Oral contraceptive use does not protect against large bowel cancer

The association between oral contraceptive (OC) use and colorectal cancer was examined in 190 female colorectal cancer cases and 200 age-matched female controls in data derived from a population-based study of large bowel cancer, "The Melbourne Colorectal Cancer Study" conducted in Melbourne, Australia. There were 47 cases (24 colon cancer, 23 rectal cancer cases) and 39 controls, who were past OC users. After adjustment was made for the confounding factors of age, number of children and age at birth of first child, a statistically significant risk was found among rectal cancer OC users, but not among colon cancer OC users (RR rectal cancer = 2.04, 95% CI = 1.00-4.14, p = 0.04; RR colon cancer = 1.17, 95% CI = 0.59-2.29, p = 0.60). These risks were not affected by adjustment for socioeconomic level, country of birth, religion, previous diet and family history of colorectal cancer. Rectal cancer risk was higher among those OC users who were also beer drinkers (RR = 6.96, 95% CI 2.09-23.1, p = 0.001).     

Children, age at first birth, and colorectal cancer risk. Data from the Melbourne Colorectal Cancer Study

During 1980 and 1981, data were obtained on the number of children and age at birth of the first child in 675 cases of colorectal cancer and in 720 age-sex frequency-matched controls as part of a large epidemiologic study of colorectal cancer conducted in Melbourne, Australia. For colorectal cancer, the relative risk (RR) for those with one or more children compared with those with no children was statistically significantly lower than one (RR = 0.61, 95% confidence interval (CI): 0.45-0.81, p less than 0.001), and with simultaneous adjustment for number of children, there was an increasing risk with increasing age at birth of first child (RR = 1.03, with each increasing year of age at birth of first child, 95% CI: 1.00-1.05, p = 0.02). The relation between both the number of children and the age at birth of the first child and colorectal cancer risk was not statistically significantly different for males and females. The risk of colorectal cancer with respect to number of children and age at birth of the first child was unaffected by the potential confounding factors of age, occupation, previous diet, oral contraceptive use in females, and a family history of colorectal cancer. Since the protection against colorectal cancer associated with having children and with earlier age at birth of the first child was found to be similar for both males and females in the Melbourne study, a life-style factor, as yet unidentified, rather than a female hormonal factor, is postulated as the mediator of these effects.     

Body weight and physical activity as predictors of colorectal cancer risk

The associations between colorectal cancer and body weight (expressed as body mass index) and between colorectal cancer and physical activity were examined in 715 histologically confirmed cases of colorectal adenocaircinoma and 727 age‐ and sex‐matched controls. The data were obtained from a large, population‐based study, The Melbourne Colorectal Cancer Study, which was conducted in Melbourne, Australia. There was a statistically significant increase in the risk of rectal cancer but not of colon cancer in overweight and obese males but not in females. This association for males remained statistically significant after adjustment was made for dietary risk factors previously established for this study (Nutr Cancer 9, 21–42, 1987), with the exception of sodium intake, which produced a downward modification of the relative risk close to unity. The increased risk of rectal cancer in overweight and obese males was modified by beer intake, which was previously found to be a risk for rectal cancer in males in this study. Various levels of physical activity were not statistically significantly associated with the risk of colorectal cancer in either males or females. Also, the colorectal cancer risks associated with the body mass index were not significantly altered by adjustment for the physical activity level.     

Body weight and physical activity as predictors of colorectal cancer risk

The associations between colorectal cancer and body weight (expressed as body mass index) and between colorectal cancer and physical activity were examined in 715 histologically confirmed cases of colorectal adenocarcinoma and 727 age- and sex-matched controls. The data were obtained from a large, population-based study, The Melbourne Colorectal Cancer Study, which was conducted in Melbourne, Australia. There was a statistically significant increase in the risk of rectal cancer but not of colon cancer in overweight and obese males but not in females. This association for males remained statistically significant after adjustment was made for dietary risk factors previously established for this study (Nutr Cancer 9, 21-42, 1987), with the exception of sodium intake, which produced a downward modification of the relative risk close to unity. The increased risk of rectal cancer in overweight and obese males was modified by beer intake, which was previously found to be a risk for rectal cancer in males in this study. Various levels of physical activity were not statistically significantly associated with the risk of colorectal cancer in either males or females. Also, the colorectal cancer risks associated with the body mass index were not significantly altered by adjustment for the physical activity level.     

Dietary sodium and potassium intake and colorectal cancer risk

In a large, comprehensive, population-based case-control study of colorectal cancer (The Melbourne Colorectal Cancer Study), a high intake of sodium was shown to be a statistically significant risk factor for rectal cancer in males (RR = 1.72, p = 0.01) and was close to statistical significance in females (RR = 1.58, p = 0.06). This was independent of previously described dietary risk factors and also independent of the previously described beer risk. A high intake of potassium was protective for both males and females, but this effect disappeared after adjustment was made for the previously described dietary risk factors. A high ratio of dietary potassium to sodium was a statistically significant protective factor in females for both colon and rectal cancer, and the significance of this effect was reduced after adjustment was made for the previously described dietary risk factor (RR for colon cancer = 0.70, p = 0.08; RR for rectal cancer = 0.67, p = 0.08). So far, no biological explanations are available for these associations, and while they are of obvious etiologic interest, they should be interpreted with caution.     

Adherence to colorectal cancer screening in an HMO population

This study aimed to determine factors that influence fecal occult blood test performance in colorectal cancer screening. A random sample was selected of men and women ages 50 to 74 years of age who had been mailed a fecal occult blood testing kit in a screening program in fall 1986. One year after initial test mailing, sample group members (n = 504) were surveyed by telephone. Four months later, the survey sample received a second fecal occult blood test mailing. Multivariable analysis for subjects with validated past fecal occult blood test status (n = 322) revealed the past testing was positively associated with physician encouragement of screening, age, the belief that cancer is curable, perceived test efficacy, and strong intention to do testing. It also was discovered that persons who felt that they had little control over their health were more likely to have done past testing. Preliminary analysis of prospective adherence showed that the strongest statistically significant independent predictor was past test performance. Prospective adherence among past nontesters (n = 121) was associated with expressed commitment to do fecal occult blood testing and reported presence of colorectal cancer risk factors. Analysis of adherence among past testers (n = 201) revealed that belief in colorectal cancer curability and age were significant predictors. The findings reported here indicate that factors influencing adherence among past nontesters differ from those for past testers. Overall, these results suggest that to increase participation in colorectal cancer screening, physicians and other health professionals should (a) deliver educational messages that increase awareness of risk factors for colorectal cancer and curability of the disease, and (b) elicit from potential screenees a commitment to engage in recommended preventive behaviors. It may also be well to consider "tailoring" messages for past nontesters and past testers, respectively, by emphasizing colorectal cancer risk factors and highlighting curability.     

Dietary sodium and potassium intake and colorectal cancer risk

Abstract

In a large, comprehensive, population‐based case‐control study of colorectal cancer (The Melbourne Colorectal Cancer Study), a high intake of sodium was shown to be a statistically significant risk factor for rectal cancer in males (RR = 1.72, p = 0.07; and was close to statistical significance in females (RR = 7.55, p = 0.06). This was independent of previously described dietary risk factors and also independent of the previously described beer risk. A high intake of potassium was protective for both males and females, but this effect disappeared after adjustment was made for the previously described dietary risk factors. A high ratio of dietary potassium to sodium was a statistically significant protective factor in females for both colon and rectal cancer, and the significance of this effect was reduced after adjustment was made for the previously described dietary risk factor (RR for colon cancer = 0.70, p = 0.08; RR for rectal cancer = 0.67, p = 0.08). So far, no biological explanations are available for these associations, and while they are of obvious etiologic interest, they should be interpreted with caution.     

Factors associated with colorectal cancer risk perception: the role of polyps and family history

It is unclear how objective risk factors influence the factors associated with colorectal cancer (CRC) risk perception. The goals of this study were to investigate factors associated with perceived risk of CRC and to explore how these relationships were modified by personal history of polyps or family history of CRC. The study involved a mailed questionnaire completed by 1646 men and women aged 50-75 years, which assessed perceived risk, demographic and health history variables and CRC worry. Participants were patients of primary care providers in a community medical group in central Massachusetts. The study sample seemed to have a generally accurate perception of CRC risk, which was appropriately increased in the presence of known risk factors. In multivariable analyses that controlled for all measured covariates, financial situation modified the association between perceived risk and a personal history of polyps, while age and insurance status modified the association between perceived risk and family history of CRC. CRC worry, self-reported health, personal history of other cancer and compliance with screening guidelines remained significant predictors of perceived risk. Potential interactions between objective risk factors and socioeconomic characteristics should be further explored in longitudinal studies.     

胃癌胃全切患者预后的影响因素

目的探讨接受胃全切治疗的胃癌患者预后的影响因素。方法回顾性分析接受胃全切手术治疗的胃癌患者的临床资料。观察患者1年死亡率,采用单因素分析法比较不同临床病理特征的胃癌患者死亡率的差异,采用Logistic回归分析法分析影响患者生存情况的因素。结果参与本项研究的210例患者中,1年内死亡28例,死亡率为13.3%;年龄≥65岁,肿瘤部位位于上部,直径≥4 cm,临床分期为Ⅲ~Ⅳ期,分化程度为中、低分化,癌胚抗原(CEA)、糖链抗原125(CA125)和高糖链抗原19-9(CA19-9)水平较高的患者死亡率较高,差异具有统计学意义(P0.05,P0.01);而不同性别的患者死亡率差异不显著;将单因素分析有意义的年龄、肿瘤部位、肿瘤直径、临床分期、分化程度、CEA、CA125和CA19-9水平为自变量,以患者是否死亡为因变量进行Logistic回归分析,结果表明,患者的临床分期、分化程度和CA19-9水平进入回归方程,OR分别为4.356、5.238和3.562,(P0.05,P0.01)。结论临床分期、分化程度和CA19-9水平是影响胃癌胃全切患者生存率的独立危险因素。     

Colorectal cancer risk, chronic illnesses, operations and medications: case control results from the Melbourne Colorectal Cancer Study. 1988

The associations between colorectal cancer risk and several chronic illnesses, operations and various medications were examined in 715 colorectal cancer cases and 727 age- and sex-matched controls in data derived from a large, comprehensive population-based study of this cancer conducted in Melbourne, Australia. There was a statistically significant deficit among cases of hypertension, heart disease, stroke, chronic chest disease and chronic arthritis and a statistically significant excess of 'haemorrhoids' among cases, and all of these differences were consistent for both colon and rectal cancers and for both males and females. Although no statistically significant differences were found for other cancers, there were twice as many breast cancers among cases (16) than among controls (8) and also there were 9 uterine cancers among cases and only 2 among controls. There was a statistically significant deficit among cases in the use of aspirin-containing medication and vitamin supplements and this was consistent for both colon and rectal cancers and for both males and females. There was a statistically significant excess of large bowel polypectomy among cases. The modelling of these significant associations simultaneously in a logistic regression equation indicated that hypertension, heart disease, chronic arthritis and aspirin use were each independent effects and consistent for both colon and rectal cancers for both males and females and also that these effects were independent of dietary risk factors previously described in the Melbourne study. The possible relevance of these findings towards an understanding of colorectal cancer risk and aetiology is discussed.     

Colorectal cancer protective effects and the dietary micronutrients folate, methionine, vitamins B6, B12, C, E, selenium, and lycopene

The data reported here were obtained from the case-control arm of a large, comprehensive, population-based investigation of colorectal cancer incidence, etiology, and survival, the Melbourne Colorectal Cancer Study, conducted in Melbourne, Australia. This part of the case-control study was designed to identify dietary factors associated with colorectal cancer risk in 715 incident cases compared with 727 age/sex frequency-matched randomly chosen community controls, in which a quantitative assessment of all foods eaten was made. New data are presented on the potential of two groups of micronutrients as protective agents, namely, those involved in DNA methylation, synthesis, and repair (folate, methionine, and vitamins B6 and B12) and those with antioxidant properties (selenium, vitamins E and C, and lycopene). The adjusted odds ratios showed that for folate there was significant protection for rectal cancer in second and third quintiles of consumption but not for colon cancer, and this was similar for methionine consumption. Vitamin B6 consumption was significantly protective for both colon and rectal cancer at the higher quintiles, and this was similar for vitamin B12. Dietary selenium was significantly protective at middle quintiles of consumption at both cancer sites. Dietary vitamins E and C were statistically significantly protective for both colon and rectal cancer at all levels of consumption, and for both vitamins there was a dose-response effect of increasing protection, particularly so for colon cancer. Lycopene was not associated with colorectal cancer risk. A combined model included vitamins E, C, and B12 and selenium as micronutrients protective for colorectal cancer and folate, which, however, showed an increased risk at the highest level of consumption. These data support the proposition that a diet containing the dietary micronutrients involved in DNA methylation (folate, methionine, and vitamins B6 and B12) and some of those with antioxidant properties (selenium and vitamins E and C) may have a role to play in lowering colorectal cancer risk and also that such protection can be achieved by dietary means alone.     

多因子降维法在人群散发性结直肠癌交互作用分析中的应用

目的 探讨DNA修复基因多态性与中国南方汉族人群散发性结直肠癌发病的相关性,验证多因子降维法(MDR)应用于多因子疾病基因-基因、基因-环境交互作用分析的可行性.方法 采用自然人群为基础的病例对照研究设计,运用PCR-RFLP方法对206例结直肠癌病例和845例正常对照开展OGG1 Ser326Cys,XRCC1 Arg194Trp、Arg280His和Arg399Gln,XPD Lys751Gln和XRCC3 Thr241Met等DNA修复体系常见单核苷酸多态性(SNP)的检测分型.结果 个体特征与结直肠癌的关联分析表明,年龄与结直肠癌的发病正相关,高年龄组(≥61岁)与低年龄组(≥42岁至＜61岁)相比,结直肠癌患病风险增高有统计学意义(校正OR=2.04,95%CI:1.49～2.80);家族肿瘤史同样与结直肠癌的发病存在有统计学意义的正相关关系(校正OR=1.51,95%CI:1.05～2.17).前述各SNP的等位基因和基因型分布频率在正常对照组和病例组间差异均无统计学意义(P＞0.05).采用MDR对基因-基因、基因-环境交互作用模型的筛选分析表明,最佳的交互作用模型包含了年龄分布、饮酒史、XRCC1 Arg194Trp和OGG1 Ser326Cys等4个因子(平均检验准确度=0.616,交叉验证一致性=10/10,P=0.011);进一步以筛选出的低风险组合为参照,logistic拟合分析发现高风险组合可以使结直肠癌的患病风险增高并有统计学意义(OR=2.72,95%CI:1.66～4.47).结论 DNA修复基因多态性对中国人散发性结直肠癌风险的遗传影响符合低外显性特征,并与环境因子可能存在着复杂的联合作用.     

Build it, and will they come? Unexpected findings from a study on a Web-based intervention to improve colorectal cancer screening

Given the extensive use of the Internet for health information, Web-based health promotion interventions are widely perceived as an effective communication channel. The authors conducted this study to determine use of a Web-based intervention intended to improve colorectal cancer screening in a population of women who are at average risk and noncompliant to current screening recommendations. The study was a randomized controlled trial designed to compare the effectiveness of colorectal cancer screening educational materials delivered using the Internet versus a printed format. In 3 years, 391 women seen for routine obstetrics/gynecology follow-up at 2 academic centers provided relevant survey information. Of these, 130 were randomized to the Web intervention. Participants received voluntary access to a password-protected, study-specific Web site that provided information about colorectal cancer and colorectal cancer screening options. The main outcome measures were self-reported and actual Web site use. Only 24.6% of women logged onto the Web site. Age was the only variable that differentiated users from nonusers (p = .03). In contrast, 16% of participants self-reported Web use. There was significant discordance between the veracity of actual and self-reported use (p = .004). Among true users, most (81%) logged on once only. These findings raise questions about how to increase use of important health communication interventions.     

Attributable risk for diet, alcohol, and family history in the Melbourne Colorectal Cancer Study.

From the data obtained in a large comprehensive population-based case-control study of colorectal cancer (The Melbourne Colorectal Cancer Study), attributable risk was calculated for a family history of colorectal cancer in near relatives for diet (when > or = 5 of the 11 previously determined dietary risk factors were present) and for beer consumption (for rectal cancer only). The attributable risk was 11% in the presence of a family history of colorectal cancer and 46% in the presence of five or more dietary risk factors. The attributable risk for rectal cancer in the presence of beer consumption was 31% in males and 11% in females. These data are relevant in the consideration of primary prevention of colorectal cancer in Australia, but their general application needs to be approached with caution in view of major differences in the genetic background and the dietary practices in various regions of the world and in view of the uncertainty of what is achievable change, especially for dietary practices.     

Colorectal polyps, diet, alcohol, and family history of colorectal cancer: a case-control study.

A case-control study was conducted in Melbourne, Australia. Cases (n = 49) were patients who had one or more histologically confirmed adenomatous polyps larger than 1 cm in diameter previously removed by endoscopy. In both the cases and the community controls (n = 727), previous diet, alcohol consumption, and family history of colorectal cancer in near relatives were investigated. The family history rate of colorectal cancer was similar in the two groups. Those with adenomatous polyps were found to have a low fiber/vegetable intake (p = 0.04); in males, there was a high intake of beef (p = 0.04), milk drinks (p = 0.01), and beer (p = 0.05). This study provides further evidence for the hypothesis that dietary factors and alcohol consumption may play a role in the development of adenomatous colorectal polyps and that these factors are similar to dietary risk factors for colorectal cancer.     

乌鲁木齐市2014年城市癌症早诊早治筛查效果分析

目的　分析乌鲁木齐2014年城市居民癌症高风险率、筛查率和检出率,为开展癌症早诊早治项目工作提供依据。方法　在乌鲁木齐市选择4个辖区,选定目标街道和社区后,以社区为单位动员所有40～69岁常住户籍居民,按照知情同意自愿的原则接受有关癌症的流行病学问卷调查和高风险评估。检出的高风险对象免费接受肺癌、肝癌、上消化道癌、女性乳腺癌和大肠癌临床筛查,分析评估癌症的高风险率、筛查率和检出率。结果 本研究共完成49 574名有效调查和风险评估,其中肺癌、肝癌、上消化道癌、女性乳腺癌和大肠癌的高风险检出率分别为13.25 %、12.03%、20.38 %、18.36%和14.21%。5类癌症高风险率中上消化道癌最高,各种癌症风险率之间差异均有统计学意义(x2=1785,P﹤0.05);肺癌的高风险率高于肝癌,但差异无统计学意(x2=1.602,P=0.21),肺癌男性高风险率是女性的3.69倍,肝癌男性高风险率是女性的1.25倍,肝癌各年龄组间的高风险检出率差异有统计学意义(x2=57.76,P﹤0.05)。单癌种、两癌种、三癌种、四癌种和五癌种同时高风险的比例依次为26.86%、9.68 %、4.50%、2.62%和0.35%。五类癌的筛查率分别为肺癌37.36%、肝癌 41.27%、上消化道癌19.82%、乳腺癌45.53%和大肠癌16.61%。肺癌或疑似肺癌检出率为0.49%,可疑肝癌检出率为0.12%,上消化道癌检出率为0.15% ,乳腺B超＋钼靶BI-RADS4-5级检出率为2.27%,大肠癌检出率为0.17%。结论　需要进一步完善城市癌症早诊早治技术方案和管理模式,提高筛查率和早诊早治效果。     

Prognostic significance of Subjective Global Assessment (SGA) in advanced colorectal cancer

OBJECTIVE: To evaluate the prognostic significance of Subjective Global Assessment (SGA) in advanced colorectal cancer and create statistically distinct prognostic groups of colorectal cancer patients based on clinical and nutritional variables. DESIGN: A retrospective clinical epidemiologic study. SETTING: A private tertiary care American Cancer Center. SUBJECTS: In total, 234 colorectal cancer patients aged 29-82 y treated at Cancer Treatment Centers of America at Midwestern Regional Medical Center between January 1995 and March 2001. INTERVENTION: SGA Questionnaire. SGA A-well nourished; SGA B-moderately malnourished; and SGA C-severely malnourished. Malnutrition was defined as either SGA B or SGA C. RESULTS: The prevalence of malnutrition in this patient population, as determined by SGA, was 52% (113/217). The median survival of patients with SGA A was 12.8 months (95% CI; 9.1-16.5), those with SGA B was 8.8 months (95% CI; 6.7-10.9) and those with SGA C was 6 months (95% CI; 3.9-8.1); the difference being statistically significant at P=0.0013. Regression tree analysis identified prior treatment history, lactate dehydrogenase (LDH) and SGA to be important predictors of survival for our patient cohort. Patients with no prior treatment history (newly diagnosed disease), low LDH scores, and SGA A had the best overall survival of 40.4 months (95% CI; 30.45-50.4), whereas patients with prior treatment history (progressive disease), high LDH scores, and SGA B/C had the worst overall survival of 4.5 months (95% CI; 2.22-6.76). CONCLUSION: The SGA provides useful prognostic information in patients with advanced colorectal cancer.     

新发结直肠癌患者膳食模式分析

目的 探讨新发结直肠癌患者的膳食模式与发病的关系,为结直肠癌的发生提供科学的干预方向。方法 以2018—2019年辽宁省某肿瘤医院就诊并经病理学确诊的新发结直肠癌患者和同期在该医院体检中心参加健康体检者为研究对象,新发结直肠癌患者为病例组,按同性别、同年龄1∶1选取健康体检者作为对照组,采用主成分分析法对调查对象的膳食模式进行分析,利用Logistic回归模型分析不同膳食模式对结直肠癌发病风险的影响。结果 本研究共对新发结直肠癌患者232例、健康体检者232人进行调查,2组人群在性别、年龄、文化程度、家庭人均月收入和体力劳动强度分布差异均无统计学意义（均P>0.05）。多因素Logistic回归分析结果显示坚果薯类膳食模式（OR=0.482）、水产奶类膳食模式（OR=0.666）和果蔬素食膳食模式（OR=0.800）是结直肠癌发生的保护性因素,西式膳食模式（OR=1.441）、辛辣熏制膳食模式（OR=1.195）、肉类膳食模式（OR=1.397）和高脂肪膳食模式（OR=1.349）为结直肠癌发病的危险因素。结论 坚果薯类、水产奶类和果蔬素食是结直肠癌发生的保护性因素。西式、辛辣熏制、肉类和高脂肪膳食为结直肠癌发病的危险因素,在结直肠癌的防病宣传健康教育中应该加强饮食健康宣传,提高防病意识,有效降低发病率。     

Inequalities in survival from colorectal cancer: a comparison of the impact of deprivation,treatment, and host factors on observed and cause specific survival

OBJECTIVE: To investigate whether socioeconomic deprivation is associated with cause specific and all cause survival for colorectal cancer and to what extent this is independent of significant prognostic factors. DESIGN: Prospective cohort. SETTING: The former Wessex Health Region, South West England. PARTICIPANTS: All patients resident in Wessex registered with a diagnosis of colorectal cancer over three years (n=5176). Survival analysis was carried out on those patients with compete data for all factors and a positive survival time (n=4419). OUTCOMES: Death from colorectal cancer and all cause over five year follow up from initial diagnosis. Main results: Deprivation was significantly associated with survival for both outcomes in univariate analysis; the unadjusted hazard ratio for dying from colorectal cancer (most deprived compared with most affluent) was 1.12 (95% CI 1.00 to 1.25) and for all cause was 1.18 (1.07 to 1.30). Significant prognostic factors for both outcomes were age, specialisation of surgeon, Dukes's stage, and emergency compared with elective surgery. Comorbidity and gender were only associated with all cause survival. After adjustment for prognostic factors, the effect of deprivation on both cause specific and all cause mortality was reduced, and it was non-significant for colorectal cancer. However, the most deprived group had consistently worse survival than the most affluent. CONCLUSIONS: Factors associated with survival with colorectal cancer depend on the outcome measure. Socioeconomic deprivation is adversely associated with survival in patients with colorectal cancer. This is strongest for non-colorectal cancer death, partly reflecting higher comorbidity, but it is there for colorectal cancer though not statistically significant. Conclusive evidence of the inequalities by socioeconomic status and underlying reasons needs to come from studies using individual based measures of socioeconomic status and more detail on treatment and host related factors.     

Recent life change and large bowel cancer. Data from the Melbourne Colorectal Cancer Study

In a large, population based, epidemiological study of colorectal cancer, The Melbourne Colorectal Cancer Study, several etiological factors were investigated. Persons' recent life changes, as well as the degree of upset they experienced as a result of these changes, were included. Interviews with 715 histologically confirmed new cases of colorectal cancer occurring over a 12-month period in Melbourne, Australia, and with 727 age and sex matched community controls were conducted. As one of the methods of assessing any effect of recall bias, 179 hospital controls were also investigated. Major illness or death of a family member, major family problems and major work problems were found to be significantly more common for cases over the 5 years preceding diagnosis compared to controls. Cases also reported being significantly more upset with their recent life changes than did controls. No significant differences in results were found between males and females, or between colon cancer and rectal cancer patients. Although the possibility of recall bias, was not completely controlled for in this study, it was probably not an important factor in explaining case-control differences. Recent life changes, and their perceptions, may have significance in the development of large bowel cancer.