Serum calcium and risk of gastrointestinal cancer in the Swedish AMORIS study

Abstract

BackgroundObservational studies have indicated that high calcium intake may prevent colorectal cancer, but as for randomized trials the results are inconclusive. Meanwhile, limited data on the link between serum calcium and cancer risk is available. We investigated the relation between serum calcium and risk of different gastrointestinal cancers in a prospective study.MethodsA cohort based on 492,044 subjects with baseline information on calcium (mmol/L) and albumin (g/L) was selected from the Swedish Apolipoprotein MOrtality RISk (AMORIS) study. Multivariable Cox proportional hazard models were used to analyse associations between standardised levels, quartiles and age/sex-specific categories of serum calcium and risk of oesophageal, stomach, colon, rectal cancer and also colorectal cancer combined, while taking into account serum albumin and other comorbidities.ResultsDuring 12 years of follow-up, we identified 323 incident oesophageal cancers, 782 stomach cancers, 2519 colon cancers, and 1495 rectal cancers. A positive association was found between albumin-adjusted serum calcium and risk of oesophageal [HR: 4.82 (95% CI: 2.07 – 11.19) for high compared to normal age-specific calcium levels] and colon cancer [e.g. HR: 1.07 (95% CI: 1.00 – 1.14) for every SD increase of calcium] as well as colorectal cancer [e.g. HR: 1.06 (95% CI: 1.02-1.11) for every SD increase of calcium] in women. In men there were similar but weaker non-statistically significant trends.ConclusionThe positive relation between serum calcium, oesophageal cancer and colorectal cancer calls for further studies including calcium regulators to evaluate whether there is a true link between calcium metabolism and development of gastrointestinal cancer.

Associations between calcium and magnesium intake and the risk of incident gastric cancer: A prospective cohort analysis of the National Institutes of Health‐American Association of Retired Persons (NIH‐AARP) Diet and Health Study

“…The Swedish AMORIS cohort study, which analyzed serum calcium and the association with gastrointestinal cancers, found no strong association between albumin adjusted-serum Ca and incident gastric cancer, although there was a suggestive inverse association in the highest vs. lowest quartiles of serum Ca. 27 Among other limitations of our study, serum calcium intake is not reflective of dietary intake or total body stores and is influenced by many other factors including albumin level; dietary intake, on the other hand, is the major determinant of total body calcium balance. 27,28 Gastric cancer-related mortality was not reported among Chinese men, nor was the risk of incident gastric cancer evaluated.…”

“…27 Among other limitations of our study, serum calcium intake is not reflective of dietary intake or total body stores and is influenced by many other factors including albumin level; dietary intake, on the other hand, is the major determinant of total body calcium balance. 27,28 Gastric cancer-related mortality was not reported among Chinese men, nor was the risk of incident gastric cancer evaluated. Results for NCGA and CGA were also not presented, which is relevant given their epidemiologic and biologic differences, as well as differences in clinical management and prognosis.…”

Serum Calcium and Risk of Nonmedullary Thyroid Cancer in Patients with Primary Hyperparathyroidism

“…2) Another study demonstrated a highly significant negative association of cancer and serum calcium levels in women [17]. 3) A positive link between serum calcium, esophageal cancer, and colorectal cancer in women was found in a prospective study [18]. 4) For prostate cancer, there were two large Swedish studies.…”

1009 Serum lactate dehydrogenase and survival following cancer diagnosis

“…We therefore accounted for period of diagnosis in our analyses as a proxy for difference in screening and treatment over time. Information on race/ethnicity was not available; however, the AMORIS cohort was similar to the general working population of Stockholm (Wulaningsih et al, 2013b) that comprised B80% Swedish-born individuals in 2000 (Statistics Sweden, 2015). Serum LDH increases because of other conditions such as myocardial infarction, inflammation and tissue injury (Drent et al, 1996;Kemp et al, 2004;Kato et al, 2006), and therefore is not a specific marker of tumour.…”