Rare germline variants in mismatch repair genes have been linked to hereditary nonpolyposis colorectal cancer; however, it is unknown whether common polymorphisms in these genes alter the risk of colorectal cancer. To examine the association between common variants in mismatch repair genes and colorectal cancer, we conducted a case-cohort study within the CLUE II cohort. Four single nucleotide polymorphisms in 3 mismatch repair genes (MSH3 R940Q, MSH3 T1036A, MSH6 G39E and MLH1 I219V) were genotyped in 237 colorectal cancer cases and a subcohort of 2,189 participants. Incidence rate ratios (RRs) and 95% confidence intervals (95% CIs) for each polymorphism were estimated. The MSH3 1036A variant was found to be associated with an increased risk of colorectal cancer (RR 5 1.28, 95% CI: 0.94-1.74 and RR 5 1.65, 95% CI: 1.01-2.70 for the AT and TT genotypes, respectively, with p trend 5 0.02), particularly proximal colon cancer. Although the MSH3 940Q variant was only weakly associated with colorectal cancer overall (p trend 5 0.07), it was associated with a significant increased risk of proximal colon cancer (RR 5 1.69, 95% CI: 1.10-2.61 and RR 5 2.68, 95% CI: 0.96-7.47 for the RQ and QQ genotypes, respectively with p trend 5 0.005). Processed meat intake appeared to modify the association between the MSH3 polymorphisms and colorectal cancer (p interaction < 0.10 for both). No association was observed with the MSH6 and MLH1 polymorphisms overall. This study suggests that common polymorphisms in the mismatch repair gene, MSH3, may increase the risk of colorectal cancer, especially proximal colon cancer. ' 2006 Wiley-Liss, Inc.Key words: mismatch repair; polymorphism; colorectal cancer; DNA repair; meat intake Alterations in mismatch repair are implicated in the etiology of colorectal cancer. Inherited mutations in mismatch repair genes cause hereditary nonpolyposis colorectal cancer (HNPCC), a familial cancer syndrome that accounts for 2-4% of colorectal cancers.1 Individuals with HNPCC inherit an inactivating mutation in a mismatch repair gene (e.g., MSH2, MLH1, MSH6 and PMS2). Although in most cases, the individual only carries one copy of the inactivating mutation and displays normal mismatch repair, 2 the somatic loss of the wild-type allele in the colorectal tissue leads to a dramatic increase in small intragenic mutations, microsatellite instability and the development of colorectal cancer. Nearly all tumors from HNPCC patients display microsatellite instability 3,4 ; however, 10-16% of colorectal tumors from patients without HNPCC also exhibit microsatellite instability, 3,5 suggesting that defects in mismatch repair may also play a role in the etiology of some non-HNPCC colorectal cancers.Mismatch repair primarily corrects single base-pair mismatches and small insertion-deletion loops that arise during replication. In mammals, single base-pair mismatches and single base insertiondeletion loops are recognized by the MSH2-MSH6 heterodimer (MutSa), whereas larger insertion-deletion loops are detected by the MSH...