title: Serum calcium and risk of gastrointestinal cancer in the Swedish AMORIS study.
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.
  
  
  CONCLUSIONS
  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.
authors.forename: Wahyu
authors.initials: W
authors.lastname: Wulaningsih
authors.forename: Karl
authors.initials: K
authors.lastname: Michaelsson
authors.forename: Hans
authors.initials: H
authors.lastname: Garmo
authors.forename: Niklas
authors.initials: N
authors.lastname: Hammar
authors.forename: Ingmar
authors.initials: I
authors.lastname: Jungner
authors.forename: Göran
authors.initials: G
authors.lastname: Walldius
authors.forename: Mats
authors.initials: M
authors.lastname: Lambe
authors.forename: Lars
authors.initials: L
authors.lastname: Holmberg
authors.affiliation: King's College London, School of Medicine, Division of Cancer Studies, Cancer Epidemiology Group, London, UK. mieke.vanhemelrijck@kcl.ac.uk.
authors.forename: Mieke
authors.initials: M
authors.lastname: Van Hemelrijck
mesh_terms: D000328:Adult; D000368:Aged; D002118:Calcium / Q000097:blood*; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013548:Sweden
chemical_list: D002118:Calcium