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Open Access Research article

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

Wahyu Wulaningsih1, Karl Michaelsson2, Hans Garmo13, Niklas Hammar45, Ingmar Jungner6, Göran Walldius4, Mats Lambe37, Lars Holmberg123 and Mieke Van Hemelrijck18*

Author affiliations

1 King’s College London, School of Medicine, Division of Cancer Studies, Cancer Epidemiology Group, London, UK

2 Department of Surgical Sciences, Uppsala University, Uppsala, Sweden

3 Regional Cancer Centre, Uppsala University, Uppsala, Sweden

4 Department of Epidemiology, Insitute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden

5 AstraZeneca Sverige, Södertalje, Sweden

6 Department of Medicine, Clinical Epidemiological Unit, Karolinska Institutet and CALAB Research, Stockholm, Sweden

7 Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden

8 King’s College London, School of Medicine, Division of Cancer Studies, Cancer Epidemiology Group, Research Oncology, 3rd Floor, Bermondsey Wing, Guy’s Hospital, London SE1 9RT, UK

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Citation and License

BMC Public Health 2013, 13:663  doi:10.1186/1471-2458-13-663

Published: 17 July 2013

Abstract

Background

Observational 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.

Methods

A 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.

Results

During 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.

Conclusion

The 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.

Keywords:
Gastrointestinal cancer; Calcium; Albumin