Colorectal cancer is the fourth most common cancer and the second leading cause of cancer death in the United States, with approximately 142 570 new cases and 51 370 colorectal cancer-related deaths expected in 2010 (1). Observational and experimental evidence suggest that sex hormones, particularly estrogen, play a role in colorectal cancer pathogenesis (2). Most notably, a substantial body of epidemiological data supports an inverse relationship between postmenopausal oral hormone therapy use and the risk of colorectal cancer (3), an association that was confirmed by results of the Women's Health Initiative (WHI) Clinical Trial, which reported a statistically significant decreased risk of colorectal cancer among women using estrogen plus progestin formulations (but not among women using estrogen alone) compared with women using placebo (4,5).By contrast, two subsequent prospective studies reported a positive association between endogenous estrogen level and the risk of colorectal cancer in postmenopausal women. The first investigation, which was conducted in the WHI Observational Study, found that a high endogenous level of estrogen was associated with a 1.5-fold increased risk of developing colorectal cancer after adjustment for established colorectal cancer risk factors (6). Similarly, the New York University Women's Health Study reported a 60% increased risk of colorectal cancer for women in the highest quartile of circulating estrogen level compared with those in the lowest quartile (7). The positive associations between endogenous estrogen level and the risk of colorectal cancer reported by these investigations are consistent with laboratory data demonstrating the proliferative effects of exogenous estradiol in colorectal tissue and in colorectal cancer cell lines (8-11). The findings from these observational and experimental studies, when considered together with the data on hormone therapy use and colorectal cancer, suggest that endogenous and exogenous sex hormones may play different roles in colorectal tumorigenesis.