Educational level and risk of colorectal cancer in EPIC with specific reference to tumor location

Anke M. Leufkens, Fränzel J B Van Duijnhoven, Hendriek C. Boshuizen, Peter D. Siersema, Anton E. Kunst, Traci Mouw, Anne Tjønneland, Anja Olsen, Kim Overvad, Marie Christine Boutron-Ruault, Françoise Clavel-Chapelon, Sophie Morois, Vittorio Krogh, Rosario Tumino, Salvatore Panico, Silvia Polidoro, Domenico Palli, Rudolf Kaaks, Birgit Teucher, Tobias PischonAntonia Trichopoulou, Philippos Orfanos, Ioulia Goufa, Petra H M Peeters, Guri Skeie, Tonje Braaten, Laudina Rodríguez, Leila Lujan-Barroso, Maria José Sánchez-Pérez, Carmen Navarro, Aurelio Barricarte, Sophia Zackrisson, Martin Almquist, Goran Hallmans, Richard Palmqvist, Konstantinos K. Tsilidis, Kay Tee Khaw, Nick Wareham, Valentina Gallo, Mazda Jenab, Elio Riboli, H. Bas Bueno-De-Mesquita

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Existing evidence is inconclusive on whether socioeconomic status (SES) and educational inequalities influence colorectal cancer (CRC) risk, and whether low or high SES/educational level is associated with developing CRC. The aim of our study was to investigate the relationship between educational level and CRC. We studied data from 400,510 participants in the EPIC (European Prospective Investigation into Cancer and Nutrition) study, of whom 2,447 developed CRC (colon: 1,551, rectum: 896, mean follow-up 8.3 years). Cox proportional hazard regression analysis stratified by age, gender and center, and adjusted for potential confounders were used to estimate hazard ratios (HR) and 95% confidence intervals (95%CI). Relative indices of inequality (RII) for education were estimated using Cox regression models. We conducted separate analyses for tumor location, gender and geographical region. Compared with participants with college/university education, participants with vocational secondary education or less had a nonsignificantly lower risk of developing CRC. When further stratified for tumor location, adjusted risk estimates for the proximal colon were statistically significant for primary education or less (HR 0.73, 95%CI 0.57-0.94) and for vocational secondary education (HR 0.76, 95%CI 0.58-0.98). The inverse association between low education and CRC risk was particularly found in women and Southern Europe. These associations were statistically significant for CRC, for colon cancer and for proximal colon cancer. In conclusion, CRC risk, especially in the proximal colon, is lower in subjects with a lower educational level compared to those with a higher educational level. This association is most pronounced in women and Southern Europe.

Original languageEnglish
Pages (from-to)622-630
Number of pages9
JournalInternational Journal of Cancer
Issue number3
Publication statusPublished - Feb 1 2012


  • colorectal cancer
  • educational level
  • tumor location

ASJC Scopus subject areas

  • Cancer Research
  • Oncology


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