental factors, which should be amenable to preventive interventions. World population growth and ageing imply a progressive increase in the cancer burden; 15 million new cases and about 10 million new deaths are expected in 2020, even if current rates remain unchanged [1].

In Europe, colon cancer incidence varies across the continent; the incidence rates in Bas-Rhin, France, are 31.3 per 105 in males and 16.9 per 105 in females [2]. In US, highest rates are in New Jersey, 31.3 per 105 in males and 23.1 per 105 among females; in Asia, higher rates are observed in Japan, Hiroshima (ASR: 59.7 per 105 in males and 28.0 per 105 in females) and also among the Chinese in Shanghai (11.5 per 105 in males and 12.0 per 105 in females) [2].

Rectal cancer incidence rates also vary across the world. Highest rates are observed in Japan, Hiroshima (M:ASR = 23.2 per 105 and F: 9.99 per 105) [2]. In France Bas-Rhin, ASR are 13.76 per 105 among males and 5.88 per 105 among females; in the United States, California, Los Angeles, show the highest rates (ASR = 13.04 per 105) among males and 6.05 per 105 among females [2]. In the Indian sub-continent, Mumbai reports an ASR of 2.9 per 105 and 1.9 per 105 for males and females respectively; however, in the south India, Bangalore has higher ASR rates (M: 3.3 per 105 and F: 2.2 per 105) [3]. This shows that the rates vary between countries and within the country across the globe.

There are several colorectal cancer studies reported in the literature from different part of the globe, but there is no colorectal case–control study reported from India. Studies elsewhere have indicated alcohol and diet, especially specific diet with high fat content, as possible risk factors for increased risk of colon cancer. Other risk factors reported in the literature are the physical activity, colorectal polyps, obesity, smoking, alcohol intake, family history of colorectal cancer, etc.

In one of the earlier studies on dietary factors, meat intake has been shown to be risk factor for colorectal cancer [4]. High levels of physical activity were the most marked life-style associated with reduced risk for colon cancer [5]. For an average Indian, the amount of physical activity, in terms of household work, farming and other related activities are varying. The Indian population is known to be less obese than the western population, basically attributed to the life-style. The body mass index is quite low for Indians. As per the recent NFHS survey [6], the mean BMI for Indian men (15–54 years) is 20.3 and for women (15–49 years) it is 20.5. The Indian diet includes a major portion of vegetables and fruits. Non-vegetarian diet is rarely consumed on a daily basis, unlike in western countries. The present study attempts to determine the various factors associated with colorectal cancer, such as tobacco, alcohol drinking and dietary items.

Section snippets

Material and methods

The present study, a hospital-based case–control study, was conducted at the Tata Memorial Hospital (TMH), Mumbai, India. The period of data collection was 1989–1992 that included subjects who visited TMH for diagnosis and treatment. Patients were interviewed at the out-patient department of TMH, prior to diagnosis. The information was recorded in a pre-designed questionnaire that included demographic characteristics (age, sex, religion, etc.), life-style (habits such as smoking, chewing,

Results

Table 1 describes the patients’ characteristics. The age groups are comparable between cases and controls. There is a male predominance in both cases and controls, and is greater in cases. Attendance of patients from Mumbai and outside-Mumbai are similar between cases and controls.

In India, chewers take pan (betel leaf), betel nut, lime and tobacco with some spices and condiments and smokers smoke Indian cigarettes called ‘bidi’ (obtained by wrapping 0.2–0.3 g of tobacco in tendu leaf),

Discussion

The present study is an unmatched hospital-based case–control study conducted at TMH in Mumbai, India. The primary source of data is from the hospital out-patient department. All the Patients were interviewed prior to diagnosis thus minimizing the interviewer's bias. However, the limitations of the study are the biases that are known in a hospital-based set-up where the study is conducted. All colorectal cases registered during the year 1989–1992 could not be interviewed due to various reasons.

Conclusion

The present study is the first hospital-based case–control study on colorectal cancer reported from India. The study concluded that eating cabbage, fresh-fish and sprouts showed protective effect for colorectal cancer and the reduction in risk varied between 30% and 70%. Given the recent changes in life-styles and dietary habits of Indian population, it is likely that the incidence of colorectal cancer will show an increase in the future. Detailed studies on colorectal cancer in a similar

Conflict of interest

None.

Acknowledgements

The authors are thankful to Director, Tata Memorial Centre for support and guidance. We are thankful to the social investigators of the Department of Biostatistics and Epidemiology, Tata Memorial Hospital, Mumbai, India, for interviewing the patients. We thank Dr. B.B. Yeole, Director, Mumbai Cancer Registry for his valuable comments and suggestions.

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